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Muscluloskeletal Systems > Rheumatoid Arthritis - Therapeutics > Flashcards

Rheumatoid Arthritis - Therapeutics Flashcards

1
Q

What score can you use to estimate cardiovascular disease risk?

A

Assign score

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2
Q

What DAS scores show active disease, low disease activity and remission?

A

> 5.1 = Active disease

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3
Q

What medications provide symptomatic relief in Rheumatoid Arthritis?

A

Analgesics +/- NSAIDs

  • Symptomatic relief from the pain and inflammation associated with rheumatoid arthritis
  • Do not retard disease progression
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4
Q

Describe the WHO analgesic ladder

3 steps

A

Step 1
-Non-opiod +/- adjuvant

Step 2
-Opioid for mild to moderate pain +/- non-opioid +/- adjuvant

Step 3
-Opioid for modaerate to severe pain +/- non-opioid +/- adjuvant

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5
Q

What percentage of all ADR are due to NSAIDs?

A

25%

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6
Q

Give some ADRs for NSAIDs

A 
GI irritation (indigestion, ulceration)
-Consider PPIs

Bronchospasm (caution in asthmatics)

Renal impairment (use with caution)

Hypersensitivity reactions

Increased blood pressure, fluid retention
-avoid in patients with CCF

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7
Q

Why does COX-1 and COX-2 ratio matter?

what is COX? What is the difference between 1 and 2? What does a disbalance risk?

A

COX = cyclo-oxygenase

Arachidonic acid —-COX—> prostaglandins

COX-1 -> GI cytoprotection
COX-2 -> Inflammation, Pain and fever

Want to target COX-2 in RA
-This leads to difference in COX-1, COX-2 ratio

Increases risk of CVS disease

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8
Q

Give some examples of COX-2 selective NSAIDs

A 
Diclofenac
Meloxicam
Celecoxib
Valdecoxib
Rofecoxib
Etoricoxib
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9
Q

Give some examples of COX-1 selective NSAIDs

A

Indomethacin
Naproxen
Ibuprofen
Piroxicam

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10
Q

What does DMARD stand for?

A

Disease Modifying Anti-Rheumatic Drugs

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11
Q

Give some examples of DMARDs

A 
METHOTREXATE
Sulphasalazine
Leflunomide
Penicillamine
Gold (injection)
Hydroxychloroquine
Azathioprine
Ciclosporin
Mycophenolate
Chorambucil
Cyclophosphamide
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12
Q

What are the side effects of methotrexate?

A

Nausea, stomatitis

Haematological toxicity

Hepatic toxicity
-LFTs, cirrhosis, hepatic fibrosis

Pulmonary toxicty
-pneumonitis

Teratogenic (ova and sperm)

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13
Q

What drug is given along side methotrexate to reduce its incidence of side effects?

A

Folic acid

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14
Q

What is the dose of methotrexate you prescribe?

A

4 x 2.5mg Once a week

10mg

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15
Q

What does TICORA stand for?

A

Tight Control for Rheumatoid Arthritis

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16
Q

What is TICORA?

A

Intensive out-patient management

“Treat to target” -> if DAS >2.4 = step up treatment

17
Q

Describe the basics of TICORA “target to treat”

What do you give?
When do you increase dose?
What if its not working?

A

Start methotrexate at 7.5mg up to 12.5mg +/- oral/im steroid

Monitor FBC, LFT every fortnight until 6 weeks after increase

Calculate DAS28 monthly

Increase dose monthly (max 25mg)

Consider sulphasalazine or hydroxychloroquine if inadequate response.

Consider anti-TNF if inadequate response or not tolerated

18
Q

What do biologics specifically target?

A

Pro-inflammatpry mediators such as:

  • TNF alpha
  • Interleukines (1 and 6)
  • B cells
  • T cells
19
Q

What is the qualifying criteria for starting a patient on biologics?

(what criteria must they meet?)

A

Fulful standard diagnostic criteria

Active disease defined by DAS >5.1

Adequate therapeutic trial of at least 2 standard DMARDs (including methotrexate)

20
Q

Give some examples of anti-TNF biologics

A 
Etanercept
Infliximab
Adalimumab
Certolizumab pegol
Golimumab
21
Q

What is a biosimilar?

A

A biological medicine that is similar to another biological medicine that has already been authorised for use

22
Q

What does Rituximab bind to?

what does it do?

A

Monoclonal antibody against CD20 found on the surface of B-cells

23
Q

How often do you take Rituximab?

A

2 infusions a fortnight apart

Re-treatment is necessary (average time between treatments is 9 months but this depends on the patient)

24
Q

Name an IL-6 antagonist

A

Tocilizumab

25
Q

How do you take Tocilizumab?

A

1 hour IV infusion every 4 weeks

weekly s/c injection

26
Q

What are the side effects of Tocilizumab?

A

Abnormal LFTs
Rise in lipids
Hypertension

27
Q

Name a T-cell co-stimulation modulator

How do you take this drug?

A

Abatacept

30 min IV infusion every 4 weeks
Weekly s/c injection

28
Q

What must you be wary of with biologic DMARDs?

side effects etc

A
  • Serious infections
  • TB
  • Malignancies/lymphoma
  • Demyelination
  • Haematologic abnormalities
  • Adimistration reactions
  • CHF
  • Hepatic side effects
  • Autoantibodies and drug induced lupus
  • Vaccination

Muscluloskeletal Systems (29 decks)

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