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PT2 Neuro 10-11 and Pain 1-4 > RA pharmacology > Flashcards

RA pharmacology Flashcards

1
Q

rheumatoid arthritis definition

A

autoimmune disease that results in chronic inflammation of the lining of the joints

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2
Q

drugs for symptomatic relief of RA

A

NSAIDs

glucocorticoids

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3
Q

disease modifying antirheumatic drugs (DMARDs)

A 
methotrexate
leflunomide
sulfasalazine
hydroxychloroquine
minocycline
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4
Q

NSAID use in RA

A

-for pain and inflammation only by reducing prostanoid production

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5
Q

glucocorticoid use in RA

A
  • provides rapid relief from symptoms

- more potent than NSAIDs

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6
Q

NSAID side effects

A

GI upset

bleeding

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7
Q

glucocorticoids acute adverse effects

A
  • GI ulceration and hemorrhage

- impaired resistance to infection

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8
Q

glucocorticoids chronic adverse effects

A
  • adrenal suppression
  • Cushing’s syndrome
  • weight gain
  • facial puffiness
  • osteoporosis
  • much more
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9
Q

DMARD use in RA

A
  • slow or stop progression

- do not provide symptomatic relief

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10
Q

cytotoxic DMARD

A

methotrexate

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11
Q

methotrexate MOA

A
  • inhibits replication and function of T and B lymphocytes

- suppress secretion of inflammatory cytokines

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12
Q

first line agent in RA

A

methotrexate

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13
Q

methotrexate adverse effects

A
  • N/D
  • rashes
  • alopecia
  • folic acid antagonism
  • teratogenic
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14
Q

notable ADME of methotrexate

A
  • gets polyglutamated which retains it in the cell

- 3-10 hr half life depending on kidney function

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15
Q

leflunomide MOA

A
  • inhibits dihydroorotate dehydrogenase

- inhibits pyrimidine biosynthesis which has cytostatic effect on B and T cells

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16
Q

leflunomide use in RA

A

can be used as additive agent due to its unique MoA

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17
Q

leflunomide adverse effects

A
  • hepatotoxicity
  • GI
  • diarrhea
  • alopecia
  • teratogen
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18
Q

leflunomide notable ADME

A

half life of 14-18 hours

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19
Q

sulfasalazine adverse effects

A
  • GI

- sulfa allergies

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20
Q

hydroxychloroquine adverse effects

A
  • ocular problems
  • retinopathy
  • irreversible visual loss
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21
Q

minocycline adverse effects

A
  • autoimmune syndromes
  • CNS effects
  • superinfection
  • teratogen
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22
Q

gold products used in RA

A

start with aura(o)

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23
Q

the two biologic response modifiers we want to target

A

IL-6

TNF-alpha

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24
Q

IL-6

A

pro-inflammatory cytokine

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25
TNF-alpha
responsible for inflammation
26
biologics that target TNF-alpha
infliximab | adalimumab
27
recombinant human TNF-alpha receptor
etanercept
28
infliximab and adalimumab adverse effects
- TB risk | - cancer risk
29
etanercept adverse effects
-rare myocardial and CNS toxicities
30
abatacept MoA
-inhibits T-cell activation by binding CD80 and CD86
31
abatacept adverse effects
- headache - nausea - infections (especially respiratory)
32
do not mix abatacept with
TNF therapy (infliximab, adalimumab)
33
rituximab MOA
-targets CD20 of B cells
34
rituximab use in RA
when other nonbiologic DMARDs fail
35
rituximab adverse effects
- hematopeoetic toxicities - CNS effects - GI toxicities
36
tocilizumab MOA
targets IL-6 receptor
37
tocilizumab adverse reactions
- increase infection susceptibility | - GI perforations
38
gout
metabolic disease characterized by chronic hyperuricemia caused by urate crystals deposits in joints and cartilage
39
potential causes of gout
- increased urate production | - decreased urate excretion
40
3 aspects of gout therapy
- inhibit inflammatory response - decrease uric acid production - enhance uric acid clearance
41
drugs for acute therapy of gout
- colchicine - NSAIDs - glucocorticoids
42
drugs for chronic therapy of gout
- probenecid - allopurinol - febuxostat - sulfinpyrazone
43
colchicine MOA
inhibit microtuble function which decreases leukocyte migration
44
colchicine use in gout
combination therapy with allopurinol and probenecid
45
colchicine adverse effects
- GI | - hematopoetic toxicities
46
NSAIDs used in gout
-indomethacine, naproxen, ibuprofen (more COX-1 selective)
47
glucocorticoid use in gout
only used in patients unable to take NSAIDs or colchicine
48
allopurinol MOA
- inhibits xanthine oxidase which prevents formation of uric acid - leads to increased excretion
49
allopurinol adverse effects
- increased risk of kidney stones - GI - peripheral neuritis - skin reactions - bone marrow depression
50
febuxostat MOA
inhibits xanthine oxidase
51
febuxostat adverse effects
similar to allopurinol
52
allopurinol and renal impairment
must adjust dosage
53
febuxostat and renal impariment
may not require dose adjustment
54
uricosuric agents ultimately work by
reducing uric acid reabsorption or increasing excretion
55
probenecid MOA
decreased reabsorption of uric acid in proximal tubule
56
probenecid adverse reactions
- GI irritation - allergic dermatitis - aplastic anemia
57
problem with probenecid initiation
may trigger acute gouty attack
58
uricosuric agents
probenecid | sulfinpyrazone
59
sulfinpyrazone MOA
- decreased reabsorption of uric acid in proximal tubule | - more potent than probenecid, but has platelet inhibition
60
sulfinpyrazone adverse effects
-GI problems
61
rasburicase MOA
catalyses the breakdown of uric acid to allantoin
62
problem with rasburicase
its a recombinant enzyme so you will develop an immune response to it
63
tofacitinib MOA
JAK inhibitor -- inhibits phosphorylation of STATs and prevents transcription

PT2 Neuro 10-11 and Pain 1-4 (5 decks)

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