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Year2 MSK exam2 > Rheumatology Pharm I > Flashcards

Rheumatology Pharm I Flashcards

1
Q

What are the nonbiologic DMARDs

A

hydroxychloroquine
leflunomide
MTX
sulfasalazine

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2
Q

What are the TNF a blocking agents

A 
Adalimumab-humera
Certolizumab
Etanercept
Golimumab
Infliximab
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3
Q

What are the other biologic DMARDs that are not TNF a blockers

A

Abatacept
Rituximab
Tocilizumab

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4
Q

What are the intraarticular corticosteroids

A

methylprednisolone and triamcinolone

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5
Q

how do DMARDs work

A

reduce pain and inflammation and reduce or prevent irreversible joint damage

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6
Q

choice of DMARD therapy based on

A

level disease activity
stage of therapy
regulatory restrictions
patient preference

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7
Q

preventative therapies for rheumatologic disorders

A 
education
psychosocial interventions
OMT
rest exercise and PT OT
nutritional and dietary couseling
preventative
immunizations to dec risk of infectious complications of immunosuppressive therapies
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8
Q

what is super important about workup before starting DMARDs

A

immunizations

because increase risk ifnections with immunosuppressive therapies

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9
Q

what is standard regimen for Tx RA

A

DMARD NSAID and corticosteroid

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10
Q

What are rec for initial Tx RA

A

MTX or leflunomide

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11
Q

main effect of DMARDs

A

delay and stop disease progression

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12
Q

use of NSAID primarily for

A

pain relief

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13
Q

glucocorticoids used for

A

short term relieve of Sx or systemic manifestations

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14
Q

if initial response to DMARD inadequate

A

second nonbiologic DMARD added

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15
Q

What are the biologic DMARDs used for initial tx if do not respond to nonbiologics

A 
entancercept
infliximab
adalimumab
golumumab
certolizumab
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16
Q

what Tx regimen is used to achieve regimen

A

use of biologic with MTX

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17
Q

Why is etanercept common first choice of biologics

A

rapid onset action and short half life so short duration toxicity

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18
Q

MOA MTX

A

inhibit dihydrogolate reductase resulting in impaired DNA synthesis causing cell death

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19
Q

low dose MTX MOA

A

anti inflammatory from increased extracellular adenosine

20
Q

MTX affect on inflammatory cells

A

stimulates apoptosis

21
Q

MTX concentration increased by

A

HCQ because of reduced clearance

22
Q

side effects MTX

A

nausea, upset stomach, loose stools, stomatitis, soreness mouth, alopecia, fever, macular punctate rash, HA, fatigue, impaired ability to concentrate

23
Q

lifethreatening side effects MTX from high doses

A

hepatotoxicity
pulmonary damage
myelosuppression
nephrotoxicity

24
Q

liver effects of MTX

A

inc hepatic enzymes
cirrhosis rare
hep B and C at risk patients need to be screened
do not drink alcohol

25
Q

MTX neoplasms

A

lung, get baseline CXR before

26
Q

what is given as supp for MTX side effects

A

folic acid leucovorin

27
Q

MTX pregnancy

A

NO

28
Q

MOA leflunomide

A

G1 arrest, inhibition of Tcell proliferation and B cell production of autoAb

29
Q

what can enhance excretion leflunomide

A

cholestyramine

30
Q

adverse effects leflunomide

A

diarrhea

elevated lft enzymes, alopecia, weight gain, inc BP, leukopenia and thrombocytopenia

31
Q

leflunomide in pregnancy

A

no

32
Q

MOA hydroxychloroquine

A

anti inflammatory mech

33
Q

where does HCQ accumulate

A

eyes because bound to melanin containing tissues

34
Q

response time to HCQ

A

3-6 mo

35
Q

HCQ used for

A

malaria, RA and lupus

36
Q

advesre effects HCQ

A

ocular toxicity, opthalmalogic monitoring needed
discontinue if signs of retinal toxicity
dyspepsia, nausea, vomiting, abdominal pain, rashes, nigthmares

37
Q

MOA sulfasalazine

A

not known

maybe dec IgA and IgM RF production

38
Q

response time sulfasalazine

A

1-3 mo

39
Q

clinical uses sulfasalazine

A

RA
UC and Juvenile Idiopathic arthritis!!!
AS, crohns psoriasis

40
Q

adverse effects sulfasalazine

A

more toxicity than HcQ
nausea vomiting, HA, anorexia and rash
reversible infertility in men!!!

41
Q

is sulfalazine safe in pregnancy

A

probably

category B

42
Q

used to prevent rejection of solid organs transplanted

A

azathioprine

43
Q

what peptide Antibiotic inhibits T cell activation

A

cyclosprine

44
Q

gold therapy

A

in children usually with progressive disease but cannot tolerate commonly used immunosuppressants or cytokine R antagonists

45
Q

what is CI in breast feeding women

A

minocycline

Year2 MSK exam2 (17 decks)

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