RA (csDAMRDS) Flashcards
what are the 2 types of pharmacologic therapy?
symptomatic treatment and chronic disease management
what drugs are included in symptomatic treatment for RA?
- NSAIDs
- steroids (oral and intra-articular) –> lowest effective dose
do NSAIDs slow RA disease progression?
No
*just help with pain
what are chronic treatment options for RA?
- non-biologic DMARDs
- anti-TNF (biologic) DMARDs
- non-TNF (biologic) DMARDs
what are the conventional non-biologic DMARDs?
- methotrexate
- hydroxychloroquine
- leflunomide
- sulfasalazine
what is the MOA & dose of methotrexate?
MOA: folate antimetabolite
Dose: 7.5mg - 25mg PO,IM SQ
what are the ADRs of methotrexate?
Thrombocytopenia, leukopenia
GI: nausea, vomiting, diarrhea,
liver damage, stomatitis, alopecia, renal damage, folic acid deficiency
what is the onset of methotrexate?
3-6 weeks
- steroids might be used as a bridge
what are CI of methotrexate?
- Pregnancy (including male patients)
- alcoholism
- liver disease
- preexisting blood dyscrasias
what labs to get to monitor methotrexate?
CBC with diff, LFTs, sCr, Hep B & C, TB serology
Labs baseline, 2-4 wks for 3 mo, and continue to increase interval
what supplement do patients on methotrexate need?
folic acid
- 1 mg daily
- also folic acid 5 mg Q week
what are the ADRs of Leflunomide?
- Headache
- alopecia
- rash
- diarrhea
- nausea
- increased LFTs
- URTI
what are CIs of leflunomide?
pregnancy
- contraceptives for both males and females
if females become pregnant, what can be used to pull leflunomide out of the body?
cholestyramine
what are the labs for monitoring for leflunomide?
- pregnancy tests prior to initiation
- CBC
- LFTs
- hepatitis
- TB
