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UNMC PA Pharmacology > Rheumatoid Arthritis and DMARDs > Flashcards

Rheumatoid Arthritis and DMARDs Flashcards

1
Q

What does DMARDs stand for?

A

Disease Modifying Anti-Rheumatic Drugs

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2
Q

Types of drugs used for RA

A

NSAIDs
Glucocorticoids
Traditional DMARDs
Biologics

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3
Q

Use of NSAIDs for RA

A

Provide initial relief of symptoms
NEVER used as monotherapy

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4
Q

Most common NSAIDs for RA

A

Naproxen
Indomethacin

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5
Q

Use of glucocorticoids for RA

A

Anti-inflammatory
Immunosuppressive
Rapid-acting bridge agent until DMARDs become effective

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6
Q

List of common DMARDs

A

Methotrexate
Hydroxychloroquine
Sulfasalazine
Leflunomide
Minocycline

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7
Q

First choice drug for RA

A

Methotrexate

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8
Q

Brand name of methotrexate

A

Rheumatrex

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9
Q

Route of administration of methotrexate

A

Oral or subcutaneous injection

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10
Q

How often is methotrexate administered?

A

Once a week

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11
Q

Methotrexate is derived from:

A

Folic acid

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12
Q

MOA for methotrexate

A

-Inhibits AICAR transformylase to increase adenosine (anti-inflammatory mediator)
-Inhibit purine and pyrimidine synthesis to inhibit inflammatory cell proliferation

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13
Q

Methotrexate side effects

A

Minor GI upset
Folate deficiency
Hepatotoxicity at high doses

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14
Q

Methotrexate is eliminated by:

A

Kidneys

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15
Q

Contraindications for methotrexate

A

Pregnancy (teratogenic)
Renal insufficiency
Liver failure

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16
Q

Hydroxychloroquine function

A

Anti-malarial and anti-inflammatory

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17
Q

Hydroxychloroquine MOA

A

Alters cell pH

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18
Q

Hydroxychloroquine’s half life is:

A

Very long (45 days)

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19
Q

Reservoir for hydroxychloroquine

A

Skin

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20
Q

Hydroxychloroquine side effects

A

GI problems
Skin problems
Retinal damage (accumulates in eyes)
Decreases blood glucose

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21
Q

Hydroxychloroquine users should have regular ____ exams.

A

Eye

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22
Q

Sulfasalazine function

A

Immunosuppressant

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23
Q

How is Sulfasalazine absorbed?

A

Metabolized into a salicylate and sulfapyridine in the gut prior to absorption

24
Q

Sulfasalazine side effects

A

GI distress
Skin reactions
Headache
Blood dyscrasias
Decreased folate absorption

25
Q

Sulfasalazine users should supplement what nutrient?

A

Folic acid

26
Q

Sulfasalazine contraindications

A

Sulfa allergy
Celebrex allergy

27
Q

Triple drug therapy for RA includes:

A

Methotrexate weekly
Hydroxychloroquine daily
Sulfasalazine daily
(Can add NSAID or prednisone)

28
Q

Common biologic drugs for RA

A

Etanercept
Infliximab
Adalimumab
Abatcept
Rituximab

29
Q

Leflunomide function

A

Immunosuppressant

30
Q

Leflunomide MOA

A

Inhibits pyrimidine synthesis and Inhibits tyrosine kinases to inhibit T-cell proliferation and B-cell antibody production

31
Q

Leflunomide has a very long half life (2.5 years) due to:

A

Repeated entero- hepatic recirculation

32
Q

Side effects of Leflunomide

A

Diarrhea
Alopecia
Inhibits CYP450s

33
Q

Leflunomide contraindications

A

Pregnancy (need a cholestyramine washout and 2 negative residual drug tests before stopping birth control)

34
Q

Minocycline function

A

Tetracycline antibiotic

35
Q

Minocycline MOA

A

Inhibits collagenase to decrease collagen degradation

36
Q

Side effects of minocycline

A

Dizziness
Hyperpigmentation (can appear blue)

37
Q

All biologic drugs are:

A

Immunosuppressants

38
Q

General biologic MOA

A

Target specific mediators early in inflammation cascade
Prevent auto-antibody production

39
Q

Common side effects of all biologics

A

Increased risk of infection
Blood dyscrasias
Increased risk of cancers
GI upset, headache, skin rash, cough

40
Q

Categories of biologics used for RA

A

Anti-TNF (tumor necrosis factor) drugs
T and B cell targeted agents

41
Q

Most common type of biologic

A

Anti-TNFs

42
Q

Etanercept is the ____ of the TNF receptor used as a drug

A

Soluble p75 subunit

43
Q

Etanercept MOA

A

Binds to and prevents TNF from binding to its intracellular receptor to inhibit all downstream steps of inflammation

44
Q

Etanercept administration

A

Injected subcutaneously weekly

45
Q

_____ has the shortest duration of all anti-TNF agents

A

Etanercept

46
Q

Etanercept side effects

A

Headaches
Allergic reactions
Progressive multi focal leukoencephalopathy
Lymphoma

47
Q

Infliximab is a ____ against TNF

A

Monoclonal antibody

48
Q

Infliximab MOA

A

Binds TNF

49
Q

Infliximab administration

A

Loading dose, with IV infusion every 4-8 weeks

50
Q

Infliximab side effect

A

Hypotension

51
Q

Adalimumab is a ____

A

Anti-TNF monoclonal antibody (fully human)

52
Q

Adalimumab side effect

A

Demyelination

53
Q

Abatacept MOA

A

CD28 receptor antagonist
T-Cell activation inhibitor

54
Q

When is abatacept used?

A

For moderate to severe RA not responsive to other DMARDs

55
Q

Abatacept side effects

A

Serious infections
Bronchospasm
Hypotension

56
Q

Abatacept contraindications

A

COPD
Don’t combine with other TNF inhibitors

57
Q

Rituximab MOA

A

Anti-CD20 monoclonal antibody
B-cell inhibitor

UNMC PA Pharmacology (23 decks)

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