Rheumatoid Arthritis Medications

Question 1

Pathophysiology of Normal bone/joint movement

Answer 1

Normally:
-synovial membranes are connective tissue that surrounds the cavities of joints (where 2 or more bones meet)
-on the ends of both bones of joint is articular cartilage (w/in synovial membrane): Articular cartilage keeps joint movements smooth and painless w/o friction or grinding

Question 2

Pathophysiology of Rheumatoid Arthritis Medications

Answer 2

-immune system gets out of control and causes immune cells (mast cells, macrophages, T lymphocytes) to release cytokine and other inflammatory mediators (tumor necrosis factor alpha: TNF-⍺)
-leads inflammation in joints. These joints swell and become tender and warm
-Over time this causes the synovial membrane to invade the joint and replace the articular cartilage
-you start hearing grinding noises
-in final stages, the 2 bones fuse together

Question 3

RA Signs and Symptoms

Answer 3

-pain, aching, tenderness, swelling and stiffness in multiple joints
-usually begin in 30s or 40s

Question 4

what are the most commonly affected joints?

Answer 4

-hands, wrists, and knees
-as the disease progresses, joints can become disfigured

Question 5

Medication Options for RA

Answer 5

1. NSAIDs
2. Glucocorticoids
3. Disease-Modifying-Anti-Rheumatic drugs (DMARDs)

Question 6

How do NSAIDs help with RA?

Answer 6

by reducing inflammation and pain. NSAIDs work quickly but don’t slow disease progression.

Question 7

-lone or -sone is the suffix for which medication?

Answer 7

oral glucocorticoids

Question 8

which oral glucocorticoids should you know?

Answer 8

1. Methylprednisolone
2. Prednisone

Question 9

Common uses of glucocorticoids

Answer 9

-rheumatoid arthritis
-osteoarthritis
-lupus
-inflammatory bowel disease
-allergic reactions
-asthma
-COPD
-prevent organ transplant rejection

Question 10

What is the Mechanism of Action for Glucocorticoids?

Answer 10

The adrenal glands produce a corticosteroid called cortisol. Specifically, cortisol increases blood glucose levels, increases blood pressure, suppresses the immune response, and many other things. Glucocorticoids are synthetic versions of cortisol.

Question 11

using glucocorticoids long term can lead to

Answer 11

osteoporosis
-doesn’t occur when inhaled (for asthma or COPD) or when used short term

Question 12

Glucocorticoids can cause _____ _______ especially if taking with NSAIDs

Answer 12

stomach ulcers (gastric ulceration) due to glucocorticoids inhibiting prostaglandin synthesis

Question 13

which electrolyte do glucocorticoids decrease?

Answer 13

Potassium

Question 14

what should clients eat when taking glucocorticoids?

Answer 14

potassium rich foods such as bananas, potatoes, and citrus fruits

Question 15

Which type of patients and labs should you monitor before giving glucocorticoids?

Answer 15

patients with diabetes and people with high blood glucose levels
-glucocorticoids can increase glucose levels

Question 16

What can lead to adrenal insufficiency?

Answer 16

when clients who take a glucocorticoid for a week or more, they stop secreting their own glucocorticoids, and then abruptly stop taking the glucocorticoid increased the risk for developing adrenal insufficiency

Question 17

adrenal insufficiency causes ___

Answer 17

flu like symptoms and hypotension

Question 18

What is the drug of choice for RA? Why?

Answer 18

Methotrexate bc highly effective, works faster than other DMARDs , relatively safe, and cheap

Question 19

Methotrexate Common Uses

Answer 19

-RA
-severe psoriasis
-certain cancers

Question 20

Methotrexate Mechanism of Action

Answer 20

Normally:
-DHFR breaks down folic acid into adenine & guanine which make of the base pairs in DNA
With Methotrexate:
-Methotrexate blocks DHFR which means adenine & guanine is form which means DNA cannot be formed either
-Bc RA is an autoimmune disease, immune cells are rapidly reproducing.
-W/o DNA, you can’t make as many immune cells
-this turns down the immune or inflammatory response thus slowing the disease progression

Question 21

Compare the dosing of Methotrexate for RA & Cancer

Answer 21

-the dose is much lower for RA (5-10 mg once a week)
-the dose is much higher for cancer patients (20,000 mg per dose)
-cancer patients will have many more side effects compared to patients with RA

Question 22

Why should patients drink plenty of water when taking methotrexate?

Answer 22

bc it can cause renal toxicity
-pts should drink 2-3L per day

Question 23

What should be monitored and avoided when taking methotrexate? why?

Answer 23

-liver function should be monitored
-hepatotoxic agents like alcohol should be avoided
-the medication is toxic to the liver

Question 24

High does of methotrexate can lead to ______ in cancer patients

Answer 24

Bone Marrow Suppression
-decreases production of blood cells (RBCs, WBCS, & platelets)
-increases risk for anemia, infection, and bleeding

Question 25

Hydroxychloroquine Common Uses

Answer 25

-malaria
-lupus
-RA
-doesn’t slow progression of RA by itself, so it is taken with methotrexate

Question 26

Retinal Damage is a rare side effect caused by which medication?

Answer 26

Hydroxychloroquine

Question 27

Another rare side effect of Hydroxychloroquine is ____

Answer 27

QT interval prolongation; slight risk is could progress to tornado de pointes and ventricular fibrillation

Question 28

Adalimumab Common Uses

Answer 28

-RA
-Psoriatic arthritis
-inflammatory bowel disease

Question 29

Adalimumab mechanism of action

Answer 29

-Adalimumab is a TNF-⍺ blocker
-it binds to TNF-⍺ and inactivates it
-made via recombinant DNA technology which means its very expensive ($7,000 a month)

Question 30

Adalimumab is given via which route? and what does it cause?

Answer 30

-subcutaneous injection
-it causes redness, swelling, pain, itching, etc. at the injection site.

Question 31

what can help to resolve injection-site reactions of Adalimumab?

Answer 31

cold packs, topical glucocorticoids, and pain medications

Question 32

Due to the suppression of TNF, clients who take adalimumab have an increased risk of

Answer 32

infection
-if a client has undiagnosed TB, adalimumab can cause major problems so clients should be tested for TB before taking this medication

Question 33

Cyclosporine Common Uses

Answer 33

-drug of choice in preventing organ rejection following a transplant
-bc of strong immunosuppressant effects, it can treat RA and psoriasis

Question 34

Cyclosporine mechanism of action

Answer 34

inhibits the synthesis of interleukin-2 (IL-2) and other cytokines. This reduces joint inflammation and pain.

Question 35

what organ can be affected (injured) when taking Cyclosporine?

Answer 35

kidneys.
-for this reason, it is not used for RA unless standard, safer treatments are ineffective

Question 36

cyclosporine can cause a moderate increase in _____ ________

Answer 36

blood pressure

Question 37

what precautions should clients taking cyclosporine take? & why?

Answer 37

bc this med is an immunosuppressant, clients must take extra precautions to prevent infection such as avoiding large crowds, undercooked meat, and live vaccines.

Question 38

when using cyclosporine to prevent organ rejection, what precautions should clients take?

Answer 38

-clients must not miss any doses and should take it at the same time every day.
-Clients should also be alert to signs of rejection

Question 39

what are some signs of organ rejection?

Answer 39

swelling of the hands/legs, decreased urine output, chills, nausea, and vomiting