Rheumatoid Arthritis and DMARDs

Question 1

What does DMARDs stand for?

Answer 1

Disease Modifying Anti-Rheumatic Drugs

Question 2

Types of drugs used for RA

Answer 2

NSAIDs
Glucocorticoids
Traditional DMARDs
Biologics

Question 3

Use of NSAIDs for RA

Answer 3

Provide initial relief of symptoms
NEVER used as monotherapy

Question 4

Most common NSAIDs for RA

Answer 4

Naproxen
Indomethacin

Question 5

Use of glucocorticoids for RA

Answer 5

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

Question 6

List of common DMARDs

Answer 6

Methotrexate
Hydroxychloroquine
Sulfasalazine
Leflunomide
Minocycline

Question 7

First choice drug for RA

Answer 7

Methotrexate

Question 8

Brand name of methotrexate

Answer 8

Rheumatrex

Question 9

Route of administration of methotrexate

Answer 9

Oral or subcutaneous injection

Question 10

How often is methotrexate administered?

Answer 10

Once a week

Question 11

Methotrexate is derived from:

Answer 11

Folic acid

Question 12

MOA for methotrexate

Answer 12

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

Question 13

Methotrexate side effects

Answer 13

Minor GI upset
Folate deficiency
Hepatotoxicity at high doses

Question 14

Methotrexate is eliminated by:

Answer 14

Kidneys

Question 15

Contraindications for methotrexate

Answer 15

Pregnancy (teratogenic)
Renal insufficiency
Liver failure

Question 16

Hydroxychloroquine function

Answer 16

Anti-malarial and anti-inflammatory

Question 17

Hydroxychloroquine MOA

Answer 17

Alters cell pH

Question 18

Hydroxychloroquine’s half life is:

Answer 18

Very long (45 days)

Question 19

Reservoir for hydroxychloroquine

Answer 19

Skin

Question 20

Hydroxychloroquine side effects

Answer 20

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

Question 21

Hydroxychloroquine users should have regular ____ exams.

Answer 21

Eye

Question 22

Sulfasalazine function

Answer 22

Immunosuppressant

Question 23

How is Sulfasalazine absorbed?

Answer 23

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

Question 24

Sulfasalazine side effects

Answer 24

GI distress
Skin reactions
Headache
Blood dyscrasias
Decreased folate absorption

Question 25

Sulfasalazine users should supplement what nutrient?

Answer 25

Folic acid

Question 26

Sulfasalazine contraindications

Answer 26

Sulfa allergy Celebrex allergy

Question 27

Triple drug therapy for RA includes:

Answer 27

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

Question 28

Common biologic drugs for RA

Answer 28

Etanercept Infliximab Adalimumab Abatcept Rituximab

Question 29

Leflunomide function

Answer 29

Immunosuppressant

Question 30

Leflunomide MOA

Answer 30

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

Question 31

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

Answer 31

Repeated entero- hepatic recirculation

Question 32

Side effects of Leflunomide

Answer 32

Diarrhea Alopecia Inhibits CYP450s

Question 33

Leflunomide contraindications

Answer 33

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

Question 34

Minocycline function

Answer 34

Tetracycline antibiotic

Question 35

Minocycline MOA

Answer 35

Inhibits collagenase to decrease collagen degradation

Question 36

Side effects of minocycline

Answer 36

Dizziness Hyperpigmentation (can appear blue)

Question 37

All biologic drugs are:

Answer 37

Immunosuppressants

Question 38

General biologic MOA

Answer 38

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

Question 39

Common side effects of all biologics

Answer 39

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

Question 40

Categories of biologics used for RA

Answer 40

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

Question 41

Most common type of biologic

Answer 41

Anti-TNFs

Question 42

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

Answer 42

Soluble p75 subunit

Question 43

Etanercept MOA

Answer 43

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

Question 44

Etanercept administration

Answer 44

Injected subcutaneously weekly

Question 45

_____ has the shortest duration of all anti-TNF agents

Answer 45

Etanercept

Question 46

Etanercept side effects

Answer 46

Headaches Allergic reactions Progressive multi focal leukoencephalopathy Lymphoma

Question 47

Infliximab is a ____ against TNF

Answer 47

Monoclonal antibody

Question 48

Infliximab MOA

Answer 48

Binds TNF

Question 49

Infliximab administration

Answer 49

Loading dose, with IV infusion every 4-8 weeks

Question 50

Infliximab side effect

Answer 50

Hypotension

Question 51

Adalimumab is a ____

Answer 51

Anti-TNF monoclonal antibody (fully human)

Question 52

Adalimumab side effect

Answer 52

Demyelination

Question 53

Abatacept MOA

Answer 53

CD28 receptor antagonist T-Cell activation inhibitor

Question 54

When is abatacept used?

Answer 54

For moderate to severe RA not responsive to other DMARDs

Question 55

Abatacept side effects

Answer 55

Serious infections Bronchospasm Hypotension

Question 56

Abatacept contraindications

Answer 56

COPD Don’t combine with other TNF inhibitors

Question 57

Rituximab MOA

Answer 57

Anti-CD20 monoclonal antibody B-cell inhibitor