Rheumatoid Arthritis and DMARDS

Question 1

What is the meaning of the acronym DMARDS.

Answer 1

Disease modifying anti-rheumatic drugs

Question 2

Indomethacin is a potent NSAID often used for RA. It is the prototype drug from _________ derivatives.

Answer 2

Acetic Acid

Question 3

Which glucocorticoid is used commonly in combination with other agents to treat RA?

Answer 3

Prednisone

Question 4

What is the most common DMARD used to treat RA in the early stages of the disease?

Answer 4

Methotrexate

Question 5

Methotrexate mechanism of action?

Answer 5

Inhibits PURINE synthesis. Folic acid analong acts as anti-metabolite. Effectively inhibits multiple immune and inflammatory cells

Question 6

Methotrexate (MTX) GI problems?

Answer 6

nausea, vomitting, cramps, anorexia “well tolerated”

Question 7

MTX adverse side affects to what organ? 4 key points to remember?

Answer 7

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

Question 8

MTX adverse rx other than liver toxicity?

Answer 8

May be teratogenic. Susceptibilty to upper respiratory, TB, fungal infections. Pneumonia, lymphoma, hepatic fibrosis.

Question 9

The DMARD that may cause retinal damage due to accumulation in what tissue?

Answer 9

Hydroxychloroquine accumlates in melanin-containing tissue like the eye. Necessitates annual eye exams

Question 10

What is the half life of Hydroxychloroquine and why is an anti-malarial used for RA?

Answer 10

45 days. Used for its anti-inflammatory properties which are idiopathic. Not a DMARD.

Question 11

Hydroxychloroquine precautions

Answer 11

do not use with psoriasis or porphyria (enzyme disorder for porphyrins and heme production). Care with liver damaged, neurologic or hematologic disorders, alcoholism

Question 12

Sulfasalazine is what type of drug? It is metabolized in the gut into two molecules:

Answer 12

immunosupressive. Salicylate and sulfapyridine

Question 13

Common side effects of Sulfasalazine

Answer 13

GI distress, anorexia, diarrhea, headache, nausea, vomiting, uticaria, pruritis.

Question 14

Sulfasalazine is poorly understood but inhibits

Answer 14

multiple immune cells and cytokines

Question 15

Which drugs are used in the triple drug therapy, also known for its acronym?

Answer 15

Methotrexate, Sulfasalazine, Hydroxychloroquine (MSH therapy)

Question 16

Describe MSH therapy

Answer 16

Start with M, then try S and H, try MSH, and may add Prednisone and or NSAIDS.

Question 17

Major actions of Leflunomide (3)

Answer 17

Immunosuppressive action. 1) inhibitis PYRIMIDINE synthesis 2) antiproliferative for T-cells 3) reduces auto-antibody formation by B-cells

Question 18

What drug should not be combined with MTX because of increased risk of liver damage?

Answer 18

Leflunomide

Question 19

side effects of Leflunomide

Answer 19

Diarrhea, alopecia
Inhibits CYP p450’s (slows drug metabolism) carcinogenic, teratogenic
liver damage combined with MTX

Question 20

Minocycline is a well-established tetracycline antibiotic that also inhibits

Answer 20

matrix metalloproteinases including collagenase which decreases collagen degradation.

Question 21

A DMARD developed at UNMC with little apparent side effects that appears effective for mild arthritis

Answer 21

Minocycline

Question 22

Biological Response Modifers are drugs which target

Answer 22

specific mediators of immunity. Not a broad immuno-toxic inhibitor as with MSH-LM

Question 23

When are biological response modifers used

Answer 23

when MSH-LM fail

Question 24

Common side effects to all immunosuppressive agents

Answer 24

Infection, blood dyscrasias, teratogenic, carinogenic, GI, headache, skin rash, cough.

Question 25

most common Ca. with immunosuppressives

Answer 25

non-hodgkins lymphoma

Question 26

3 anti-TNF drugs used to treat juvenile idiopathic arthitis, RA, crohn’s….

Answer 26

EIA: Etanercept, Infliximab, Adalimumab

Question 27

-mab drugs

Answer 27

Monoclonal Antibody

Question 28

T cell targeted drug

Answer 28

Abatacept

Question 29

B cell targeted drug

Answer 29

Rituximab