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Pharmacology II > Rheumatoid Arthritis (exam 1) > Flashcards

Rheumatoid Arthritis (exam 1) Flashcards

1
Q

rheumatoid arthritis

A

chronic inflammation of the synovial tissue

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2
Q

pannus

A

invades the cartilage and bone surface
produces erosion of bone and cartilage

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3
Q

who is more likely to have arthritis?

A

women

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4
Q

RA symtoms can be associated with many diseases including

A

fibromyalgia
SLE
gouty arthritis
psoriatic arthritis

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5
Q

osteoarthritis pathology

A

thinned cartilage leads to bone ends rubbing together

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6
Q

rheumatoid arthritis pathology

A

bone erosion and swollen inflamed synovial membrane

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7
Q

in 75% of cases, T cell antigen motif ______________ signaling pathway involved in T cell ______________

A

Q(K/R)RA IL2

activation and proliferation

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8
Q

inflammation of RA leads to

A

severe pain
palpable synovial swelling
morning stiffness
loss of function in joints

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9
Q

RA occurs in a _________________ and typically involves the ______________

A

symmetrical pattern

wrists, MCP and PIP joints

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10
Q

MCP

A

metacarpophalangeal joints

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11
Q

PIP

A

proximal interphalangeal joints

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12
Q

what can cause RA?

A

infectious agents
environmental triggers
genetic risk factors

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13
Q

rheumatoid factor

A

autoantibody associated with RA
antibody against the Fc portion of IgG

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14
Q

RF and IgG form ____________ that contribute to the disease process

A

immune complexes

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15
Q

rheumatoid factors are antibodies with

A

various isotopes and affinities

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16
Q

most commonly mentioned RF

A

is an IgM

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17
Q

loss of tolerance to the proteins that have a citrulline residue likely produce autoantibodies like

A

anti-cyclic citrullinated protein/peptide antibody (ACPA) and RF

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18
Q

synovitis stage of RA

A

synovial membrane inflamed and thickened
bones and cartilage gradually eroded

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19
Q

pannus stage of RA

A

extensive cartilage loss
exposed and pitted bones

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20
Q

fibrous anklosis stage of RA

A

joint invaded by fibrous connective tissue

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21
Q

bony anklosis stage of RA

A

bones fused

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22
Q

RF is ____________ in the first 6 months and ____________ with established disease

A

45% positive

85% positive

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23
Q

PIP swelling in RA

A

swelling is confined to the area of the joint capsule
synovial thickening feels like a firm sponge

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24
Q

Rheumatoid arthritis is not

A

restricted to the joints in the wrists

can be anywhere in the body!

25
Q

genetic factors that can cause RA

A

HLA-DRB1
STAT4
PADI4
DR1

26
Q

production of inflammatory cytokines leads to

A

decreased production of hyaluronan
inflammation increases MMP production, increases cartilage damage
plasma cell antibodies form immune complexes

27
Q

joint damage recruits _____________________ which causes _____________ of the synovial membrane. This leads to ______________

A

neutrophils, T cells and B cells

hyperplasia and angiogenesis

palpable lumps in the joints (boggy joints)

28
Q

pannus invades and _______________ which leads to __________ and continued usage on the joints can ______________

A

enzymatically destroys joint tissue

decreased joint mobility

Mal-align, sublux or collapse joints

29
Q

diagnostic factor of RA

A

RF
anti-cyclic citrullinated peptide

30
Q

treatment for RA

A

NSAIDS
TNF-a inhibitors
steroids/corticosteroids
DMARDs
immunosuppressants

31
Q

within the first three months, treatment is

A

MTX (or other DMARD), NSAID and prednisone

32
Q

when there is poor response for initial treatment of RA,

A

try other combination

triple drug (DMARD and biologic), low dose prednisone long term and consider second line DMARD

33
Q

NSAIDs effects for RA

A

relieve pain
reduce inflammation

34
Q

types of NSAIDs for RA

A

ibuprofen (Advil, Motrin)
naproxen (aleve)

35
Q

side effects of NSAIDs

A

tinnitus
stomach irritation
heart problems
liver/kidney damage

36
Q

TNF-a inhibitors effects for RA

A

reduce pain, morning stiffness and tender or swollen joints

37
Q

examples of TNF-a inhibitors for RA

A

Etanercept (Enbrel)
infliximab (Remicade)
adalimumab (HUMIRA)
Golimumab (simponi)
certolizumab (cimzia)

38
Q

side effects of TNF-a inhibitors

A

risk of serious infections
congestive heart failure
cancer

39
Q

steroids/corticosteroids effects for RA

A

reduce inflammation and pain
slow joint damage

40
Q

side effects of steroids/corticosteroids

A

thinning of bones, cataracts, weight gain, and diabetes

41
Q

DMARDs effects for RA

A

slow the progression of RA
save joints/tissues from permanent damage

42
Q

side effects of DMARDs

A

liver damage
bone marrow suppression
severe lung infections

43
Q

DMARDs examples for RA

A

methotrexate (Trexall)
leflunomide (Arava)
hydroxychloroquine (Plaquenil)
sulfasalazine (Azulfidine)
minocycline (Dynacin, Minocin)

44
Q

immunosuppressants effects of RA

side effects?

A

tackle immune system

increase susceptibility to infection

45
Q

examples of immunosuppressants for RA

A

azathioprine (Imuran, Azasan)
cyclosporine (Neoral, sandimmune, Gengraf)
cyclophosphamide (cytoxan)

46
Q

which TNF-a inhibitors are human monoclonal antibodies?

A

adalimumab
certolizumab

47
Q

which TNF-a inhibitors are chimeric monoclonal antibodies?

A

infliximab

48
Q

methotrexate MOA

A

interferes with DNA synthesis, repair and cellular replication

inhibits dihydrofolate reductase

49
Q

MTX inhibits _____________ uptake which shows

A

DNA precursor

spleen cell hypo responsiveness and suppresses IL-2 production

50
Q

what happens when dihydrofolate reductase is inhibited?

A

dihydrofolates cannot be converted to tetrahydrofolates which are needed for synthesis of purine nucleotides and thymidylate

51
Q

what type of metabolism does MTX go through?

A

hepatic and intracellular metabolism to polyglutamated forms

52
Q

polyglutamates act as

A

inhibitors to dihydrofolate reductase and thymidylate synthetase

53
Q

how is MTX excreted?

A

renally
80-90% unchanged in urine

54
Q

what is given to reduce toxicity of high dose regimens/delayed excretion of MTX?

A

leucovorin calcium (leucovorin rescue)

55
Q

what is the half life of MTX?

at high doses?

A

3-10 hours

8-15 hours

56
Q

ADRs of MTX

A

bone marrow suppression
aplastic anemia
GI toxicity

57
Q

after prolonged use, MTX can cause

A

hepatotoxicity, fibrosis, cirrhosis and pulmonary toxicity

58
Q

MTX can be detected in _________ which can be an issue with babies

A

human breast milk

Pharmacology II (5 decks)

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