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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
Q

Leflunomide monitoring

A

CVC, SCr, LFT

26
Q

Sulfasalazine MOA

A
  • cleaved to sulphapyridine and 5-ASA
  • inhibits IL-1
27
Q

Sulfasalazine dosing

A

500mg BID
1g BID to TID

28
Q

sulfasalazine AE

A
  • N/V/D, anorexia
  • rash/ urticaria/ photosensitivity
  • leukopenia, thrombocytopenia
  • anemia
  • potential allergic reaction
29
Q

sulfasalazine monitoring

A

CBC, SCr, LFT

30
Q

hydroxychloroquine MOA

A

modifies cytokine infiltration in joint

31
Q

hydroxychloroquine dosing

A

200mg PO BID

32
Q

hydroxychloroquine AE

A

advantages: no myelosuppression, hepatic, or renal toxicities
- retinal toxicity (cumulative dose >800g)
- N/V/D
- Skin pigment, rash, alopecia

33
Q

hydroxychloroquine monitoring

A

vision exam Q6-12 months

34
Q

biologic DMARDs: The neutralizers

A
  • Etanercept
  • Infliximab
  • Adalimumab
  • Golimumab
  • Certolizumab
35
Q

the neutralizers warning

A
  • infection risk
    do not use with IL-1 inhibitors
  • black box warnings: neurologic/ demyelinating disorders, malignancies, CHF, Heb B, no live vaccines
36
Q

The neutralizers AE

A
  • HA and rash
  • risk of infection
  • injection site rxn
    CHF exacerbation
    malignancy risk
    demyelinating disease
37
Q

Etanercept (Enbrel) MOA

A
  • tnf inhibitor
  • 500mg SC once weekly
38
Q

infliximab (Remicade) dosing

A

3mg/kg IV at 0,2&6 weeks, then every 8 weeks
max dose 10mg/kg
- use with methotrexate!!!

39
Q

adalimumab (Humira)

A
  • TNF-a inhibitor
40
Q

adalimumab indications

A
  • inadequate response to one or more DMARDs
  • alone or in combination
41
Q

adalimumab (Humira) dosing

A

40mg SC every other week
40mg weekly for improved response if no methotrexate

42
Q

Golimumab (Simponi) indications and MOA

A
  • moderate to severe RA, used in combo with MTX
  • TNF-a inhibitors
43
Q

Golimumab (Simponi) dosing

A
  • 50mg SC once monthly
44
Q

Certolizumab (Cimzia) MOA and indications

A

TNF-a inhibitor
- moderate to severe disease
- use alone or in combo with other DMARDS

45
Q

Certolizumab (Cimzia) dosing

A

400mg SQ at 0, 2, 4 weeks, then 200mg every 2 weeks or 400mg every 4 weeks.

46
Q

ANAKINRA (Kineret) indication

A
  • moderate to severe RA in patients who failed one or more DMARDS
  • Can use alone or in combo
  • IL-1 blocker
47
Q

Anakinra (Kineret) dosing

A

100mg SC daily; CrCl <30 mL/min, use 100mg SQ QOD.
- Do not use with TNF agents

48
Q

Anakinra AE

A
  • injection site reactions
  • HA, N/V, and flu-like symptoms
  • hypersensitivity to e.coli derived proteins
  • increased risk of infections
  • decreased neutrophils
49
Q

anakinra monitoring

A

neutrophil count

50
Q

Abatacept (Orencia)

A
  • moderate to severe RA
  • selective t-cell co-stimulation modulator
  • inhibits t-cell activation
51
Q

Abatacept dosing

A

weight-based dosing
<60kg: 500mg IV over 30 mins
60-100kg: 750mg IV over 30 minutes
>100kg: 1g IV over 30 mins

52
Q

Abatacept warnings

A

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
Q

IL-6 Receptor inhibitors

A

tocilizumab and sarilumab

54
Q

tocilizumab and sarilumab indication

A
  • moderate to severe RA; inadequate response to one or more DMARDS
  • use alone or in combination with MTX or another DMARD
55
Q

tocilizumab and sarilumab dosing

A

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
Q

IL-6 Inhibitor Warnings

A
  • infections
  • liver toxicity, thrombocytopenia, neutropenia
57
Q

IL-6 inhibitor monitoring

A

neutrophil, platelet, LFTs, lipid profile

58
Q

rituximab MOA and indication

A

moderate to severe RA, inadequate response to TNF antagonists
- use in combination with MTX
Binds to CD20
CBC Scr

PHRM 864 (9 decks)

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