Rheumatology Pharm I Flashcards
What are the nonbiologic DMARDs
hydroxychloroquine
leflunomide
MTX
sulfasalazine
What are the TNF a blocking agents
Adalimumab-humera Certolizumab Etanercept Golimumab Infliximab
What are the other biologic DMARDs that are not TNF a blockers
Abatacept
Rituximab
Tocilizumab
What are the intraarticular corticosteroids
methylprednisolone and triamcinolone
how do DMARDs work
reduce pain and inflammation and reduce or prevent irreversible joint damage
choice of DMARD therapy based on
level disease activity
stage of therapy
regulatory restrictions
patient preference
preventative therapies for rheumatologic disorders
education psychosocial interventions OMT rest exercise and PT OT nutritional and dietary couseling preventative immunizations to dec risk of infectious complications of immunosuppressive therapies
what is super important about workup before starting DMARDs
immunizations
because increase risk ifnections with immunosuppressive therapies
what is standard regimen for Tx RA
DMARD NSAID and corticosteroid
What are rec for initial Tx RA
MTX or leflunomide
main effect of DMARDs
delay and stop disease progression
use of NSAID primarily for
pain relief
glucocorticoids used for
short term relieve of Sx or systemic manifestations
if initial response to DMARD inadequate
second nonbiologic DMARD added
What are the biologic DMARDs used for initial tx if do not respond to nonbiologics
entancercept infliximab adalimumab golumumab certolizumab
what Tx regimen is used to achieve regimen
use of biologic with MTX
Why is etanercept common first choice of biologics
rapid onset action and short half life so short duration toxicity
MOA MTX
inhibit dihydrogolate reductase resulting in impaired DNA synthesis causing cell death
low dose MTX MOA
anti inflammatory from increased extracellular adenosine
MTX affect on inflammatory cells
stimulates apoptosis
MTX concentration increased by
HCQ because of reduced clearance
side effects MTX
nausea, upset stomach, loose stools, stomatitis, soreness mouth, alopecia, fever, macular punctate rash, HA, fatigue, impaired ability to concentrate
lifethreatening side effects MTX from high doses
hepatotoxicity
pulmonary damage
myelosuppression
nephrotoxicity
liver effects of MTX
inc hepatic enzymes
cirrhosis rare
hep B and C at risk patients need to be screened
do not drink alcohol
