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Pharm > Rheumatoid Arthritis Drugs > Flashcards

Rheumatoid Arthritis Drugs Flashcards

1
Q

Treatments for Mild Rheumatoid Arthritis

A

NSAIDs

Plaquenil

Sulfasalazine

Minocycline

Methotrexate

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2
Q

Treatment for moderately severe Rheumatoid Arthritis

A

Agents used in Mild Rheumatoid Arthritis

Methotrexate

Anti-TNF-a agents

Anti-IL-1 agents

Leflunomide

Azathioprine

Gold

Cyclosporine

(All single or in combination)

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3
Q

Treatment for Severe or Refractory Rheumatoid Arthritis

A

Combination DMARDS

oral steroids

cytotoxan

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4
Q

MOA of NSAIDs

A

inhibits COX, thus preventing synthesis of prostaglandins

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5
Q

Side effects of NSAIDS

A

GI upset

peptic ulcers

kidney damage

diversion of arachidonic acid to leukotrienes

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6
Q

MOA of glucocorticoids

A
  • Inhibits Phospholipase A2 to inhibit the synthesis of prostaglandins and leukotrienes
  • Inhibits NF-kB to downregulate transcription and proliferation of lymphocytes
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7
Q

Side effects of glucocorticoids

A

Hyperglycemia

weight gain

HTN

corticosteroid-induced myopathy

immunosuppression

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8
Q

MOA of Methotrexate

A

inhibits DHF reductase, which prevents DNA synthesis

  • No synthesis = No proliferation
  • No proliferation= decreased cytokines
  • Decreased cytokines= decreased the immune response
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9
Q

Methotrexate rescue

A

Leucovorin

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10
Q

Methotrexate side effects

A

Leukopenia

Anemia

stomatitis

GI ulcers

Alopecia

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11
Q

MOA of Sulfasalazine

A

inhibits prostaglandin synthesis and prevents migration of inflammatory cells

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12
Q

Side effects of Sulfasalazine

A

Hemolytic anemia in G6PD

Methemoglobinemia

Sulfa allergy

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13
Q

MOA of Leflunomide

A

inhibits dihydropterate dehydrogenase to prevent DNA replication

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14
Q

Side effects of Leflunomide

A

Teratogenic

Rash

Alopecia

Increased LFTs

Diarrhea

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15
Q

What DMARD can be used as an alternative or in combination with Methotrexate?

What happens

A

Leflunomide

increased hepatotoxicity when used with Methotrexate

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16
Q

MOA of Hydroxychloroquine

A

inhibits production of rheumatoid factor and acute phase reactants

Stabilizes lysosomal membranes

inhibits collagenase

17
Q

Side Effects of Hydroxychloroquine

A

Muscle Disorder

Abnormal vision

Hypoglycemia

Agranulocytosis

Torsades de pointes

Hemolytic anemia in G6PD

Angioedema

Thrombocytopenia

18
Q

Which DMARD is safe to use during pregnancy

A

Hydroxychloroquine

19
Q

MOA of Azathioprine

A

Guanine analog that inhibits DNA synthesis, thus decreasing lymphocyte function, Ig production and IL-2 secretion

20
Q
A
21
Q

Side effects of Azathioprine

A

Bone marrow suppression

GI disturbance

Hepatotoxicity

increased rik of infection

22
Q

MOA of Cyclosporine

A

Inhibits Calcineurin to decrease IL-2 production

  • inhibits macrophage/ T cell interaction and T cell responsiveness
23
Q

Cyclosporine Side Effects

A

Myelosuppression

Gingival Hyperplasia

Nephrotoxic

HLD

Hirsutism

  • High doses could be cardiotoxic
24
Q

MOA of cyclophosphamide

A

Nitrogen mustard prodrug that alkylates DNA via cross-linking, which prevents replication

  • Suppresses lymphocyte function
25
Q

Side effects of Cyclophosphamide

A

hemorrhagic cystitis

myelosuppression

pulmonary fibrosis

Alopecia

N/V

26
Q

Cyclophosphamide rescue

A

MESNA

27
Q

MOA of Mycophenolate Mofetil

A

inhibits IMP dehydrogenase, inhibiting DNA/ RNA synthesis

  • inhibits E-selectin, P-selectin, and intracellular adhesion
  • interferes with leukocyte adhesion to endothelial cells
28
Q

Side Effects of Mycophenolate Mofetil

A

hepatotoxic

nephrotoxic

Gi disturbance

leukopenia

thrombocytopenia

29
Q

Abatacept

  • Classification
  • MOA
  • Side Effects
A

Class: Biologic DMARD

MOA: fusion protein composed of the Fc region of the immunoglobulin IgG1 fused to the extracellular domain of CTLA-4, this inhibiting T cell activation

Side Effects: URI, Infusion-related hypersensitivity

30
Q

Anakinra

  • Class
  • MOA
  • Side Effects
A

Class: Biologic DMARD

MOA: Recombinant IL-1Ra that binds to and blocks IL-1

Side Effects: serious infections

31
Q

Rituximab

Class

MAO

Side Effects

A

Class: Biologic DMARD

MOA: anti-CD-20 analog that causes cell lysis

Side Effects: chills, fever, HA, nausea, myelosuppression, infusion-related rash

32
Q

Tocilizumab

Class

MOA

Side effects

A

Class: Biologic DMARD

MOA: Anti IL-6 recombinant cytokine

Side Effects: serious infection

Be sure to screen for TB

33
Q

Adalimumab

Class

MOA

Side Effects

A

Class: Biologic DMARD: TNF-a inhibitor

Class: IgG1 ant-monoclonal antibody that prevents interactionwithp55 and p75 cell receptors

Side Effects: Myelosuppression

Infection

  • Be sure to screen for TB
34
Q

Etanercept

Class

MOA

Side Effects

A

Class Biological DMARD- TNF-a inhibitor

MOA: Recombinant fusion protein consisting of 2 soluble TNF p75 receptor moieties linked to the Fc portion of IGg

Side Effects: Myelosuppression and Risk of infection

Be sure to screen for TB

35
Q

Infliximab

Class

MOA

Side Effects

A

Class: Biologic DMARD- TNF-a inhibitor

MOA: chimeric IgG1 monoclonal antibody that binds with high affinity to soluble and membrane-bound TNF

Side Effects: Myelosuppression and infection

Be sure to screen for TB

Pharm (10 decks)

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