RA Flashcards
1
Q
RA can be triggered by?
A
vaccines!!!
2
Q
RA- drug classes
A
Immunosuppression/antiprolif:
-DMARDs (disease modifying anti-rheumatoid drugs)
-anti-TNFalpha, anti-IL-1 ab’s/antagonists (Biological agents)
-Janus kinase inhibitor (Signal Modulation)
Anti-infl:
-glucocorticoids
3
Q
DMARDs- drugs
A
(antiprolif, immunosuppressive) -Hydroxychloroquine -Leflunomide- inhibits dihydroorotate dehydrogenase -Methotrexate- inhibits DHFR -Sulfasalazine (HLMS)
4
Q
frontline DMARD for mild/moderate RA?
A
-low-dose Methotrexate
5
Q
MTX- moa
A
- pro-drug- becomes MTX-(glu)n (takes 25-30 wks)
- inhibits DHFR: DHF–DHFR-> THF–> Thymidine, purines)- anti-prolif, immunosuppressive!
- inhibits AICAR TFase: AICAR –> F-AICAR
- AICAR buildup–> Adenosine- anti-infl!!!
6
Q
MTX- bioavailability, clearance
A
- Oral- variable absorbed
- parenteral (IM,SC)- inc bioavailability!!
- cleared via kidneys
7
Q
MTX- toxicities
A
- hepatotoxicity- do liver fxn tests!!
- pulm damage- hypersensitivity
- myelosuppression
- take folic acid to prevent hematologic SE’s!!
8
Q
withdrawal of MTX
A
-flare of RA within 3-6 wks
9
Q
pts who dont respond to MTX- do what
A
combo of MTX And other DMARDs
10
Q
Anti-infl glucocorticoids- moa
A
- repress transcription of infl cytokines- repress NFkB TF
- tx acute flares- therapeutic bridge b/w initiation of and response to DMARDs!!!
- SEs- osteoporosis, diabetegenic!!!
11
Q
Anti-infl corticosteroids- drugs
A
- prednisone
- methylprednisolone
- Triamcinolone hexacetonide
12
Q
Biological agents for RA (moderate to severe)
A
used in combo with low dose MTX
-anti-TNF agents
13
Q
Anti-TNF agents
A
- TNF R- Etanercept
- Anti-TNF monoclonal ab’s- Infliximab, Adalimumab
- R antagonist- Anakinra
14
Q
TNF R
A
Etanercept
15
Q
Anti-TNF monoclonal ab’s
A
- Infliximab
- Adalimumab
