RA Flashcards
What symptom makes RA different from OA?
Prolonged morning stiffness
Have pt on DMARD within how long of RA diagnosis?
3 months
What are the non biologic DMARDs used in RA?
Methotrexate Hydroxychloroquine Leflunomide Sulfasalazine Minocycline
Methotrexate is used how?
Alone or in combo
What doses of ibuprofen give anti-inflammatory affect?
Higher doses
What agents are used short term in bridge therapy in RA?
NSAIDS and CS
What type of dosing helps decrease adrenal suppression and toxic effects of steroids?
Alternate day therapy (ADT)
What are the 2 name brands for methotrexate?
Rheumatrex
Trexall
What kind of doses of methotrexate are used in RA?
Low weekly doses, never daily for RA
Methotrexate can cause what toxicity?
Hepatotoxicity
What two populations are CI in methotrexate therapy?
Pregnancy - category x
Alcoholism - alcohol and mtx combo increases hepatotoxicity
Give what with mtx to decrease side effects?
Folic acid
Give folic acid when during mtx treatment?
The day following mtx administration
Sulfasalazine should be taken with what to prevent crystalluria?
Food and 8 oz of water
What are 2 name brands of sulfasalazine?
Azulfidine
Sulfazine
Sulfasalazine can cause what deficiency?
Folate
RA manifestations are always what?
Polyarticular and symmetrical
Sulfasalazine causes what coloration of skin/urine?
Yellow orange
Sulfasalazine impairs absorption of what?
Folate
Supplement with 1mg of folic acid
What are minocycline’s 2 name brands?
Minocin
Solodyn
What instructions are needed for Minocycline administration?
Drink with 8 oz of water
Stay upright for 30 minutes after taking
Don’t give tetracycline antibiotics to what two groups of people?
Pregnancy
Children 8 or under
Tetracyclines cause what sensitivity?
Photosenitivity
What is leflunomide’s name brand?
Arava
Who should absolutely not get leflunomide?
Pregnant women
Category X
Must wait how long after discontinuing leflunomide to get pregnant?
2 years after
Leflunomide can cause what toxicity?
Hepatotoxicity
What DMARDs can you take with methotrexate?
Leflunomide
Tofacitinib
What if Tofacitinib name brand?
Xeljanz
Don’t use Xeljanz with what other RA agents?
Biologic DMARDs
Don’t take methotrexate with what because increase risk of hepatotoxicity?
Alcohol
Methotrexate decreases the effectiveness of what diuretics?
Loops
Loop diuretics to what to methotrexate?
Increase methotrexate concentrations
Methotrexate when used concomitantly with what med cause an increase in both med concentrations?
Cyclosporine
Methotrexate is what pregnancy category?
X
What main class of biologic DMARDs are used in RA?
TNF inhibitors
What is etanercept name brand?
Enbrel
What is Humira generic?
Adalimumab
What is Remicades generic?
Infliximab
What is certolizumab name brand?
Cimzia
What is Simponi generic?
Golimumab
What TNF inhibitors are used only in combo with methotrexate for RA?
Remicade
Simponi
What should be tested for before starting biologics?
TB test
All TNF inhibitors must be stored how?
In refrigerator
Allow each TNF inhibitors to do what before administration?
Come to room temp over 15-30 minutes
Don’t use biologics how?
More than one concurrently
What 4 bad things can happen with TNF inhibitor therapy?
HBV reactivation
Heart failure
Hepatotoxicity
Lupus like syndrome
What is rituximabs name brand?
Rituxan
How does rituximab work?
Deleted CD20 B cells
Is Rituxan given with or without methotrexate in RA?
With
Screen for what two things before Rituxan initiation?
TB
HBV
Anakinra has what mechanism of action?
IL-1 receptor antagonist
What is Anakinra’s name brand?
Kineret
What MOA does abatacept have?
Inhibits T cell activation by binding to CD80 and CD86
What is abatacept name brand?
Orencia
Caution abatacept use with what co morbidity?
COPD
may worsen symptoms
MOA of tocilizumab?
IL-6 receptor antagonist
What is tocilizumab’s name brand?
Actemra
Where should biologics be administered?
Upper middle thigh
Abdomen
What vaccine can patients in biologics still get?
Influenza
Get Simponi to room temperature how?
Letting product sit at room temp for 30 minutes
