Rheumatoid Arthritis

Question 1

s/sx of RA

Answer 1

Autoimmue

Morning bilateral stiffness

Question 2

2 common non-biologic DMARDS?

Answer 2

Methotrexate and leflunomide

Question 3

Methotrexate

Brand
MOA
Dose
ADE
3 drugs to avoid
Reversal

Answer 3

Trexall (PO)
Oxtrexup, rasuvo ( SUBQ)

Antimetabolite, s-phase toxin, inhibits DHFR, inhibits pyrimidine synthesis

7.5mg/ WEEK single dose or 2.5mg Q12H x 4 doses with MAX 20mg/ week

• oral ulcers, heaptotox, renal damage, pulmonary fibrosis, pneumonitis, myelosuppression, alopecia/skin rash

Bactrim, PPI, keppra

Leucovorin

Question 4

Leflunomide

Brand
MOA
Dose
ADE
Washout - when and what to give

Answer 4

Arava

Purimidine inhibitor

LD - 100mg QD x 3 days
MD - 10-20mg QD

Nausea, alopecia, increase LFT

Must have washout if switching to DMAR, hepatox, or pregnant

Can give cholestyramine 6mg TID x 11d or activated charcoal 50g Q12H x 11 days

Question 5

Azathioprine

Brand
MOA
Dosing
Drug interactions

Answer 5

Imuran

Purine analog converts to 6MP

100mg QD

Allopurinol / febuxostat ( can increase imuran concentration) because 6MP needs XO to inactivate

Question 6

D-penicillamine

Brand
MOA
Dosing
Contraindication

Answer 6

Cuprimine

Lowers copper and mercury and lowers IgM rheumatoid factor

Start low up to 1000mg QD on EMPTY STOMACH

D/C if myasthenia gravis

Question 7

Hydroxychloroquine

Brand
Indication
Dose
ADE

Answer 7

Plaquenil

Antimalarial and early RA

200-400mg PO QD with food or milk and stop if no response in 6 months

Myopathy, retinopathy, neurologic, tinnitus

Question 8

Sulfasalazine

Brand
Indication
Dosing
ADE

Answer 8

Azulfidine

RA and ulcerative colitis

500mg qd-bid

Fertility impairment, rash, myelosuppression, orange/yellow discoloration

Question 9

Tofactinib

Brand
ADE
Don’t combine with __ and ___

Answer 9

Xeljanx

Infection, TB

Azathioprine and cyclosporine

Question 10

Anakinra

Brand
MOA
Dosing
ADE

Answer 10

Kineret

IL1R antagonist

100mg SUBQ QD

NeutropeniaE

Question 11

Etanercept

Brand
MOA
Dosing

Answer 11

Enbrek, erelzi

TNFR blocker

50mg SUBQ Weekly

Question 12

Infliximab

Brand
Dose
Contraindication
ADE

Answer 12

Remicade, inflectra

2mg/kg IV 0,2,6 weeks then 3mg/kg IV every 8 weeks

TB and live vaccines

worsen HF, malignancies, hepatic reactions

Question 13

Adalimumab

Brand
MOA
Dosing
ADE

Answer 13

Humira, amjevita

TNF-a blocker

40mg SUBQ every other week if on MTX or every week if not on MTX

Infection, HF, lupus-like syndrome

Question 14

Golimumab

Brand
MOA
BBW
Dose

Answer 14

Simpone SUBQ or IV

TNF-a inhibitor

Risk of TB invasive fungal infections

50mg SUBq monthly

Question 15

Certolizumab

Brand
MOA
Dose

Answer 15

Cimzia

TNF inhibitor

400mg SUBQ weekly

Question 16

Abtacept

Brand
MIA
Dosing

Answer 16

Orencia IV/SUBQ

T cell costimulation moduator

IV is monthly
SUBQ is weekly

Question 17

Rituximab

Brand
MOA
Indication
Dosing

Answer 17

Rituxan

Deplete CD20 positive B cells

Refractory RA

1g IV with premedication of methylprednisone

TLS, infusion reactions, progressive multifocal leukoencephalopathy (PML)

Question 18

Tocilizumab

Brand
MOA
Dosing

Answer 18

Actemra

IL6 inhibitor

4-8mg/kg IV monthly
162mg SubQ weekly

Question 19

Sarilumab

Brand
MOA
Dose

Answer 19

Kevzara

IL6 Inhibitor

200mg SUBQ every 2 weeks

Question 20

Barcitinib

Brand
Dose

Answer 20

Olumiant

2mg PO QD

Question 21

Upadacitinib

Brand
Dose

Answer 21

Rinvoq

15mg PO QD