Rheumatic Disease, Suppressing Drugs Flashcards
Systemic and discoid lupus erythematosus are sometimes treated with _______________ or ________________
chloroquine
hydroxychloroquine sulfate
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
Methotrexate
sulfasalazine
intramuscular gold
penicillamine
*plus antimalarials in mild RA and SLE (chloroquine and hydroxychloroquine)
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
methotrexate
sulfasalazine
Gold, given as sodium aurothiomalate, is licensed for _________________; it must be given by deep intramuscular injection and the area gently massaged
active progressive rheumatoid arthritis
__________, given as sodium aurothiomalate, is licensed for active progressive rheumatoid arthritis; it must be given by deep intramuscular injection and the area gently massaged
Gold
When prescribing gold for patients with RA, a ______________ must be given followed by doses at ______________ intervals until there is definite evidence of remission.
test dose
weekly
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.
2 months
- It is important to avoid complete relapse since second courses of gold are not usually effective
_____________ has a similar action to gold. More patients are able to continue treatment than with gold but side-effects are common
Penicillamine
*used to eliminate copper ions in Wilson’s disease as well as treatment of severe RA, autoimmune hepatitis (rarely), and cystinuria
Patients taking penicillamine should be warned not to expect improvement for at least ____________ weeks after treatment is initiated
6 to 12
*Penicillamine should be discontinued if there is no improvement within 1 year.
Antimalarial drugs ____________ and _____________ are useful in the treatment of mild RA and SLE
Hydroxychloroquine
Chloroquine
Which of the antimalarial drugs is used more frequently in the treatment of rheumatic disease?
Hydroxychloroquine; chloroquine generally reserved for use if other drugs have failed
Antimalarials are useful in the treatment of which inflammatory conditions? (2)
- RA
2. SLE
Leflunomide acts on the immune system as a _____________
DMARD
What is the drug class and mechanism of action of leflunomide?
Immunomodulatory drug
Inhibits mitochondrial enzyme dihydroorotate dehydrogenase (DHODH)
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
corticosteroids
Which drugs inhibit the activity of TNF-a? (5)
- Adalimumab
- Certolizumab pegol
- Etanercept
- Golimumab
- Infliximab
TNF-a inhibitors are considered ___________ modulators
Cytokine
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
rheumatoid arthritis
In addition to being used in the treatment of RA, adalimumab is also licensed for the treatment of active and progressive _____________ and severe active _____________
psoriatic arthritis
ankylosing spondylitis
*Adalimumab also has a role in inflammatory bowel disease and plaque psoriasis
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
Janus kinase
What are the Janus kinase inhibitors? (4)
- Baricitinib
- Filgotinib
- Tofacitinib
- Upadacitinib
Belimumab inhibits the activity of ______________ stimulator
B-lymphocyte
Sarilumab is a recombinant human monoclonal antibody that specifically binds to _______________ receptors and blocks the activity of pro-inflammatory cytokines
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
Anakinra inhibits the activity of _____________
interleukin-1
- Anakinra (in combination with methotrexate) is licensed for the treatment of rheumatoid arthritis which has not responded to methotrexate alone
Abatacept prevents the full activation of _______________
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)
Abatacept is not recommended for use in combination with ______________
TNF inhibitors
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
Malignant
In addition to being used in the treatment of active RA in combination with MTX, infliximab is also used in the treatment of ______________ and ________________
Ankylosing spondylitis
Psoriatic arthritis (alone or in combination with MTX)
In addition to being used in the treatment of moderate to severe RA, golimumab is used to treat ____________ and _____________
Psoriatic arthritis
Ankylosing spondylitis
In addition to being used in the treatment of moderate to severe RA, etanercept is used to treat ____________ and _____________
Psoriatic arthritis
Ankylosing spondylitis
In addition to being used in the treatment of RA, certolizumab pegol is also used to treat _____________ and _____________
Ankylosing spondylitis
Axial spondyloarthritis
Secukinumab inhibits the activity of _______________
interleukin-17A
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 _______________
Psoriatic arthritis
Ankylosing spondylitis
Plaque psoriasis
Tocilizumab antagonises the actions of ______________
interleukin-6.
Tocilizumab is used in the treatment of which rheumatic condition(s)?
RA only
Also used in the treatment of GCA
Ustekinumab inhibits the activity of interleukins ____ and ____
12
23
Ustekinumab is used in the treatment of which rheumatic condition(s)?
Psoriatic arthritis only
Also used to treat plaque psoriasis, IBD
Some children with ______________ do not require DMARDs
juvenile idiopathic arthritis (juvenile chronic arthritis)
If required, which anti-rheumatic drug(s) are preferred for the treatment of juvenile idiopathic arthritis?
MTX
Cytokine modulators have a role in SOME forms of JIA
Sulfasalazine (unlicensed)
*gold and penicillamine no longer used
Sulfasalazine [unlicensed] is an alternative to MTX in the treatment of juvenile idiopathic arthritis but it should be avoided in ____________ juvenile idiopathic arthritis
systemic-onset
Which drugs are no longer used in the treatment of Juvenile idiopathic arthritis?
Gold
Penicillamine
