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Muscoskeletal > Rheumatoid Arthritis Day 2 > Flashcards

Rheumatoid Arthritis Day 2 Flashcards

1
Q

When do you initiate DMARDs?

A

within 3 months of diagnosis and the benifitis may take weeks to months to see benefit

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2
Q

What do DMARDs do?

A

reduce disease activity and preserve/ improve function

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3
Q

What are the 4 DMARDs?

A

hydrochloroquine, sulfasalazine, methotrexate, leflunomide

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4
Q

hydrochloroquine MOA?

A

inhibits APC action and T cell signaling. It also reduces IL- 1,2,6 and TNF- alpha

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5
Q

hydrochloroquine Dosing?

A

200-300 mg BID initial then 200 mg a day or BID

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6
Q

hydrochloroquine onset?

A

6 weeks to 6 months

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7
Q

hydrochloroquine adverse effects?

A

macular damage, rash, diarrhea

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8
Q

hydrochloroquine monitoring?

A

yearly eye exam, Amsler every 2 weeks at home

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9
Q

when do you use caution with hydrochloroquine?

A

significant visual impairment and hepatic and renal impairment

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10
Q

hydrochloroquine place in therapy?

A

elder, milder progresstion, improves symptoms and function but no radiographical data

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11
Q

Sulfasalazine MOA?

A

modualtes mediators of inflammatory response and inhibits TNF- alpha

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12
Q

Sulfasalazine dose?

A

500 mg to start then increase to 1000 mg BID

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13
Q

Sulfasalazine onset?

A

1-2 months

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14
Q

Sulfasalazine adverse effects?

A

myelosupression and rash

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15
Q

Sulfasalazine monitoring?

A

CBC every 1-2 months and LFTs

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16
Q

when is Sulfasalazine contraindicated?

A

sulfa allergy, kidney/hepatic impairment, glucose-6 phosphosphate dehydrogenase deficiency

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17
Q

Methotrexate MOA?

A

it is unknown in RA but it inhibits the cytokine production and purine biosynthesis

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18
Q

Methotrexate dosing?

A

7.5 mg a week and pulse dosing is 2.5 mg BID for only 3 days a week. Take with 1 mg folic acid a day

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19
Q

Methotrexate onset?

A

2 weeks to 2 months

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20
Q

Methotrexate adverse effects?

A

hepatic fibrosis, cirrhosis, stomatitis, reddening of skin, N/V/D, renal failure, leucopenia and thrombocytopenia

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21
Q

Methotrexate monitoring?

A

LFTs, CBC, SCr, Hep B&C, for baseline and during CBC and LFT every 1-2 months

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22
Q

when is Methotrexate contraindicated?

A

Pregnancy Category X, Chronic Liver Disease, immunosupression, and pre-existing blood dyscrasias

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23
Q

Leflunomide MOA?

A

inhibits pyrimidine synthesis. it prevents proliferation of lymphocytes

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24
Q

Leflunomide dosing?

A

loading is 100 mg/day for 3 days then 20 mg/day

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25
Q

Leflunomide onset?

A

1-3 months

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26
Q

Leflunomide adverse effects?

A

elevated LFTs, N/V/D, adominal pain, alopecia

27
Q

Leflunomide monitoring?

A

LFTs and CBC at baseline then monthy til stable then every 2 months

28
Q

What are the contraindications of Leflunomide?

A

Pregnancy Category X and pre-existing liver disease

29
Q

What do the Biologic agents do?

A

leads to significant reduction in the development in the progression and development of joint erosion. It is for moderate to severe RA. It is best with MTX then alone

30
Q

What drugs bind to Tumor Necrosis Factor and blocks its interaction with cell surface receptors?

A

Entanercept, Infiximab, Adalimumab, Golimumab, Certolizumab, Tofactitinib

31
Q

What is the dosing of Entanercept?

A

50 mg SUBQ weekly or 25 mg twice weekly

32
Q

What is the dosing of Infiximab?

A

3-10 mg/kg IV q4-8 wks

33
Q

What is the dosing of Adalimumab?

A

40 mg SUBQ q2weeks

34
Q

What is the dosing of Golimumab?

A

50 mg SUBQ qmonthly or 2mg/kg IV q8weeks

35
Q

What is the dosing of Certolizumab?

A

200mg SUBQ every other week

36
Q

What is the dosing of Tofactitinib?

A

5mg PO BID

37
Q

What is the onset of Tumor Necrosis Factor Antagonists?

A

2-3 weeks

38
Q

What are the adverse effects of Tumor Necrosis Factor Antagonists?

A

infection (TB, Hep B and C), malignancy (lymphoma), injection/infusion sire reaction, Demyeliminating syndromes (exacerbation of multiple sclerosis), HF

39
Q

What is the MOA of Anakinra?

A

blocks the effects of IL-1 thereby decreasing inflammation, aids in cartilage protection and decreases bone reabsorption

40
Q

What is the onset of Anakinra?

A

days- months

41
Q

What is the dose of Anakinra?

A

100 mg SUBQ daily

42
Q

What are the adverse effects of Anakinra?

A

infection site reaction and infection

43
Q

What do you monitor with Anakinra?

A

Baseline TB skin test, CBC base line the monthly for 3 months then every 3 months, signs of infections continuously

44
Q

what are the contraindications of Anakinra?

A

uncontrolled CHF

45
Q

What is the MOA of Abatacept?

A

inhibits T cell activation by blocking interaction between APCs and T- cells

46
Q

What is the dosing of Abatacept?

A

less than 60 kg- 500 mg IV q4wk
60-100- 750 mg IV q4wk
100 kg 1000 mg IV q4wk
125 mg SUBQ weekly

47
Q

What is the onset of Abatacept?

A

1-3 months

48
Q

What is the adverse effects of Abatacept?

A

nausea, headache, infection, infusion reaction

49
Q

what do you monitor with Abatacept?

A

signs of infection

50
Q

What is the MOA of Rituximab?

A

monoclonal antibody against B- lymphocytes

51
Q

What is the dosing of Rituximab?

A

1000 mg IV days 1 and 15 and repeat every 16- 24 weeks

52
Q

When is Rituximab used?

A

last line

53
Q

What is the onset of Rituximab?

A

rapid and sustained up to 6 months

54
Q

What is the adverse effects of Rituximab?

A

Nausea, fatigue, cytopenias

55
Q

What do you monitor for Rituximab?

A

CBC

56
Q

What is the MOA of Tocilizumab?

A

blocks IL-6 binding leading to a decrease in cytokine and acute phase reactant production

57
Q

What is the dosing of Tocilizumab?

A

4 mg/kg IV q4weeks

58
Q

What is the onset of Tocilizumab?

A

2 weeks - 1 month

59
Q

What is the adverse effects of Tocilizumab?

A

infection, injection site reaction

60
Q

What do you monitor in Tocilizumab?

A

AST/ALT, CBC with plt

61
Q

What therapies do you use in moderate to high disease activity?

A

Dual DMARD and Triple DMARD

62
Q

What are the Dual DMARD options?

A

Methotrexate+hydrochloroquine
Methotrexate + Lefunomide
Methotrexate + Sulfasalazine

63
Q

What is the triple DMARD therapy option?

A

Methotrexate + Sulfasalzine + Hydrochloroquine

64
Q

What immunizations do you administer in RA patients?

A

administer prior vaccines prior to immunosuppressive treatment when possible. Live vaccines should not be given in patients on biologic DMARDs. Inactivated vaccines are safe

Muscoskeletal (9 decks)

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