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PHRM 864 > Rheumatoid Arthritis > Flashcards

Rheumatoid Arthritis Flashcards

1
Q

Pathogenesis of RA

A

inflamed synovial membrane

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2
Q

Diagnostic Criteria

A

Joint involvement, serology, symptom duration, acute phase reactants,

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3
Q

Most commonly affected joints:

A

elbows, hands, shoulders, wrists, hips, knees, feet, ankles

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4
Q

common locations for nodules

A

hands, elbows, forearms

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5
Q

ESR

A

Normal 0-20 (RA >20)

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6
Q

CRP

A

Normal 0-0.5 mg/dL (RA>0.5mg/dL)

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7
Q

Rheumatoid Factor

A

antibody for IgM (60-70% of patients are RF+)

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8
Q

Other indicators/ biomarkers for RA

A

Anti-CCP/ACPA, ANA, Joint Aspiration

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9
Q

Pharm Treatment of RA

A

NSAIDS, corticosteroids, DMARDs, Anti-TNF biologic agents, Non-TNF biologic agents

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10
Q

Role of NSAIDS in OA

A

reduce pain, swelling, and stiffness
use in combo with DMARDs

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11
Q

role of corticosteroids in OA

A

anti-inflammatory and immunosuppressive; NOT monotherapy
use in combo with DMARD

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12
Q

corticosteroid dosing

A

low dose <10mg/day prednisone
high dose >10mg/day up to 60mg/day
should be short-term <3 months

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13
Q

Intraarticular steroid injection dosing

A

do not use > than every 2-3 months; use 10-25mg/injection of HC per joint

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14
Q

Long term steroid AE

A

aseptic necrosis, cataracts, obesity, growth failure, osteoporosis

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15
Q

steroids monitoring parameters

A

baseline: BP & BG
maintenance: BP & BG (Q3-6 months)

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16
Q

Conventional synthetic DMARDS

A
  • methotrexate (MTX)
  • Sulfasalazine (SSZ)
  • Hydroxychloroquine (HCQ)
  • Leflunomide
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17
Q

Methotrexate in RA

A
  • First line
  • MOA: inhibit dihydrofolic acid reductase
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18
Q

Methotrexate dosing

A

7.5mg per week IM or PO (up to 15-20 mg)
onset 1-2 months

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19
Q

Methotrexate AE

A
  • bone marrow suppression*
  • N/V/D*
  • Stomatitis/mucositis*
  • Cirrhosis/hepatitis/fibrosis
  • pneumonitis
  • fibrosis
  • rash/urticaria/alopecia
  • teratogenic
    prescribed folic acid 1mg PO daily
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20
Q

Methotrexate contraindications

A
  • pregnancy
  • Chronic liver disease
  • immunodeficiency
  • pre-existing blood dyscrasias
  • EtOH Abuse
  • Immunodeficiency
  • Pleural effusions
  • Leukopenia/thrombocytopenia
  • CrCl <40 mL/min
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21
Q

Leflunomide MOA

A
  • prodrug
  • Inhibits de novo biosynthesis of pyrimidines
  • half life of 16 days
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22
Q

Leflunomide Dosing for OA

A

100mg PO daily x3 days, then 20mg PO daily

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23
Q

Leflunomide AE

A
  • diarrhea
  • rash
  • alopecia
  • increased LFTs
  • Teratogenicity
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24
Q

methotrexate monitoring

A

CXR, CBC, SCr,, LFTs, Albumin

25
Leflunomide monitoring
CVC, SCr, LFT
26
Sulfasalazine MOA
- cleaved to sulphapyridine and 5-ASA - inhibits IL-1
27
Sulfasalazine dosing
500mg BID 1g BID to TID
28
sulfasalazine AE
- N/V/D, anorexia - rash/ urticaria/ photosensitivity - leukopenia, thrombocytopenia - anemia - potential allergic reaction
29
sulfasalazine monitoring
CBC, SCr, LFT
30
hydroxychloroquine MOA
modifies cytokine infiltration in joint
31
hydroxychloroquine dosing
200mg PO BID
32
hydroxychloroquine AE
advantages: no myelosuppression, hepatic, or renal toxicities - retinal toxicity (cumulative dose >800g) - N/V/D - Skin pigment, rash, alopecia
33
hydroxychloroquine monitoring
vision exam Q6-12 months
34
biologic DMARDs: The neutralizers
- Etanercept - Infliximab - Adalimumab - Golimumab - Certolizumab
35
the neutralizers warning
- infection risk do not use with IL-1 inhibitors - black box warnings: neurologic/ demyelinating disorders, malignancies, CHF, Heb B, no live vaccines
36
The neutralizers AE
- HA and rash - risk of infection - injection site rxn CHF exacerbation malignancy risk demyelinating disease
37
Etanercept (Enbrel) MOA
- tnf inhibitor - 500mg SC once weekly
38
infliximab (Remicade) dosing
3mg/kg IV at 0,2&6 weeks, then every 8 weeks max dose 10mg/kg - use with methotrexate!!!
39
adalimumab (Humira)
- TNF-a inhibitor
40
adalimumab indications
- inadequate response to one or more DMARDs - alone or in combination
41
adalimumab (Humira) dosing
40mg SC every other week 40mg weekly for improved response if no methotrexate
42
Golimumab (Simponi) indications and MOA
- moderate to severe RA, used in combo with MTX - TNF-a inhibitors
43
Golimumab (Simponi) dosing
- 50mg SC once monthly
44
Certolizumab (Cimzia) MOA and indications
TNF-a inhibitor - moderate to severe disease - use alone or in combo with other DMARDS
45
Certolizumab (Cimzia) dosing
400mg SQ at 0, 2, 4 weeks, then 200mg every 2 weeks or 400mg every 4 weeks.
46
ANAKINRA (Kineret) indication
- moderate to severe RA in patients who failed one or more DMARDS - Can use alone or in combo - IL-1 blocker
47
Anakinra (Kineret) dosing
100mg SC daily; CrCl <30 mL/min, use 100mg SQ QOD. - Do not use with TNF agents
48
Anakinra AE
- injection site reactions - HA, N/V, and flu-like symptoms - hypersensitivity to e.coli derived proteins - increased risk of infections - decreased neutrophils
49
anakinra monitoring
neutrophil count
50
Abatacept (Orencia)
- moderate to severe RA - selective t-cell co-stimulation modulator - inhibits t-cell activation
51
Abatacept dosing
weight-based dosing <60kg: 500mg IV over 30 mins 60-100kg: 750mg IV over 30 minutes >100kg: 1g IV over 30 mins
52
Abatacept warnings
Do not use with TNF antagonists or IL-1 antagonist - no live vaccines - caution in COPD AE: - HA, N/V - URT infection - nasopharyngitis - infusion reactions - serious infection - malignancy
53
IL-6 Receptor inhibitors
tocilizumab and sarilumab
54
tocilizumab and sarilumab indication
- moderate to severe RA; inadequate response to one or more DMARDS - use alone or in combination with MTX or another DMARD
55
tocilizumab and sarilumab dosing
tocilizumab: 4mg/kg IV over one hour - can increase to 8mg/kg - max dose 800mg sarilumab: 200mg SQ every 2 weeks may reduce to 150mg
56
IL-6 Inhibitor Warnings
- infections - liver toxicity, thrombocytopenia, neutropenia
57
IL-6 inhibitor monitoring
neutrophil, platelet, LFTs, lipid profile
58
rituximab MOA and indication
moderate to severe RA, inadequate response to TNF antagonists - use in combination with MTX Binds to CD20 CBC Scr

PHRM 864 (13 decks)

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