RA Pharm - Fitz

Question 1

4 drugs classes (besides anti-inflammatories) for RA

Non-specific drug types for RA

Answer 1

• DMARDs
• Anti-TNF-alpha
• Anti-IL1
• JAK inhibitor
• NSAIDs
• Steroids

Question 2

4 DMARD (disease-modifying anti-rheumatic drugs)

Answer 2

• Methotrexate
• Hydroxychloroquine
• Sulfasalazine
• Leflufamide

Question 3

MoA of Leflunamide

Answer 3

Inhibits dihydroorotate dehydrogenase

Question 4

Frontline DMARD of choice for RA

**How does it work (for RA)?

Answer 4

Methotrexate

Slowly becomes polyglutaminated within cells over 25-30 weeks (takes long time to reach steady state), then inhibits AICAR TRANSFORMYLASE. AICAR accumulation leads to ADENOSINE accumulation, which leads to ANTI-INFLAMMATORY effect

Question 5

Methotrexate - major side effect

Should do what else with it?

Answer 5

Hepatotoxicity

Take folic acid or eat foods high in it

Question 6

MoA of glucocorticoids in RA

Adverse effects?

Answer 6

Repress NFkB transcription factor, thus repressing transcription of cytokines secondarily

Osteoporosis, DM

Question 7

Etanercept - MoA

Answer 7

TNF receptor decoy, thus absorbing TNF-alpha

Question 8

Anti-TNF monoclonal antibodies

Answer 8

Infliximab

Adalimumab

Question 9

Anakinra

Answer 9

IL-1 receptor antagonist

Question 10

Anti-TNF agents (3)

All share what?

Answer 10

Etanercept, Infliximab, Adalimumab

Risk of serious opportunistic infections (TB, others)

Question 11

Tofacitinib

Answer 11

JAK inhibitor