Rheumatoid Arthritis and DMARDS Flashcards
What is the meaning of the acronym DMARDS.
Disease modifying anti-rheumatic drugs
Indomethacin is a potent NSAID often used for RA. It is the prototype drug from _________ derivatives.
Acetic Acid
Which glucocorticoid is used commonly in combination with other agents to treat RA?
Prednisone
What is the most common DMARD used to treat RA in the early stages of the disease?
Methotrexate
Methotrexate mechanism of action?
Inhibits PURINE synthesis. Folic acid analong acts as anti-metabolite. Effectively inhibits multiple immune and inflammatory cells
Methotrexate (MTX) GI problems?
nausea, vomitting, cramps, anorexia “well tolerated”
MTX adverse side affects to what organ? 4 key points to remember?
Hepatoxicity in 40% of pts. 1) minor elevations in liver enzymes expected 2) monitor liver function 3) NO ethanol 4) never use MTX with pts with liver failure
MTX adverse rx other than liver toxicity?
May be teratogenic. Susceptibilty to upper respiratory, TB, fungal infections. Pneumonia, lymphoma, hepatic fibrosis.
The DMARD that may cause retinal damage due to accumulation in what tissue?
Hydroxychloroquine accumlates in melanin-containing tissue like the eye. Necessitates annual eye exams
What is the half life of Hydroxychloroquine and why is an anti-malarial used for RA?
45 days. Used for its anti-inflammatory properties which are idiopathic. Not a DMARD.
Hydroxychloroquine precautions
do not use with psoriasis or porphyria (enzyme disorder for porphyrins and heme production). Care with liver damaged, neurologic or hematologic disorders, alcoholism
Sulfasalazine is what type of drug? It is metabolized in the gut into two molecules:
immunosupressive. Salicylate and sulfapyridine
Common side effects of Sulfasalazine
GI distress, anorexia, diarrhea, headache, nausea, vomiting, uticaria, pruritis.
Sulfasalazine is poorly understood but inhibits
multiple immune cells and cytokines
Which drugs are used in the triple drug therapy, also known for its acronym?
Methotrexate, Sulfasalazine, Hydroxychloroquine (MSH therapy)
Describe MSH therapy
Start with M, then try S and H, try MSH, and may add Prednisone and or NSAIDS.
Major actions of Leflunomide (3)
Immunosuppressive action. 1) inhibitis PYRIMIDINE synthesis 2) antiproliferative for T-cells 3) reduces auto-antibody formation by B-cells
What drug should not be combined with MTX because of increased risk of liver damage?
Leflunomide
side effects of Leflunomide
Diarrhea, alopecia
Inhibits CYP p450’s (slows drug metabolism) carcinogenic, teratogenic
liver damage combined with MTX
Minocycline is a well-established tetracycline antibiotic that also inhibits
matrix metalloproteinases including collagenase which decreases collagen degradation.
A DMARD developed at UNMC with little apparent side effects that appears effective for mild arthritis
Minocycline
Biological Response Modifers are drugs which target
specific mediators of immunity. Not a broad immuno-toxic inhibitor as with MSH-LM
When are biological response modifers used
when MSH-LM fail
Common side effects to all immunosuppressive agents
Infection, blood dyscrasias, teratogenic, carinogenic, GI, headache, skin rash, cough.
most common Ca. with immunosuppressives
non-hodgkins lymphoma
3 anti-TNF drugs used to treat juvenile idiopathic arthitis, RA, crohn’s….
EIA: Etanercept, Infliximab, Adalimumab
-mab drugs
Monoclonal Antibody
T cell targeted drug
Abatacept
B cell targeted drug
Rituximab
