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MSK II > Rheumatic diseases pharm > Flashcards

Rheumatic diseases pharm Flashcards

1
Q

nonbio DMARDs

A

hydroxycholoroquine
leflunomide
MTX
sulfasalazine

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2
Q

rarely used nonbio DMARDs

A

azathiprine
cyclosporine
gold salts
minocycline

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3
Q

bio DMARDs TNF-alpha blockers

A 
adalimumab
certolizumab
etanercept
folimumab
inflizimab
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4
Q

other bio DMARDs

A

abatacept
rituximab
tocilizumab

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5
Q

NSAIDs

A

celecoxib
ibuprofen
naproxen

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6
Q

corticosteroids

A

prednisone
methyprednisolone
trimcinolon

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7
Q

acute gout drugs

A

NSAIDs
colchicine
cortiosterids

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8
Q

prevents of gout drugs

A

allopurinol
febuxostat
pegloticase
probenecid

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9
Q

standard drug combo for RA

A

DMARD
NSAID
+/- corticosteroid

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10
Q

recommend initial Tx DMARDs for RA

A

MTX or LEF

if disease is mild can use the safer HCQ or sulfasalazine

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11
Q

MTX MOA

A

at high doses (chemo) inhibits dihydrofolate reductase
low doses used in RA MOA unknown, but does have direct inhibitory effect on proliferation and stimulates apoptosis of immune cells

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12
Q

MTX drug interactions

A

concentration is increased by HCQ

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13
Q

common adverse effects of MTX

A

nausea, upset stomach, diarrhea
stomatitis, alopecia, fever
macular punctate rash, HA, fatigue, inability to concentrate

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14
Q

life threatening adverse effects of MTX

A

hepatotoxic
pulmonary damage
myelosupression
nephrotoxicity (basically never occurs with low doses used for RA)

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15
Q

MTX and hepatic enzymes

A

freqently elevated, but cirrhosis is rare
liver enzymes should be monitored before and after Tx
Pts at risk for hep B and C should be screened before starting MTX
should not drink alcohol

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16
Q

MTX and lungs

A

baseline chest x-ray should be obtained before initiating Tx

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17
Q

MTX CI

A

pregnancy

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18
Q

leflunomide MOA

A

prodrug converted to active A77-1726 in intestines and plasma
inhibiits dihydroorotate dehydrogenase -> T proliferation and B cell production of Abs inhibited

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19
Q

uses of leflunomide

A

as effective as MTX in preventing RA-assocaited bone damage
can be used as initial monotherapy or added when MTX ineffective
best results when LEF and MTX combined, but hepatotoxicity effective may be additive

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20
Q

LEF adverse effects

A

diarrhea very common

elevation of liver enzymes, mild alopecia, weight gain, increased BP, leukopenia, and thrombocytopenia

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21
Q

LEF CI

A

prego

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22
Q

HCQ MOA

A

poorly understood
possibly suppression of T-cell responses to mitogens, decreased leukocyte chemotaxis, stabilization of lysosomal enzymes, inhibition of DNA and RNA synthesis and trapping of free radicals

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23
Q

HCQ uses

A

best known for malaria
RA and lupus
usually used in combo with either MTX or sulfasalazine

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24
Q

adverse effects of HCQ

A 
ocular toxicity (should be screened yearly)
dyspepsia, nausea, vomiting, abdominal pain, rashes, nightmares
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25
sulfasalazine MOA
poorly understood decreased IgA and IgM rheumatoid factor production suppression of T cell responses and B cell proliferation inhibition of cytokine release
26
sulfasalazine metabolites
sulfapyridine and 5-ASA | 5-ASA is active drug in IBD, but sulfapyridine is active drug in RA
27
uses of sulfasalazine
reduces radiologic disease progression in RA | also used for Tx of UC and JIA
28
sulfasalazine adverse effects
more toxic then HCQ nausea, vomitins, HA, anorezia, and rash common reversible infertility in men probably safe in prego
29
adverse effects of TNF-alpha blockers
injection site rxn common fever, uticaria, dyspnea, hypotension cytopenias, CBCs should be monitored regularly
30
serious adverse effects of TNF-alpha blockers
serious infections, sepsis, TV,
31
TNF alpha blockers and CA
increased risk of lymphomas
32
TNF alpha blockers and heart
associated with heart failure and should not be used in pts with class III/IV CHF and EF <50%
33
TNF alpha blockers and prego
ok
34
abatacept MOA
genetically engineered fusion protein of CTLA-4 R and Fc region of human IgG binds CD80 and CD86 -> inhibits T cell activation
35
abatacept response tme
can have relief with one dose, full benefit in 6 months
36
uses of abatacept
RA | JIA
37
adverse effects abatacept
infusion rxns -> HTN, HA, dizzy, anaphylacotoid rxn increase of serious infections pregnancy- C risk of fetal autoimmune disease
38
Rituximab MOA
chimeric MAB that depletes CD20 expressing B cells
39
rituximab PK
IV
40
rituximab uses
RA, usually in combo with MTX | hematological malignancies
41
rituximab adverse effects
mild infusion rxn (rash) severe infusion rxn (urticarial or anaphylactoid) rare increased infections
42
tocilizumab MOA
humanized MAB bind and inhibits IL-6 R signaling
43
tocilizumab PK
IV or sub-Q
44
tocilizumab uses
effective in some RA pts refractory to nonbio DMARDs or anti TNFs JIA
45
adverse effects tocilizumab
``` infusion rxn HTN neutropenia elevated transaminases dyslipidemai serious: GI perforation, serious infections, anaphylaxis ```
46
tolmetin
not effective for gout
47
aspirin
less effective then other NSAIDs for anklosing spondylitis not sued for gout bc can inhibit uric excretion at low doses and increased excretion at high doses, but increases risk for stones
48
first line Tx for gout
NSAIDs
49
oxaprozin
should not be given to pts with uric acid stones b/c increased uric acid secretion in urine
50
colchicine
primary Tx for many years, but declined d/t toxicity | may be used if NSAIDs CI
51
probenecid
only potent uricosuric agent in US
52
pegloticase
recombinant uricase available for Tx of severe chronic gout refractory to conventional antihyperuricemic therapy
53
colchicine MOA
binds tubulin and prevents polymerization of microtubules -> inhibits leukocyte migration and phagocytosis
54
uses of colchicine
second line for acute gout basically only effective if initiated w/in 12-24hours of onset of attack used at low doses for prophylaxis
55
allopurinol MOA
purine analog that competitively and irreversibly inhibits xanthine oxidase
56
allopurinol uses
preferred Tx for gout inbetween episodes
57
adverse effects of allopurinol
can precipitate acute gouty arthritis, should be given with NSAIDs or colchicine at first GI
58
febuxostat MOA
non-purine xanthine oxidase inhibitor
59
febuxostat uses
Tx of chronic hyperuricemia in gout pts
60
adverse effects of febuxostat
can precipitate acute gouty arthritis, should be given with NSAIDs or colchicine at first generally well tolerated most frequent: liver fnx abnormalities, diarrhea, HA, nausea
61
febuxostat drug interactions
cannot be combined with azathioprine or 6-mercaptopurine
62
pegloticase MOA
recombinant uricase converts uric acid to allantoin
63
pegloticase administration
IV every 2 wks
64
pegloticase uses
chronic gout
65
pegloticase adverse effects
can precipitate acute gouty arthritis, should be given with NSAIDs or colchicine at first infusion rxns common anaphylaxia body may initiate an immune attack on drug
66
pegloticase CI
glucose-6-phoaphatate dehydrogenase deficiency dt concern for hemolytic anemia
67
probenecid MOA
organic acid that acts at anionic transport site of renal tubules ot reduce resorption of uric acid
68
probenecid uses
when allopurinol or febuxostat CI or when tophi present
69
probenecid adverse effects
increased uric acid secretion -> increased stone, CI in those with stones generally well tolerated mild GI and rash
70
probenecid drug interactions
aspirin and other salicylates diminish effects

MSK II (19 decks)

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