Rheumatoid Arthritis Treatments Flashcards

1
Q

Name the 3 categories of rheumatoid arthritis therapies.

A

NSAIDs, DMARDs (disease-modifying anti-rheumatic drugs), and biologic response modifiers

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2
Q

Indomethacin, naproxen, celecoxib, and other NSAIDs can be used to treat what 2 symptoms of rheumatoid arthritis and acute gouty arthritis? What aspect of these diseases do they not treat?

A

Treat pain and inflammation; do not slow disease progression

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3
Q

Why are the COX-2 selective NSAIDs becoming a more popular treatment for rheumatoid arthritis than the non-selective NSAIDs?

A

50% less side effects of gastric and duodenal ulcers

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4
Q

Name 6 DMARDs (disease-modifying anti-rheumatic drugs) that can be used to treat rheumatoid arthritis.

A

Gold salts, quinolones, glucocorticoids/corticosteroids, sulfasalazine, methotrexate, and leflunomide

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5
Q

Which DMARD is antipruritic and represses macrophage function, but is rarely used today because it causes serious side effects in 30% of patients?

A

Gold salts

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6
Q

The quinolones are both anti-malarials and rheumatic disorder DMARDs. By what mechanisms do they achieve these 2 separate therapeutic functions?

A

Antimalarial: accumulates in the food vacuoles of Plasmodium and cause oxidative damage

DMARD: reduce T-cell activation and chemotaxis

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7
Q

Give one reason a patient would be prescribed a quinolone for rheumatoid arthritis, and one possible side effect if chloroquine was the quinolone prescribed.

A

Quinolones can be used if the patient is no longer responding to NSAIDs [or can’t tolerate gold or penillamine]; possible side effect is retinal damage

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8
Q

What DMARD class can, like NSAIDs, be used to treat both rheumatoid arthritis and acute gouty arthritis? What 2 pathways does this DMARD target?

A

Corticosteroids/glucocorticoids; inhibits phospholipase A2 (which makes arachidonic acid) and cytokine production (which induces COX-2) pathways

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9
Q

By what mechanism does the DMARD sulfasalazine help treat rheumatoid arthritis?

A

Inhibit TNF-α and IL-1 release

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10
Q

Name the 2 immunosuppressive DMARDs. Which one inhibits aminoimidazolecarboxamide (AICAR) transformylase, thymidylate synthetase, and PMN chemotaxis while increasing adenosine accumulation (which is anti-inflammatory)?

A

Methotrexate and leflunomide; methotrexate has all these actions (note: DHFR inhibition is not seen at these low doses)

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11
Q

Which DMARD acts by inhibiting dihydroorotate dehydrogenase (DHODH)? What molecules are not synthesized and what cells’ response to stimuli are inhibited as a result?

A

Leflunomide; inhibits de novo pyrimidine (UMP) synthesis which inhibits T-cell response to stimuli

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12
Q

Which of the following DMARDs is fastest acting: corticosteroids, sulfasalazine, methotrexate, or leflunomide?

A

Corticosteroids (sulfasalazine takes about 1 month and methotrexate & leflunomide both take several weeks to have an effect)

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13
Q

Which DMARD can cause Cushing syndrome-like symptoms as a side effect?

A

Corticosteroids/glucocorticoids

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14
Q

Which class of DMARDs can cause GI problems like nausea, stomatitis, and diarrhea, and also liver problems?

A

The immunosuppressives (methotrexate and leflunomide)

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15
Q

30% of patients discontinue use of which DMARD because of nausea, vomiting, skin rashes, neutropenia, and headaches?

A

Sulfasalazine

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16
Q

List 5 different suppressive strategies employed by biologic response modifiers to treat rheumatoid arthritis.

A

Block TNF-α, block IL-1, block IL-6, reduce CD20 B cells (using antibodies), and reduce T cells (decrease activation and increase apoptosis)

17
Q

Name the 5 TNF-α antagonists that are used to treat rheumatoid arthritis.

A

Etanercept, infliximab, adalimumab, golimumab, cirtolizumab

18
Q

Of the 4 monoclonal antibody TNF-α antagonists, which one is a chimeric mouse/human hybrid that can cause an antigenic response in patients? Which one is humanized, and which 2 are fully human antibodies?

A

Infliximab is chimeric; certolizumab is humanized; adalimumab and golimumab are fully human

19
Q

List the following TNF-α antagonists in terms of how often they are given, from most frequent to least frequent dosing: etanercept, golimumab, adalimumb.

A

Etanercept (2x/week), adalimumab (2x/month), golimumab (1x/month)

20
Q

Which 4 biologic response modifiers are not TNF-α antagonists?

A

Anakinra, tocilizumab, rituximab, abatacept

21
Q

Name the biologic response modifier that is an IL-1 antagonist. What is its half life?

A

Anakinra; 6 hours (short, so need high doses daily)

22
Q

Name the biologic response modifier that is an IL-6 antagonist.

A

Tocilizumab

23
Q

Name the biologic response modifier that is an anti-CD20 monoclonal antibody. What cells does it target?

A

Rituximab; B-cells

24
Q

Name the biologic response modifier that inhibits T cell activation and induces T cell apoptosis.

A

Abatacept

25
Q

What is the most common risk of using TNF-α antagonists or any of the other biologic-response-modifying drugs for rheumatoid arthritis?

A

Increased risk of serious infections, such as TB, fungal, and other opportunistic pathogens

26
Q

Of the co-stimulation modulators rituximab and abatacept, which one can cause headaches and which can cause hypersensitivity reactions?

A

Abatacept can cause headaches, rituximab can cause hypersensitivity

27
Q

In current therapy, what drugs are given to patients with early rheumatoid arthritis and low disease activity?

A

Nonbiologic DMARD monotherapy (ex. hydroxychloroquine, sulfasalazine, methotrexate, or leflunomide)

28
Q

In current therapy, what drugs are given to patients with moderate or high rheumatoid arthritis disease activity but without poor prognostic features?

A

DMARD monotherapy or the DMARD combination of methotrexate+hydroxychloroquine

29
Q

In current therapy, what drugs are given to patients with moderate or high rheumatoid arthritis disease activity and poor prognostic features?

A

DMARD combination therapy (ex. MTX+hydroxychloroquine, MTX+sulfasalazine, MTX+sulfa+hydroxy) or anti-TNF therapy

30
Q

In current therapy, what 2 drugs can be given to patients who have rheumatoid arthritis refractory to methotrexate and TNF-α inhibitors?

A

Rituximab and abatacept