RA/Gout not covered in sketchy Flashcards
Major side effects of hydroxychloroquine?
Rare occular toxicity
Which biologic inhibits JAK kinase, blocking immune cytokine signaling?
Tofactinib
Tofac blocks JAK
Which biologic has this MoA: CTLA-4-IgG fusion protein. Binds CD80/86. Blocks T cell co-stimulation via CD28.
Abatacept
Abba hates Mr. T
Besides increasing risk of infection, what side effects can abatacept cause?
None, just increased risk of infection.
Abba is pure
Which biologic is an IL-6R monoclonal AB?
Tocilizumab
Tociliz blocks IL-siz
Which DMARD can be used as an alternate to MTX for treating mod-severe RA?
Leflunomide
Name the 4 Traditional DMARDs (disease-modifying anti-rheumatic drugs).
Hydroxychloroquine
Sulfasalazine
Methotrexate
Leflunomide
Besides increasing risk of infection, what side effects can rituximab cause?
PML (progressive multifocal leukoencephalopathy- reactivation of JC virus)
Which biologics are contraindicated in pregnancy?
None
What is the key feature of all DMARDs?
Slow-acting (take 1-3 months)
Major side effects of leflunomide?
Hepatotoxicity (esp. w/MTX); HTN (esp. NSAIDs); Diarrhea, nausea (~15%)
What is the MoA for Leflunomide?
Inhibitor of dihydroorotate DH (uridine synthesis) -> G1 cell cycle arrest. ( -> Inhibits B & T cell proliferation)
Le flu? Ur a Dean. (hypochondriac)
What is the DOC for mod-severe RA?
Methotrexate
Which of the biologics and DMARDs can cause increased risk of hepatotoxicty?
DMARDs: Methotrexate, leflunomide, sulfasalazine
Biologics: tocilizumab, tofactinib
Which DMARDs can be used to treat mild RA?
Hydroxychloroquine
Sulfasalazine
Besides increasing risk of infection, what side effects can tocilizumab and tofactinib cause?
Hepatotoxicity, hypercholesterolemia, BM suppression.
Increased risk of malignancy (esp. immuno)
(the 2 T biologics have the same side effects)
Which biologic is an IL-1R antagonist?
Anakinra
Anna Kareninina is #1 book
Major side effects of methotrexate?
Hepatotoxicity (common; abstain from etoh)
Rare: pulmonary toxicity; BM suppression; risk of lymphoma.
What is the indication for all of the biologics?
Active RA
What is the general MoA for Methotrexate?
Increases adenosine leading to immunosuppression. (MOA in RA different from use in cancer).
What drugs can provide symptomatic relief for RA, without treating the actual cause? (3)
- Analgesics (anetaminophen, capsacin, opioids)
- NSAIDS (ibuprofen, naproxin)
- Glucocorticoids (dexamethasone)
Which biologic binds to CD-20 on B cells?
Rituximab
What drugs should you avoid combining biologics w/?
Other biologics
Name 3 biologic response modifiers (biologics) that inhibit TNF-alpha.
Adlimumab, entanercept, infliximab
a, e, i (first 3 vowels)
What is the MoA for Sulfasalazine?
Pro Drug: Sulfayradine/5-aminosalicylic acid. Metabolized to active component (sulfapyridine) by colonic bacteria.
MOA unknown; Inhibits T & B cells probably via NF-kB.
Besides increasing risk of infection, what side effects can anakinra cause?
BM suppression (neutropenia via IL-1). Increased risk malignancy.
(Anna Karenina has neutropenia due to her stress)
Which DMARDs are safe in pregnancy?
Which are not?
Safe: Hydroxychloroquine, Sulfasalazine
Unsafe: Methotrexate, Leflunomide
Which DMARD would be safest for a pt w/liver dz?
-Hydroxychloroquine would be safest
Not safe: Methotrexate and leflunomide, sulfasalazine.
Which DMARDs/biologics are contraindicated in renal disease?
Methotrexate
For which biologic do you not need to screen for TB and HPV?
Anakinra
according to his table
Major side effects of sulfasalazine?
Hepatotoxicity; agranulocytosis (rare)
Which biologics increase risk of infection?
All
all probably cause increased risk malignancy as well
What is the MoA for Hydroxychloroquine?
Inhibits:
a) TLR signaling
b) Antigen presentation
Which DMARDs/biologics would you use to treat mild RA sx?
Mod?
Severe?
Mild: hydroxychloroquine or sulfasalazine (or combo of them)
Mod: MTX (alt: leflunomide)
Severe: MTX + a biologic
Which 2 DMARDs are often combined together?
Hydroxychloroquine and sulfasalazine
Which of the biologics and DMARDs are contraindicated in pregnancy?
DMARDs: Methotrexate, leflunomide
Biologics: none
Besides increasing risk of infection, what side effects can entanercept, adlimumab, and infliximab cause?
Rare: Exacerbates CHF. Increase risk demyelinating disease.
Increased risk malignancy.
Which anti-RA drugs cause an increased risk of malignancy?
DMARDs: MTX
Biologics: all except abatacept, rituximab
Which DMARD can cause agranulocytosis?
Sulfasalazine
Which of the DMARDs and biologics cause bone marrow suppression?
DMARDs: MTX
Biologics: Anakinra, tocilizumab, tofactinib
