Rheumatoid Arthritis Flashcards
RA Drugs Overview
NSAIDs: rapid relief, safer than glucocorticoids, or DMARDs, less monitoring, initial therapy to allow DMARDs time.
Glucocorticoids: rapid relief and slow dz progression. Very effective and long term use can cause serious toxicities. Reserved for short term management to control exacerbations or allow DMARD time
DMARDs: Reduce joint destruction and slow dz. Traditional and biologic. Longer time to take effect. More rigorous monitoring and ADRs. Start early, w/in 3 months.
Pretreatment Eval
Test for Hep B and C as well as TB
Smoking cessation and mgmt of dyslipidemia - reduces CV dz risk
Immunizations: Decrease risk of infectious complications
Treatment approach
NSAID or GC and DMART initiated with Methotrexate or other non-biologic if MTX is bad.
Additional DMARD is added non-bio or bio and then JAK inhibitors/last line bios
Methotrexate
IND: RA
MOA: Folic acid antimetabolite that inhibits DNA synthesis, repair, and replication
BOX: Oral dose ONCE WEEKLY (daily is only for oncology)
CON: Pregnancy, alcohol, liver dz, immunodeficiency syndrome, blood dyscrasias
ADR: Increased LFTs, hepatotoxic. Bone marrow suppression, alopecia, photosensitivity. Supplement with daily Folic acid except days on MTX
Hydroxycholoroquinalone
IND: RA
MOA: Not understood. Inhibit immune activation by reducing cytokines
BOX: n/a
CON: n/a
ADR: Cardiomyopathy. Retinal Toxicity MC after 5 years. Takes up to 6 months to fully evaluate if this drug has worked
Sulfasalazine
IND: RA
MOA: Unknown. Modulates inflammatory response
BOX:
CON: Sulfa allergies or aspirin. intestine/urinary obstruction. Porphria
ADR: Rash. GI
Leflunomide
IND: RA
MOA: Inhibits pyridine synthesis; antiproliferative/antiinflammatory
BOX: Embryofetal toxicity.
Hepatotoxicity; deadly
CON: Pregnancy, hepatic impairment
ADR: HA, Alopecia, GI
Cyclosporine
IND: RA
MOA: Inhibits activation on IL-2; inhibts T cell activation.
BOX: HTN/nephrotoxic; monitor renal fxn.
Increased risk of skin cancer and other malignancies.
Experienced providers only
CON: Abnormal renal fxn. Uncontrolled HTN. Malignant
ADR: HTN, hirsutism, increased TGs, SCr, UTIs
Azathioprine
IND: RA
MOA: Halts cell division
BOX: Immunosuppression and increased risk of malignancy
CON: n/a
ADR: infection/leukopenia
TNF Blocking Agents (Biologics)
IND: RA, further down the line
MOA: Protein that contains TNF receptor, sucks up TNF, no TNF left to cause inflammation
BOX: Serious infections.
Malignancies
CON: Sepsis
ADR: Injection site rxn, infusion rxn. GI. Infections.
TNF Agent Names
Adalimumab
Certolizumab
Etanercept
Golimumab
Infliximab
Tocilizumab and Sarilumab
IND: RA
MOA: IL 6 receptor antagonist. IV only
BOX: Serious infections
CON:
ADR: Increased chol, AST/ALT. Infusion rxn
Abatacept
IND: RA
MOA: Inhibits T cell activation
BOX: n/a
CON: n/a
ADR: AB development. Infections
Rituximab
IND: RA
MOA: B Cell targeted
BOX: Infusion rxns. Mucocutaneous rxns.
Hep B and opportunistic rxns
CON:
ADR: lots
JAK 2 Inhibitors
IND: RA
MOA: Prevents cytokine activity
BOX: Serious infections.
Mortality (Tofacitinib ONLY) 50 or older
Malignancies.
Thrombosis 50 or older
CON: n/a
ADR:Infections
