Rheumatoid Arthritis Medications Flashcards
Pathophysiology of Normal bone/joint movement
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
Pathophysiology of Rheumatoid Arthritis Medications
-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
RA Signs and Symptoms
-pain, aching, tenderness, swelling and stiffness in multiple joints
-usually begin in 30s or 40s
what are the most commonly affected joints?
-hands, wrists, and knees
-as the disease progresses, joints can become disfigured
Medication Options for RA
- NSAIDs
- Glucocorticoids
- Disease-Modifying-Anti-Rheumatic drugs (DMARDs)
How do NSAIDs help with RA?
by reducing inflammation and pain. NSAIDs work quickly but don’t slow disease progression.
-lone or -sone is the suffix for which medication?
oral glucocorticoids
which oral glucocorticoids should you know?
- Methylprednisolone
- Prednisone
Common uses of glucocorticoids
-rheumatoid arthritis
-osteoarthritis
-lupus
-inflammatory bowel disease
-allergic reactions
-asthma
-COPD
-prevent organ transplant rejection
What is the Mechanism of Action for Glucocorticoids?
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.
using glucocorticoids long term can lead to
osteoporosis
-doesn’t occur when inhaled (for asthma or COPD) or when used short term
Glucocorticoids can cause _____ _______ especially if taking with NSAIDs
stomach ulcers (gastric ulceration) due to glucocorticoids inhibiting prostaglandin synthesis
which electrolyte do glucocorticoids decrease?
Potassium
what should clients eat when taking glucocorticoids?
potassium rich foods such as bananas, potatoes, and citrus fruits
Which type of patients and labs should you monitor before giving glucocorticoids?
patients with diabetes and people with high blood glucose levels
-glucocorticoids can increase glucose levels
What can lead to adrenal insufficiency?
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
adrenal insufficiency causes ___
flu like symptoms and hypotension
What is the drug of choice for RA? Why?
Methotrexate bc highly effective, works faster than other DMARDs , relatively safe, and cheap
Methotrexate Common Uses
-RA
-severe psoriasis
-certain cancers
Methotrexate Mechanism of Action
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
Compare the dosing of Methotrexate for RA & Cancer
-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
Why should patients drink plenty of water when taking methotrexate?
bc it can cause renal toxicity
-pts should drink 2-3L per day
What should be monitored and avoided when taking methotrexate? why?
-liver function should be monitored
-hepatotoxic agents like alcohol should be avoided
-the medication is toxic to the liver
High does of methotrexate can lead to ______ in cancer patients
Bone Marrow Suppression
-decreases production of blood cells (RBCs, WBCS, & platelets)
-increases risk for anemia, infection, and bleeding
