Rheumatoid Arthritis Drugs Flashcards
Treatments for Mild Rheumatoid Arthritis
NSAIDs
Plaquenil
Sulfasalazine
Minocycline
Methotrexate
Treatment for moderately severe Rheumatoid Arthritis
Agents used in Mild Rheumatoid Arthritis
Methotrexate
Anti-TNF-a agents
Anti-IL-1 agents
Leflunomide
Azathioprine
Gold
Cyclosporine
(All single or in combination)
Treatment for Severe or Refractory Rheumatoid Arthritis
Combination DMARDS
oral steroids
cytotoxan
MOA of NSAIDs
inhibits COX, thus preventing synthesis of prostaglandins
Side effects of NSAIDS
GI upset
peptic ulcers
kidney damage
diversion of arachidonic acid to leukotrienes
MOA of glucocorticoids
- Inhibits Phospholipase A2 to inhibit the synthesis of prostaglandins and leukotrienes
- Inhibits NF-kB to downregulate transcription and proliferation of lymphocytes
Side effects of glucocorticoids
Hyperglycemia
weight gain
HTN
corticosteroid-induced myopathy
immunosuppression
MOA of Methotrexate
inhibits DHF reductase, which prevents DNA synthesis
- No synthesis = No proliferation
- No proliferation= decreased cytokines
- Decreased cytokines= decreased the immune response
Methotrexate rescue
Leucovorin
Methotrexate side effects
Leukopenia
Anemia
stomatitis
GI ulcers
Alopecia
MOA of Sulfasalazine
inhibits prostaglandin synthesis and prevents migration of inflammatory cells
Side effects of Sulfasalazine
Hemolytic anemia in G6PD
Methemoglobinemia
Sulfa allergy
MOA of Leflunomide
inhibits dihydropterate dehydrogenase to prevent DNA replication
Side effects of Leflunomide
Teratogenic
Rash
Alopecia
Increased LFTs
Diarrhea
What DMARD can be used as an alternative or in combination with Methotrexate?
What happens
Leflunomide
increased hepatotoxicity when used with Methotrexate
MOA of Hydroxychloroquine
inhibits production of rheumatoid factor and acute phase reactants
Stabilizes lysosomal membranes
inhibits collagenase
Side Effects of Hydroxychloroquine
Muscle Disorder
Abnormal vision
Hypoglycemia
Agranulocytosis
Torsades de pointes
Hemolytic anemia in G6PD
Angioedema
Thrombocytopenia
Which DMARD is safe to use during pregnancy
Hydroxychloroquine
MOA of Azathioprine
Guanine analog that inhibits DNA synthesis, thus decreasing lymphocyte function, Ig production and IL-2 secretion
Side effects of Azathioprine
Bone marrow suppression
GI disturbance
Hepatotoxicity
increased rik of infection
MOA of Cyclosporine
Inhibits Calcineurin to decrease IL-2 production
- inhibits macrophage/ T cell interaction and T cell responsiveness
Cyclosporine Side Effects
Myelosuppression
Gingival Hyperplasia
Nephrotoxic
HLD
Hirsutism
- High doses could be cardiotoxic
MOA of cyclophosphamide
Nitrogen mustard prodrug that alkylates DNA via cross-linking, which prevents replication
- Suppresses lymphocyte function
Side effects of Cyclophosphamide
hemorrhagic cystitis
myelosuppression
pulmonary fibrosis
Alopecia
N/V
Cyclophosphamide rescue
MESNA
MOA of Mycophenolate Mofetil
inhibits IMP dehydrogenase, inhibiting DNA/ RNA synthesis
- inhibits E-selectin, P-selectin, and intracellular adhesion
- interferes with leukocyte adhesion to endothelial cells
Side Effects of Mycophenolate Mofetil
hepatotoxic
nephrotoxic
Gi disturbance
leukopenia
thrombocytopenia
Abatacept
- Classification
- MOA
- Side Effects
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
Anakinra
- Class
- MOA
- Side Effects
Class: Biologic DMARD
MOA: Recombinant IL-1Ra that binds to and blocks IL-1
Side Effects: serious infections
Rituximab
Class
MAO
Side Effects
Class: Biologic DMARD
MOA: anti-CD-20 analog that causes cell lysis
Side Effects: chills, fever, HA, nausea, myelosuppression, infusion-related rash
Tocilizumab
Class
MOA
Side effects
Class: Biologic DMARD
MOA: Anti IL-6 recombinant cytokine
Side Effects: serious infection
Be sure to screen for TB
Adalimumab
Class
MOA
Side Effects
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
Etanercept
Class
MOA
Side Effects
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
Infliximab
Class
MOA
Side Effects
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
