RA II Flashcards
IL-6 RECEPTOR INHIBITORS
___ (Actrema®) and ___ (Kevzara®)
Indication
- Moderate to severe RA after inadequate response to one or more ___
- Alone or in combination with ___ or another DMARD
Mechanism of Action
- binds to soluble and membrane bound ___ receptors
- tocilizumab, sarilumab
- DMARDs
- MTX
- IL-6
TOCILIZUMAB: DOSING
- 4mg/kg ___ infusion given over one hour
- Can increase to 8mg/kg
- Given every __ weeks
- Doses > ___ mg are not recommended
IV
4
800 mg
SARILUMAB: DOSING
- 200mg ___ every 2 weeks
- May reduce to 150mg dose if ___ , thrombocytopenia or increased LFTs
- SC
- neutropenia
IL-6 INHIBITOR: WARNINGS
Black box warning: serious ___
CI in patients with ___ toxicity, ___ and ____
- infections
- liver, thrombocytopenia, neutropenia
IL-6 INHIBITOR: ADVERSE EFFECTS
- Serious ___
- ___ toxicity
- ___ penia
- ___
- ___ abnormalities
- Intestinal perforations ( ___ )
- Infusion reactions ( ___ )
- infection
- liver
- thrombocytopenia
- neutropenia
- lipid
- tocilizumab
- tocilizumab
IL-6 INHIBITOR: MONITORING PARAMETERS
- ___ count – at 4-8 weeks then every 3 months
- ___ count – at 4-8 weeks then every 3 months
- ___ – at 4-8 weeks then every 3 months
- ___ profile – after 4-8 weeks then every 6 months
- neutrophil
- platelet
- LFTs
- lipid
ANTI-CD20 ANTIBODY: RITUXIMAB
(Rituxan®)
Indication
■ For moderate to severe RA
■ In those with inadequate response to ___ antagonists
■ In combination with ___
Mechanism of Action
■ Bind specifically to antigen ___
- TNF
- MTX
- CD20
RITUXIMAB: DOSING
- Two 1g IV infusions separated by two weeks
- Can retreat at __ -month intervals
- Administer ___ 100mg IV 30 minutes before nfusion to reduce infusion reactions
- 6
- methylprednisolone
RITUXIMAB: ADVERSE EFFECTS
- ___ ___ syndrome
- ___ reactions
- ___ infection
- Hypersensitivity
- ___ toxicity
- ___ obstruction
- ___ reactivation
- Cardiac ___
- tumor lysis
- mucocutaneous
- viral
- renal
- bowel
- hepatitis
- arrhythmia
RITUXIMAB: MONITORING
■ CBC with ___
■ ___
■ Vital signs (during ___ )
- platelet
- SCr
- infusions
JANUS KINASE INHIBITORS
Indication:
■ Moderate to severe RA after inadequate response to ___
■ Alone or in combination with ___ or another ___
■ Not in combination with BRM, ___ , or cyclosporine
Mechanism of Action:
■ inhibits janus kinase
- TNF-a
- MTX, DMARD
- AZA
JAK INHIBITORS: DOSING
___ (Xeljanz® & Xeljanz XR®)
■ 5mg by mouth twice daily or 11mg once daily
___ (Olumiant®)
■ 2mg by mouth once daily
___ (Rinvoq®)
■ 15mg by mouth once daily
- tofacitinib
- baricitinib
- upadacitinib
JAK INHIBITORS: WARNINGS
- Cytochrome P450 interactions
- Do not use in ___ impairment
- Risk of ___
- Risk of ___
- MACE
- Thrombosis
- ___ perforations
- No ___ vaccines
Do not use if:
– Hemoglobin < __ mg/dL
– ANC < ____ cells/mm3
– ALC < ___ cells/mm3
- hepatic
- infection
- malignancy
- GI
- live
- 9
- 1000
- 500
JAK INHIBITORS
Adverse Effects:
■ Upper respiratory
■ Headache
■ Nausea
Monitoring Parameters:
■ ___ count
■ ___ count
■ ___
■ ___ enzymes
■ ___ profile
- lymphocyte
- neutrophil
- hemoglobin
- liver
- lipid
COMBINATION THERAPY
- Drugs with different MOA
- Decreased dosages & minimizes ___
■ More effective in treating ___
■ May provide dramatic slowing of ___
■ ___ in combination with other DMARDs
- AE
- resistance
- progression
- MTX
