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PHAR 255 > Rheumatoid Arthritis > Flashcards

Rheumatoid Arthritis Flashcards

1
Q

Process of RA development?

A

chronic inflammation –> growth of tissue (pannus) –> loss of bone and cartilage

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2
Q

RA triggers?

A

genetics
stochastic event

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3
Q

Consequences of inflammation?

A

loss of cartilage
formation of scar tissue
ligament laxity
tendon contractures

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4
Q

Gender more common for RA?

A

women 3:1

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5
Q

RA symptoms?

A

symmetrical joint pain and stiffness > 6 weeks
muscle pain
fatigue, weakness, low-grade fever, appetite decrease
joint tenderness and warmth ans swelling over affected joints
Rheumatoid nodule development

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6
Q

WHat joints is does RA usually start in

A

peripheral joints

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7
Q

Diagnosis for RA?

A

joint involvement
lab tests
- Rheumatoid factor in 60-70% pts
- elevated ESR and CRP
- anti-cyclic citrullinated pepide antibody
Duration of symptoms

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8
Q

When to start DMARDs?

A

within first 3 months of diagnosis

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9
Q

Non-pharm treatment?

A

Pts education
rest activity balance
reduce joint stress
diet
wt loss
surgery
occupational and physical therapy

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10
Q

Main DMARD used?

A

Methotrexate

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11
Q

MOA of Methotrexate?

A

anti-folate, less DNA synthesis, repair, cellular replication and immune response

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12
Q

Onset of methotrexate?

A

1-2 months

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13
Q

Methotrexate dosing?

A

7.5-25mg po weekly

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14
Q

Methotrexate common AE’s?

A

N & V
Fatigue
stomatisis
skin itch, burining, rash
hair loss
photosensitivity

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15
Q

Serious SE of methotrexate?

A

hepatotoxicity
hematologic abnormalities
pulmonary toxicity
reversible sterile in men
infection increase

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16
Q

Unique SE of hydroxchloroquine?

A

ocular toxicity?

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17
Q

DMARD drugs?

A

hydroxychloroquine
sulfasalazine
methotrexate
leflunomide

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18
Q

CI w/ methotrexate?

A

pregnancy/breastfeeding
severe hepatic impairment
caution in lung dysfunction
Current hematological abnormalities

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19
Q

DI w/ methotrexate?

A

TRIMETHOPRIM**

NSAIDs, PPI’s, Loops –> in doses 500-2000mg weekly

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20
Q

Monitoring DMARDs?

A

disease activity q 1-3m
radiographs q 6-12m

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21
Q

Saftey monitoring for methotrexate?

A

CBCs and LFTs
Creatinine
Initial chest x-ray

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22
Q

Which DMARD can replace methotrexate if not tolerated?

A

leflunomide

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23
Q

Biologic DMARDs?

A

TNF
Interleukins

24
Q

What do biologic DMARDs cause over time?

A

soft tissue and bone damage

25
Common SEs of biologic DMARDs?
Nausea headache Diarrhea Malaise
26
Pre-treatment of biologic DMARDs?
acet + antihistamine + steroid 90 min prior
27
When is Infection rate increase highest
early in therapy
28
Cancer risks in biologic DMARDs?
skin Lymphomas
29
Which biologic DMARD does not have antibody development?
IL-6 inhibtors
30
Antibody development more common in TNF or B/T cell treatment?
More in TNF
31
Which biologic DMARDs are indicated in combo w/ methotrexate?
Infliximab Golimumab
32
CI of TNF?
active severe infection HF
33
unique concerns w/ TNF?
autoimmune diseases Seizures
34
Oneset of IL-1 or 6?
weeks, peak at 5-6 months
35
WHich IL has a CI of active infections?
tocilizumab
36
Anakinra dosing?
100mg SubQ daily
37
Does anakinra cause GI issues/ perforation?
no
38
Unique SE w/ sarilumab/tocilizumab?
dyslipidemia
39
unique T cell SEs?
COPD exacerbations HTN BG increase
40
T cell drug?
Abatacept
41
B cell drug?
Rituximab
42
What must B cell depletor be pre-treated w/?
methylprednisolone Acet diphenhydramine
43
Dosing of Rituximab?
1g IV infusion, 2 doses spaced 2 weeks apart
44
When can you retreat w/ rituximab?
when needed, usually 6 months
45
What needs to be held prior to rituximab infusion?
HTN meds
46
Serious AE of Rituximab?
SJS/TEN
47
SE of rituximab?
HTN GI perforation BG increase
48
Biologic DMARDs place in therapy?
after other options have been tried unless severe RA 1. TNF 2. IL-1 or 6 3. abatacept 4. Rituximab
49
Janus kinase inhibitors?
Tofacitinib Baricitinib Upadacitinib
50
Concern for antibody formation with janus kinas inhibitor?
NONE
51
Janus kinase inhibitors CYP substrate?
3A4
52
First line approach for DMARDs in low disease activity?
HCQ>SSZ>MTX>LEF
53
First line approach for DMARDs in moderate to high disease activity?
MTX strongly recommended over HCQ and SSZ, conditionally recommended over LEF
54
Drugs safe in pregnancy?
HCQ and SSZ good options Stop MTX 3 months prior to conception (male and female) all biologics except rituximab have favourable saftey profiles
55

PHAR 255 (14 decks)

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