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Roomies Collab Deck 5: Rheumatology, Immunology, and Dermatology > Rheumatic Disease, Suppressing Drugs > Flashcards

Rheumatic Disease, Suppressing Drugs Flashcards

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1
Q

Systemic and discoid lupus erythematosus are sometimes treated with _______________ or ________________

A

chloroquine

hydroxychloroquine sulfate

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2
Q

The choice of a disease-modifying antirheumatic drug (DMARD) should take into account co-morbidity and patient preference. _______________, ________________, _________________, and ________________ are similar in efficacy. However, methotrexate or sulfasalazine may be better tolerated

A

Methotrexate

sulfasalazine

intramuscular gold

penicillamine

*plus antimalarials in mild RA and SLE (chloroquine and hydroxychloroquine)

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3
Q

The choice of a disease-modifying antirheumatic drug (DMARD) should take into account co-morbidity and patient preference. Methotrexate, sulfasalazine, intramuscular gold, and penicillamine are similar in efficacy. However, _______________ or ________________ may be better tolerated

A

methotrexate

sulfasalazine

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4
Q

Gold, given as sodium aurothiomalate, is licensed for _________________; it must be given by deep intramuscular injection and the area gently massaged

A

active progressive rheumatoid arthritis

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5
Q

__________, given as sodium aurothiomalate, is licensed for active progressive rheumatoid arthritis; it must be given by deep intramuscular injection and the area gently massaged

A

Gold

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6
Q

When prescribing gold for patients with RA, a ______________ must be given followed by doses at ______________ intervals until there is definite evidence of remission.

A

test dose

weekly

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7
Q

If relapse occurs following administration of gold for RA treatment, the dosage frequency may be immediately increased and only once control has been obtained again should the dosage frequency be decreased; if no response is seen within _______________, alternative treatment should be sought.

A

2 months

  • It is important to avoid complete relapse since second courses of gold are not usually effective
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8
Q

_____________ has a similar action to gold. More patients are able to continue treatment than with gold but side-effects are common

A

Penicillamine

*used to eliminate copper ions in Wilson’s disease as well as treatment of severe RA, autoimmune hepatitis (rarely), and cystinuria

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9
Q

Patients taking penicillamine should be warned not to expect improvement for at least ____________ weeks after treatment is initiated

A

6 to 12

*Penicillamine should be discontinued if there is no improvement within 1 year.

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10
Q

Antimalarial drugs ____________ and _____________ are useful in the treatment of mild RA and SLE

A

Hydroxychloroquine

Chloroquine

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11
Q

Which of the antimalarial drugs is used more frequently in the treatment of rheumatic disease?

A

Hydroxychloroquine; chloroquine generally reserved for use if other drugs have failed

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12
Q

Antimalarials are useful in the treatment of which inflammatory conditions? (2)

A
  1. RA

2. SLE

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13
Q

Leflunomide acts on the immune system as a _____________

A

DMARD

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14
Q

What is the drug class and mechanism of action of leflunomide?

A

Immunomodulatory drug

Inhibits mitochondrial enzyme dihydroorotate dehydrogenase (DHODH)

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15
Q

Drugs that affect the immune response are also used in the management of severe cases of systemic lupus erythematosus and other connective tissue disorders. They are often given in conjunction with _____________ for patients with severe or progressive renal disease

A

corticosteroids

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16
Q

Which drugs inhibit the activity of TNF-a? (5)

A
  1. Adalimumab
  2. Certolizumab pegol
  3. Etanercept
  4. Golimumab
  5. Infliximab
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17
Q

TNF-a inhibitors are considered ___________ modulators

A

Cytokine

18
Q

Adalimumab, Certolizumab pegol, Etanercept, Golimumab, Infliximab, Rituximab, Abatacept, Anakinra, Sarilumab, Tocilizumab, and the Janus kinase inhibitors are licensed for the treatment of moderate to severe active _____________ when response to other DMARDs (including methotrexate) has been inadequate

A

rheumatoid arthritis

19
Q

In addition to being used in the treatment of RA, adalimumab is also licensed for the treatment of active and progressive _____________ and severe active _____________

A

psoriatic arthritis

ankylosing spondylitis

*Adalimumab also has a role in inflammatory bowel disease and plaque psoriasis

20
Q

The ______________ inhibitors baricitinib, filgotinib, tofacitinib, and upadacitinib are licensed for use as monotherapy or in combination with methotrexate for the treatment of moderate to severe active rheumatoid arthritis in patients who have had an inadequate response to, or who are intolerant to, one or more DMARDs

A

Janus kinase

21
Q

What are the Janus kinase inhibitors? (4)

A
  1. Baricitinib
  2. Filgotinib
  3. Tofacitinib
  4. Upadacitinib
22
Q

Belimumab inhibits the activity of ______________ stimulator

A

B-lymphocyte

23
Q

Sarilumab is a recombinant human monoclonal antibody that specifically binds to _______________ receptors and blocks the activity of pro-inflammatory cytokines

A

interleukin-6

  • licensed alone or in combination with methotrexate for the treatment of moderate to severe active rheumatoid arthritis in patients who have had an inadequate response to, or are intolerant to one or more DMARDs
24
Q

Anakinra inhibits the activity of _____________

A

interleukin-1

  • Anakinra (in combination with methotrexate) is licensed for the treatment of rheumatoid arthritis which has not responded to methotrexate alone
25
Q

Abatacept prevents the full activation of _______________

A

T-lymphocytes

*licensed for moderate to severe active rheumatoid arthritis in combination with methotrexate, in patients unresponsive to other DMARDs (including methotrexate or a tumour necrosis factor (TNF) inhibitor)

26
Q

Abatacept is not recommended for use in combination with ______________

A

TNF inhibitors

27
Q

In addition to being used in combination with MTX for the treatment of severe active RA in patients whose condition has not responded adequately to DMARDs, Rituximab has a role in treating ___________ disease

A

Malignant

28
Q

In addition to being used in the treatment of active RA in combination with MTX, infliximab is also used in the treatment of ______________ and ________________

A

Ankylosing spondylitis

Psoriatic arthritis (alone or in combination with MTX)

29
Q

In addition to being used in the treatment of moderate to severe RA, golimumab is used to treat ____________ and _____________

A

Psoriatic arthritis

Ankylosing spondylitis

30
Q

In addition to being used in the treatment of moderate to severe RA, etanercept is used to treat ____________ and _____________

A

Psoriatic arthritis

Ankylosing spondylitis

31
Q

In addition to being used in the treatment of RA, certolizumab pegol is also used to treat _____________ and _____________

A

Ankylosing spondylitis

Axial spondyloarthritis

32
Q

Secukinumab inhibits the activity of _______________

A

interleukin-17A

33
Q

Secukinumab is used in the treatment of _____________ and ______________ in patients who have not responded adequately to conventional therapy; also has a role in the treatment of _______________

A

Psoriatic arthritis

Ankylosing spondylitis

Plaque psoriasis

34
Q

Tocilizumab antagonises the actions of ______________

A

interleukin-6.

35
Q

Tocilizumab is used in the treatment of which rheumatic condition(s)?

A

RA only

Also used in the treatment of GCA

36
Q

Ustekinumab inhibits the activity of interleukins ____ and ____

A

12

23

37
Q

Ustekinumab is used in the treatment of which rheumatic condition(s)?

A

Psoriatic arthritis only

Also used to treat plaque psoriasis, IBD

38
Q

Some children with ______________ do not require DMARDs

A

juvenile idiopathic arthritis (juvenile chronic arthritis)

39
Q

If required, which anti-rheumatic drug(s) are preferred for the treatment of juvenile idiopathic arthritis?

A

MTX

Cytokine modulators have a role in SOME forms of JIA

Sulfasalazine (unlicensed)

*gold and penicillamine no longer used

40
Q

Sulfasalazine [unlicensed] is an alternative to MTX in the treatment of juvenile idiopathic arthritis but it should be avoided in ____________ juvenile idiopathic arthritis

A

systemic-onset

41
Q

Which drugs are no longer used in the treatment of Juvenile idiopathic arthritis?

A

Gold

Penicillamine

Roomies Collab Deck 5: Rheumatology, Immunology, and Dermatology (27 decks)

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