RA

Question 1

Methotrexate - treatment

Answer 1

see effects in 3-6 weeks; 1st choice

folate antagonists so patients need to take folate supplement

Question 2

Methotrexate - AE

Answer 2

• hepatic fibrosis, bone marrow suppression, GI ulceration, PNA

Question 3

Methotrexate - contraindications

Answer 3

Pregnancy and BF

Question 4

Methotrexate - interactions

Answer 4

other drugs that harm liver, live vaccines

Question 5

Hydroxychlororquinine (Plaquenil) - treatment

Answer 5

usually combined with methotrexate, onset 3-6 months

Question 6

Hydroxychlororquinine (Plaquenil) - AE

Answer 6

retinal damage (irreversible - needs to be closely monitored)

• cardiac problems with high doses
• hypoglycemia, myopathy, neuropathy, GI disturbance (take with milk or food)

Question 7

Lefluonmide (Arava) - treatment (AE and considerations)

Answer 7

AE: hepatic fibrosis, bone marrow suppression, GI ulceration, PNA, SJS
- more AE and expensive so second choice

Question 8

Sulfasalazine (Azulfinide) - AE

Answer 8

GI effects, derm rxns, SJS, liver damage, bone marrow suppression, dont prescribe to pts with a sulfa allergy

Question 9

Biologic DMARDS (expensive) - names

Answer 9

Golimumab (Simponi), -mab, Infliximab (Remicade), Adalimumab (Humira)Abakinra (Kineret)

Question 10

Biologic DMARDS - AE

Answer 10

SJS, HF, hematologic disorders, liver injury, increased r/o infection and cancer

Question 11

DMARDS - targeted - types

Answer 11

Janus Kinase Inhibitors
Tofactinab - used in pts that cant take methotrexate (last choice)
- don’t give with biologics, CYP3A4 or CYP2C19 inhibitors