RA/Gout not covered in sketchy

Question 1

Major side effects of hydroxychloroquine?

Answer 1

Rare occular toxicity

Question 2

Which biologic inhibits JAK kinase, blocking immune cytokine signaling?

Answer 2

Tofactinib

Tofac blocks JAK

Question 3

Which biologic has this MoA: CTLA-4-IgG fusion protein. Binds CD80/86. Blocks T cell co-stimulation via CD28.

Answer 3

Abatacept

Abba hates Mr. T

Question 4

Besides increasing risk of infection, what side effects can abatacept cause?

Answer 4

None, just increased risk of infection.

Abba is pure

Question 5

Which biologic is an IL-6R monoclonal AB?

Answer 5

Tocilizumab

Tociliz blocks IL-siz

Question 6

Which DMARD can be used as an alternate to MTX for treating mod-severe RA?

Answer 6

Leflunomide

Question 7

Name the 4 Traditional DMARDs (disease-modifying anti-rheumatic drugs).

Answer 7

Hydroxychloroquine
Sulfasalazine
Methotrexate
Leflunomide

Question 8

Besides increasing risk of infection, what side effects can rituximab cause?

Answer 8

PML (progressive multifocal leukoencephalopathy- reactivation of JC virus)

Question 9

Which biologics are contraindicated in pregnancy?

Answer 9

None

Question 10

What is the key feature of all DMARDs?

Answer 10

Slow-acting (take 1-3 months)

Question 11

Major side effects of leflunomide?

Answer 11

Hepatotoxicity (esp. w/MTX); HTN (esp. NSAIDs); Diarrhea, nausea (~15%)

Question 12

What is the MoA for Leflunomide?

Answer 12

Inhibitor of dihydroorotate DH (uridine synthesis) -> G1 cell cycle arrest. ( -> Inhibits B & T cell proliferation)

Le flu? Ur a Dean. (hypochondriac)

Question 13

What is the DOC for mod-severe RA?

Answer 13

Methotrexate

Question 14

Which of the biologics and DMARDs can cause increased risk of hepatotoxicty?

Answer 14

DMARDs: Methotrexate, leflunomide, sulfasalazine
Biologics: tocilizumab, tofactinib

Question 15

Which DMARDs can be used to treat mild RA?

Answer 15

Hydroxychloroquine

Sulfasalazine

Question 16

Besides increasing risk of infection, what side effects can tocilizumab and tofactinib cause?

Answer 16

Hepatotoxicity, hypercholesterolemia, BM suppression.
Increased risk of malignancy (esp. immuno)

(the 2 T biologics have the same side effects)

Question 17

Which biologic is an IL-1R antagonist?

Answer 17

Anakinra

Anna Kareninina is #1 book

Question 18

Major side effects of methotrexate?

Answer 18

Hepatotoxicity (common; abstain from etoh)

Rare: pulmonary toxicity; BM suppression; risk of lymphoma.

Question 19

What is the indication for all of the biologics?

Answer 19

Active RA

Question 20

What is the general MoA for Methotrexate?

Answer 20

Increases adenosine leading to immunosuppression. (MOA in RA different from use in cancer).

Question 21

What drugs can provide symptomatic relief for RA, without treating the actual cause? (3)

Answer 21

• Analgesics (anetaminophen, capsacin, opioids)
• NSAIDS (ibuprofen, naproxin)
• Glucocorticoids (dexamethasone)

Question 22

Which biologic binds to CD-20 on B cells?

Answer 22

Rituximab

Question 23

What drugs should you avoid combining biologics w/?

Answer 23

Other biologics

Question 24

Name 3 biologic response modifiers (biologics) that inhibit TNF-alpha.

Answer 24

Adlimumab, entanercept, infliximab

a, e, i (first 3 vowels)

Question 25

What is the MoA for Sulfasalazine?

Answer 25

Pro Drug: Sulfayradine/5-aminosalicylic acid. Metabolized to active component (sulfapyridine) by colonic bacteria.
MOA unknown; Inhibits T & B cells probably via NF-kB.

Question 26

Besides increasing risk of infection, what side effects can anakinra cause?

Answer 26

BM suppression (neutropenia via IL-1). 
Increased risk malignancy.

(Anna Karenina has neutropenia due to her stress)

Question 27

Which DMARDs are safe in pregnancy?

Which are not?

Answer 27

Safe: Hydroxychloroquine, Sulfasalazine
Unsafe: Methotrexate, Leflunomide

Question 28

Which DMARD would be safest for a pt w/liver dz?

Answer 28

-Hydroxychloroquine would be safest

Not safe: Methotrexate and leflunomide, sulfasalazine.

Question 29

Which DMARDs/biologics are contraindicated in renal disease?

Answer 29

Methotrexate

Question 30

For which biologic do you not need to screen for TB and HPV?

Answer 30

Anakinra

according to his table

Question 31

Major side effects of sulfasalazine?

Answer 31

Hepatotoxicity; agranulocytosis (rare)

Question 32

Which biologics increase risk of infection?

Answer 32

All

all probably cause increased risk malignancy as well

Question 33

What is the MoA for Hydroxychloroquine?

Answer 33

Inhibits:

a) TLR signaling
b) Antigen presentation

Question 34

Which DMARDs/biologics would you use to treat mild RA sx?
Mod?
Severe?

Answer 34

Mild: hydroxychloroquine or sulfasalazine (or combo of them)
Mod: MTX (alt: leflunomide)
Severe: MTX + a biologic

Question 35

Which 2 DMARDs are often combined together?

Answer 35

Hydroxychloroquine and sulfasalazine

Question 36

Which of the biologics and DMARDs are contraindicated in pregnancy?

Answer 36

DMARDs: Methotrexate, leflunomide
Biologics: none

Question 37

Besides increasing risk of infection, what side effects can entanercept, adlimumab, and infliximab cause?

Answer 37

Rare: Exacerbates CHF. Increase risk demyelinating disease.

Increased risk malignancy.

Question 38

Which anti-RA drugs cause an increased risk of malignancy?

Answer 38

DMARDs: MTX
Biologics: all except abatacept, rituximab

Question 39

Which DMARD can cause agranulocytosis?

Answer 39

Sulfasalazine

Question 40

Which of the DMARDs and biologics cause bone marrow suppression?

Answer 40

DMARDs: MTX
Biologics: Anakinra, tocilizumab, tofactinib