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Board Review > RA and SLE > Flashcards

RA and SLE Flashcards

1
Q

The classic symptoms of RA include:

A

Joint swelling, Stiffness, Pain, Weakness and eventually Bone deformity

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2
Q

What time of day do RA symptoms seem to be the worst in patients:

A

Morning

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3
Q

Diagnostic criteria for RA include: 1) Morning stiffness of joints lasting >1hr; 2) Arthritis in 3 or more joints; 3) Swelling (arthritis) of hand, foot or wrist joints; 4) Symmetric involvement; 5) Subcutaneous nodules; 6) Positive serum rheumatoid factor (~70% of patients); 7) Radiographic erosions or periarticular osteopenia in hand or wrist joints. How long much symptoms be present for diagnosis?

A

> =6 weeks. Must have criteria 1-4. Minimum of 4 criteria for diagnosis.

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4
Q

How long after diagnosis of RA should patients be started on DMARDs?

A

within 3 months of diagnosis.

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5
Q

What class of drugs may be used as bridge therapy for patients with RA?

A

NSAIDs or steroids.

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6
Q

What class of drugs help to slow down RA and help prevent further joint damage?

A

DMARDs (Disease-Modifying Antirheumatic Drugs).

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7
Q

Name some short term side effects of Prednisone therapy.

A

Fluid retention, Stomach upset, Emotional instability, Increased appetitie, Weight gain. (With high doses: increased blood glucose and/or BP)

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8
Q

Name some long-term side effects of Prednisone therapy.

A

Adrenal suppression/Cushing’s syndrome; Impaired wound healing; HTN; Hyperglycemia, Cataracts; Osteoporosis; Hypokalemia; Grouth suppression in children; Muscle wasting; Dermal thinning; Bruising; Can; Menstrual irregularities; and others

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9
Q

Methotrexate (Rheumatrex), Hydrochloroquine (Plaquenil), Sulfasalazine; Minocycline; Leflunomide (Arava) are all examples of (biologic/non-biologic) DMARDs

A

Non-biologic. Methotrexate and Hydroxychloroquine are most commonly used.

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10
Q

Most common side effects of Methotrexate include:

A

N/V/D, GI upset, Anorexia, Reddening of skin, can cause LIVER, LUNGS (dammage) , nausea, darreha and STOMATITIS (MOUTH SORES). Hence dry cough, sob, weakness, yellow skin

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11
Q

What is the dosing interval of Methotrexate for RA?

A

WEEKLY. Dose may be spread over 12-36 hours. It is NEVER dosed daily for RA.

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12
Q

Methotrexate is a Pregnancy category _

A

X. Under no circumstances should it be used during pregnancy or suspected pregnancy.

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13
Q

Hydroxychlorquine common side effects inlude:

A

Decreased visual acuity, Photophobia, Blurred vision, Corneal deposits, N/V, Others: SJS, pruritus, alopecia, ataxia, pigmentation of skin and hair, neuromyopathy with long-term use

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14
Q

Etanercept (Enbrel), Adalimumab (Humira), Infliximab (Remicade), Crtolizumab (Cimzia), Golimumab (Simponi), Rituximab (Rituxan), Anakinra (Kineret) Abatacept (Orencia) and Tocilzumab (Actermra) are all examples of (biologic/non-biologic) DMARDs

A

Biologic. (Note the mab suffixes of more of these drugs)Most commonly used: Etanercept, Adalimumab, Infliximab, Rituximab

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15
Q

Infliximab (Remicade) and Rituximab (Rituxan) may be given with ___ for the treatment of RA.

A

Methotrexate

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16
Q

The DMARDs Etanercept (Enbrel), Adalimumab (Humira), Infliximab (Remicade), Certolizumab pegol (Cimzia) and Golimumab (Simponi) are all part of the class __ __ __ __ inhibitors

A

Tumor necrosis factor alpha inhibitors (TNF-alpha inhibitors)

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17
Q

BBW for most biologic DMARDs includes risk of ____ or ___

A

Serious infections or malignancies

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18
Q

The most common side effects of biologic DMARDs are:

A

Infections and injection site reactions

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19
Q

Biologic DMARDs should not be used if the patient has an active ____.

A

Infection. (ie severe infection or sepsis)

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20
Q

What medication is considered first line for RA?

A

Methotrexate. Biologic DMARDs may be added on as second-line therapy (most commonly Etanercept (Enbrel) or Adalimumab (Humira))

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21
Q

Can you use more than one biologic DMARD for RA at once?

A

No. Do not use biologics in combination. TNF inhibitors may cause neurological reactions, demyelinating disease, malignancies, HepB reactivation, TB activation, HF, SLE, or immunosuppression

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22
Q

(True/False) Live vaccines should not be given to patients using biologic DMARDs

A

True. Avoid live vaccines.

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23
Q

All TNF-alpha blockers requires a test for this infectious disease prior to administration, then annually thereafter:

A

TB. TNF-alpha blockers may activate latent TB.

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24
Q

Name the 7 drugs commonly associated with Drug induced lupus:

A

Procainamide, Hydralazine, Isoniazid, Quinidine, Chlorpromazine, Methyldopa, and Minocycline.

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25
Q

The most common symptoms of SLE include:

A

Fatigue, Fever, Anorexia, Weight loss, Muscle aches, Arthritis, Rash (Butterfly rash), Photosensitivity, Joint pain, Stiffness

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26
Q

(True/False) SLE can cause severe damage to several organs

A

True. It is important to treat SLE to prevent disease flares.

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27
Q

What two antimalarial agents may be used to treat SLE?

A

Hydroxychloroquine or Chloroquine. May take up to 6 months to see maximal effects.

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28
Q

What medication may be prescribed at higher doses to help control a current flare or at lower doses as chronic, suppressive therapy for SLE?

A

Prednisone

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29
Q

What biologic agent may be used for SLE?

A

Belimumab (Benlysta) - inhibits B cells* know brand name

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30
Q

The cytotoxic agents Cyclophosphamide, Azathioprine or Mycophenolate mofetil (Cellcept) may be used in (mild/moderate/severe) SLE.

A

Severe.

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31
Q

MESNA therapy and hydration may help with this side effect of Cyclophosphamide:

A

Hemorrhagic cystitis

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32
Q

Can methotrexate be used while breastfeeding?

A

No

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33
Q

Methotrexate may cause failure of this organ:

A

Liver (Toxicity)

34
Q

Etanercept may cause damage to of this organ:

A

Liver

35
Q

Etanercept is injected where and how often?

A

SC into thigh, abdomen, or upper are. One time or weekly

36
Q

How should Etanercept (Enbrel) be stored?

A

Refrigerator. Allow to cool to room temperature before injecting. Do not shake. If particles or discoloration are present then do not use.

37
Q

Brand name of Etanercept:

A

Enbrel

38
Q

Brand name of Adalimumab

A

Humira

39
Q

Brand name of Infliximab

A

Remicade

40
Q

Brand name of Rituximab

A

Rituxan

41
Q

prior to starting enbrel get tested for

A

TB, WBC and liver enzymes

42
Q

TB positive and found to be latent now what w/ tnf?

A

Start tb therapy BEFORE starting on TNFF

43
Q

leflunamide and pregnancy

A

wait 2 years after stopping to start this agent. teratogenic.

44
Q

All TNF blockers BBW

A

BBW: infection and malignancies

45
Q

All TNF blockers ADR

A

ADR: injection site reactions (fever rash etc)

46
Q

All TNF blockers CI

A

CI: sepsis

47
Q

All TNF blockers monitoring

A

Montior: WBC, HF, LFTs

48
Q

what are the first line in biologics?

A

Enbrel and Humira - Self inject and first line w/ biologics

49
Q

All TNF blockers special injection instructions

A

Do not shake, refrigiergate and bring to room temp before injecting

50
Q

All TNF blockers, what disease should they be evaluated for and what is the treatment?

A

Evauluate for TB- if latent give ISONIAZID!!!! nothing else.

51
Q

adalimumab humira dosing

A

EVERY OTHER WEEK!!!

52
Q

ENBREL- dosing

A

ENBREL- once a week enbrel is the only weekly one

53
Q

INFLIXIMAb dosing

A

INFLIXIMAN also 0,2, 6,8 (every other)

54
Q

abatacept

A

Orencia

55
Q

Rituxan

A

Anti Cd 20 monoclonal antibody** note NOT TNF but still a biologics

56
Q

BBW of rituxan:

A
  1. progressive multifocal leukoencephlopathy, Tumor lysis, Fata mucocutaneous reactions (SJS, TEN)
57
Q

monitoring of rituxan

A

monitoring: cardiac, vital signs, CBC, CD20, REnal

58
Q

tofacitinib, MPOA, Pregancy category?

A

Tofacitinib (Xeljanz) is an inhibitor of Janus kinase (JAKs). It is a new ORAL medication that is taken BID. Tofacitinib is pregnancy category C and should not be used with biologic DMARDS or other potent immunosuppressants like cyclosporine or azathioprine.

59
Q

cytotoxic agents

A

cyclophosphamide, azathioprine, mycophenalate mofetil all cause hepatotoxicity, malignancy, and bone marrow supression

60
Q

anakinra

A

kineret

61
Q

abacept

A

orenecia

62
Q

tocilizumab

A

actemra

63
Q

name two NSAIDs commonly used for RA treatment?

A

Ibuprofen and celecoxib

64
Q

the celecoxibe dose for RA ?

A

100-200 po BID whihci s a higer dose than the max dose for OA 200 QD

65
Q

what are some contraindationts to prednisone?

A

live vaccines, systemic fungal infections, and varicell (see immunizations chapter)

66
Q

trexall

A

methotrexate

67
Q

rheumatrex

A

methotrexate

68
Q

plaquenil

A

hydroxycholorquin

69
Q

contraindications for methotrexate?

A

pregnacy
alcoholoism
chronic liver disease
bloodyscrasias

70
Q

mechanism of action of methotrexate?

A

folate antimetabolite that inhibits DNA synthesis ( decreasing the activity of immune system)

71
Q

hydroxycholorqine dose for RA

A

400-600mg per day initially then 200-400 mg/day maintenance. Take with food.

72
Q

which agents can you used for mild RA?

A

minocycline, sulfasalazine, hydroxycholroquine

73
Q

dyancin

A

minocycline

74
Q

minocycline dose

A

100mg po bid

75
Q

enbrel

A

etanecept

76
Q

etanercept MOA

A

TNF inhibitor

77
Q

adalimumab moa

A

tnf inhibitor

78
Q

infliximab MOA

A

TNF inhibitor

79
Q

remicade

A

infliximab

80
Q

humira

A

adalimumab

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