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Pharm II MHM - FINAL > RA > Flashcards

RA Flashcards

1
Q

Risk factors of RA

A
  • Viral infection
  • Birthweight greater than 10 lbs
  • HLA DR4 allele
  • Decaf coffee consumption
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2
Q

Factors that decrease risk of RA

A
  • High Vit D intake
  • OCPs
  • Tea consumption
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3
Q

Systemic inflammation that occurs with RA

A
  • Blood vessels
  • Eyes
  • Nerves
  • Heart
  • Skin
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4
Q

Misc effects of RA

A
  • Decreased QOL
  • Increased med costs
  • Decreased employability
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5
Q

RA vs. OA

A
  • Symmetrical (bilateral)

- Younger pts

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6
Q

Early vs. established RA classifications

A

Less than 6 months (early)

Over 6 months (established)

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7
Q

Low vs. moderate vs. high rheumatoid activity

A

Less than 6 joints (low)
6-20 joints (moderate)
Over 20 joints (high)

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8
Q

Poor prognosis factors of RA

A
  • Persistent synovitis
  • Early erosive disease
  • Rheumatoid nodules
  • HLA-DR4 alleles
  • Fam hx
  • High ESR and CRP
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9
Q

When should DMARDs be given in RA?

A

Within first 3 months of onset

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10
Q

Types of DMARDs

A
  • Non biologic

- Biologic

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11
Q

When are nonbiologic DMARDs used in RA?

A
  • Early disease w/low activity w/o poor prognosis (monotherapy)
  • Early diseae w/HIGH activity w/o poor prognosis
  • Established disease, low activity, w/o poor prognosis
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12
Q

MC used nonbiologic DMARD in RA?

A

MTX

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13
Q

MTX MOA in RA

A
  • 1st line
  • Inhibits DNA synth, repair, cellular replication
  • May affect immune function
  • Unclear how exactly it works in RA
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14
Q

Key features of RA (dosing, onset, ADEs)

A
  • Weekly dosing
  • Onset in 3-6 wks
  • Avoid ETOH and PPIs
  • Can cause stomatitis, nausea, diarrhea, alopecia
  • Preg Cat X
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15
Q

What can be taken to decrease the side effects of MTX?

A

Folic acid

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16
Q

What is Leflunomide (Arava)? MOA?

A
  • Immunomodulatory pro-drug
  • Usually 2nd line to MTX
  • Inhibits pyrimidine synthesis (anti-proliferative and anti-inflammatory effects)
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17
Q

Leflunomide ADEs

A
  • Diarrhea, alopecia, rash, HA
  • Hepatotoxicity, PN, wt gain
  • Maintain hydration
  • Monitor BP
  • Preg Cat X
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18
Q

When is Hydroxycholoroquine (Plaquenil) used in RA and MOA?

A
  • Mild to mod w/o poor prognosis and for women of CBP
  • Inhibits locomotion of neutrophils and chemotaxis of eosinophils
  • Impairs complement-dependent antigen-antibody reactions
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19
Q

Features of hydroxycholoroquine (Plaquenil)

A
  • Longer onset of action (8-12 wks)
  • Eye exam every 3 months
  • Rash, diarrhea, abdominal
  • Blue/black skin discoloration
  • Deafness, tinnitus
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20
Q

Sulfasalazine use in RA

A
  • Can be monotherapy (MTX usually better choice)

- Inhibits PG synthesis

21
Q

ADEs of sulfasalazine

A
  • HA, nausea, dyspepsia
  • Blue skin, sun sensitivity, jaundice
  • Preg Cat B
22
Q

How is minocycline used in RA?

A
  • Unlabeled use
  • Antimicrobial, immunomodulatory
  • Potent inhibitor of metalloproteinates (which are active in RA joint destruction)
23
Q

ADEs of minocycline

A
  • Rash, HA, diarrhea
  • Anorexia, tooth discoloration
  • Avoid in pregnancy
24
Q

Use of tofacitinib in RA

A
  • 2nd line to MTX
  • JAK inhibitor (reduces inflammation)
  • Should NOT be combined with a biologic
25
Q

ADEs of tofacitinb

A
  • TB
  • Lowers blood counts
  • Increases cholesterol and liver enzymes
  • HA, diarrhea, infection, hepatic injury
26
Q

Types of biologics used in RA

A
  • Anti TNF biologics

- Non TNF biologics

27
Q

When are biologics used in RA?

A

High disease activity w/poor prognosis

28
Q

General warnings of biologics

A 
Serious infections (including TB)
Malignancy
29
Q

What is etanercept and its MOA?

A
  • Self injection biologic for RA
  • Binds w/circulating TNF inhibiting it
  • No development of neutralizing antibodies
30
Q

ADEs and other features of etanercept

A
  • Self injected
  • Keep refrigerated
  • Local reactions, HA, rash, respiratory infections, etc.
  • Preg Cat B
31
Q

If latent TB test is positive, what should be done before starting biologic for RA?

A

Start treatment for TB prior to starting biologic

32
Q

What is infliximab and its MOA?

A
  • IV biologic for RA
  • Chimeric monoclonal ab (human and mouse proteins)
  • Binds w/circulating TNF inhibiting it
33
Q

Which biologic is better to combine w/MTX to reduce risk of antibody development?

A

Infliximab

34
Q

ADEs and other features of infliximab

A
  • IV infusion

- Rash, fever, HA, chills, hepatic impairment

35
Q

What is infliximab pretreated with?

A

Corticosteroid and oral antihistamine

36
Q

What is adalimumab and its MOA?

A
  • Self injected biologic for RA
  • Fully human monoclonal ab
  • Inhibits TNF (p55 and p75)
37
Q

ADEs of adalimumab

A
  • Latex allergy
  • HA, rash, injection site reaction, URI, back pain
  • HTN, hypercholesterol
  • Stop at 30 weeks gestation (crosses placenta)
38
Q

What is abatacept and its MOA?

A
  • Non TNF biologic for RA
  • Inhibits activation of T cells
  • IV loading dose and then SC maintenance
39
Q

ADEs of abatacept

A
  • HA, rash, nausea, URI, back pain, HTN, injection site irritation
  • Preg Cat C
40
Q

What is tocilizumab and its MOA?

A
  • Non TNF biologic for RA
  • MAB that inhibits IL6 reducing cytokines and inflammation
  • IV every 4 weeks
41
Q

ADEs of tocilizumab

A
  • Increased LFTs
  • HA, HTN, injection site irritation, jaundice
  • Preg Cat C
42
Q

What is rituximab and its MOA?

A
  • Non TNF biologic for mod-severe RA
  • Chimeric murine/human MAB
  • Removes circulating B cells
  • IV infusion w/MTX
43
Q

ADEs of rituximab

A

Edema, fever, fatigue, HA, insomnia, flu like symptoms, HTN or hypotension

44
Q

Pretreatment of rituximab

A

Corticosteroids, APAP, antihistamine

45
Q

What are the less common biologics for RA?

A
  • Golimumab (greater risk of infection)
  • Certolizumab pegol
  • Anakinra (requires daily injection and not as efficacious)
46
Q

How can different agents be combined in RA?

A

Nonbiologic and nonbiologic
Biologic and nonbiologic
NOT NOT biologic and biologic

47
Q

Which RA drugs require TB screening?

A

Biologics
MTX
Leflunomide

48
Q

How many anti-TNF biologics do we try before moving to a non TNF biologic in RA?

A

2

Pharm II MHM - FINAL (17 decks)

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