Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Intro to D&D Midterm > Saad - Rheumatoid Arthritis Part 2 > Flashcards

Saad - Rheumatoid Arthritis Part 2 Flashcards

1
Q

MOA of methotrexate

A

inhibits DHFR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what is the DMARD of choice for most patients

is it used alone or in combination with other DMARDS

A

methotrexate

can be either monotherapy or in combo with other DMARDS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

around how long does it take to see the clinical benefits of MTX

A

3-6 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

how is methotrexate dosed

why is this a concern

A

WEEKLY – NOT QD

can very easily not read the directions correctly and OD causing blood toxicity and other toxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what is max dose methotrexate/week for RA

A

20-25 mg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

is renal dose adjustment required for MTX

A

yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

name 5 scenarios in which methotrexate is CONTRAINDICATED

A

teratogenic - no pts who are pregnant or breastfeeding

alcoholism

alcoholic/chronic liver disease

immunodeficiency

hematologic disorders like leukopenia (INC INFECTION RISK) or thrombocytopenia (platelets) - BLEEDING

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what is methotrexate supplemented with and why

A

FOLIC ACID
usually greater than 5mg a day
to reduce adverse events from methotrexate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

name some adverse effects of methotrexate

A

GI – NVD, anorexia, dyspepsia

mucosistis (mouth and GI ulceration)

liver fxn abnormalities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

in a patient CURRENTLY taking methotrexate, what should they be monitored for

A

CBC, ALT, AST (liver), renal functio

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what is done in pts with an underlying LUNG DISEASE about to start MTX

A

a chest xray

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what kind of screenings must be done before MTX is intitiated

A

in high risk pts - hep b and c (do NOT want further liver toxicity from MTX) and tb screeenings

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

***important consideration regarding leflunomide and why

A

it has a very long half life (2 weeks)

therefore, if allergic or experience some toxic effects, it is more of a concern

give cholestyramine if need to wash out bc of toxic effects or a pregnancy the pt wasnt aware of – its teratogenic like MTX

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is an alternative to MTX in pts who cannot tolerate or dont get benefit from it

A

leflunomide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

MOA of leflunomide

A

inhibits pyrimidine synthesis
inhibits T cell response to some stimuli
halts the cell cycle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

around how long to see efficacy after taking leflunomide

A

1 month

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

how does the monitoring when taking leflunomide compare to methotrexate

A

BASICALLY SAME

ALT/AST, CVC, renal function
should get TB screening, CBC with diff prior to start

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

name 3 scenarios in which leflunomide is CONTRAINDICATED

A

pregnancy
impaired liver fxn (inc hep b/c)
sevre immunocomp pts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

true or false

leflunomide is HIGHLY TERATOGENIC, even after discontinuation

A

TRUE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

name some AE of leflunomide

A

GI - NVD, anorexia, cramps
inc liver fxn tests, liver failure

myelosuppression when combined with other treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

when educating a patient who is taking leflunomide, name 3 points to mention

A

stay hydrated
report GI symptoms like NVD or jaundice immediately
report sign of infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

hydroxychloroquine brand

A

plaquenil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

explain the mechanism of hydroxychloroquine

A

has anti inflammatory properties by interfering with macrophages and other APC’s and their antigen processing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what is the role of hydroxychloroquine in RA

A

use in mild RA in combination therapy – for those who can’t tolerate MTX

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

what is the biggest concern with ppl taking hydroxychloroquine***

A

there is a LIFETIME MAX DOSE due to ocular side effects

must get eye exams bc of ophthalmic toxicities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

name some ocular toxicity effects of hydroxychloroquine

A

blurred vision
night blindness
retinal damage
loss of vission

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

name some neurologic side effects of hydroxychloroquine

A

mild – headache, vertigo, insomnia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

dermatologic side effects of hydroxychloroquine

A

rash alopecia hyperpigementation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

what is sulfasalazine

A

another DMARD that is used if MTX can’t be tolerated.
it is a prodrug

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

sulfasalazine has ___ and ____ properties

A

immunomodulating AND anti-inflammatory properties

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

what are the 2 metabolites of the prodrug sulfasalazine

A

5-ASA (aminosalicylic acid) and sulfapyridine

32
Q

can sulfasalazine be used in pregnant and nursing moms

A

it does cross placenta and is present in breast milk

however, it can be used with caution

33
Q

name 2 contraindications for sulfasalazine

A

allergy to sulfonamide or salicylate

34
Q

what is a main side effect of sulfasalazine

A

urine and skin discoloration - can turn orange or yellow

35
Q

name 2 OA/RA drugs that are contraindicated in those with sulfa allergy

A

celecoxib and sulfasalazine

36
Q

in the 4 DMARDS discussed (MTX, leflunomide, hydroxychloroquine, and sulfasalazine)
when is the most frequent monitoring done?

A

within 3 months of starting therapy - done 2-4 weeks

after that it continually decreases, with it being done every 12 weeks after 6 months of taking

37
Q

BIOLOGIC DMARDS are associated with an increased risk of what and why?

A

risk of infection bc of their immunosuppressant effects

therefore, TB skin test or IGRA blood test is done to detect and treat latent or active tb

should also be screened for Hep B and C - risk of reactivation

38
Q

true or false

biologic agents cannot be used in combination with conventional DMARDS

A

FALSE - they can

39
Q

true or false

biologics can NOT be given with another biologic

A

true

they have additive immunosuppressant effects - dangerous

40
Q

if patients dont have success with a biologic, what is the next course of treatment

A

try a different biologic – never use 2 at once

41
Q

what is the mechanism of TNFa inhibitor biologics

A

block TNFa, a proinflammatory cytokine

42
Q

when would a biologic TNFa inhibitor be used in an RA patient

A

when, despite conventional/synthetic DMARD therapy, the disease activity is still mod-high

43
Q

**contraindication for TNFa inhibitors

A

those with moderate-severe heart failure

new onset or worsened heart failure has been reported

44
Q

what is a big concern with TNFa inhibitor biologics, besides being contraindicated in heart fialure patients

A

they can increase the risk of serious infection and MALIGNANCIES like lymphoma or skin cancer

also, multiple sclerosis, a demyelinating disroder, has occurred

45
Q

before starting TNFa inhibitors, patients should be screened for what

A

TB and hep B and C

46
Q

DURING TNFa therapy, what should be monitored periodically and why

A

CBC with differential – bc they can cause blood disorders like pancytopenia (lower RBC, WBC, platelets)

also watch for signs of malignancy and serious infectionse

47
Q

name the 2 BBW for TNFa antagonists

A

malignancy, specifically hepatosplenic T cell lymphoma (HSTCL)

FATAL INFECTIONS - opportunistic infections like legionella and listeria

48
Q

true or false

JAK inhibitors can be used in combo with a biologic DMARD or JAK inhibitor

A

FALSE

can be used with synthetic/conventional DMARD, but not another biologic OR JAK INHIBITOR. way too potent

49
Q

explain how JAK inhibitors function

A

they bind the catalytic portion of JAK and block the messaging pathway of multiple pro-inflam cytokines

50
Q

can JAK inhibitors be used by themselves (monotherapy)

A

yes

51
Q

can JAK inhibitors be used with other JAK inhibitors

A

NO

52
Q

black box warnings for JAK inhibitors

A

serious infections

malignancies

CLOTS – DVT, PE, thrombosis

53
Q

TB testing is recommended prior to treatment with WHAT 3 THINGS

A

biologics

methotrexate

leflunomide

54
Q

if a TB infection occurs while on MTX/leflunomide/biologics - what should be done

A

temporarily discontinue until infection is cured

55
Q

are JAK inhibitors biologics

A

NO
kind of like a “targeted” synthetic - not conventional synthetic like MTX

56
Q

a patient with a history of significant TB exposure or recurrent TB infection may not be a candidate for which drugs

A

MTX, leflunomide, biologics

57
Q

if a patient has an active or latent TB infection and is looking to start MTX or leflunomide or biologics, what must be done?

A

they get antitubercular treatment

treatment with biologics can start after ONE MONTH of latent TB treatment with meds and after completing treatment of active TB (as applicable)

58
Q

ALL PATIENTS receiving DMARDS should get what 4 vaccinations

A

influenza
pneumonia
HPV
herpes zoster (NOT THE LIVE ONE)

59
Q

If a patient gets the LIVE herpes zoster vaccine, how long do they have to wait before starting biologics

A

2 weeks

60
Q

the hepatitis B vaccine is reccomended to certain patients getting biologic OR nonbiologic DMARDS
name these 3 populations

A

healthcare workers

those who use IV drugs

those who have mult sex partneers

61
Q

name 3 live vaccines that can NOT be given to patients on biologics

A

MMR
yellow fever
LIVE herpes zoster

62
Q

4 patient populations with high risk comorbidities

A

hepb/c
congestive heart failure
malignancy
serious infections

63
Q

a patient has an active hep B infection and is receiving effective treatment for it

what kind of RA therapy should they get

what about a patient with chronic hep B who is UNTREATED

A

same as someone who doesnt have the infection

UNTREATED - refer to antiviral therapy before getting immunosuppressants

64
Q

pt with Hep C infection and receiving effective treatment - what RA therapy should they get??

pt with hep C infection NOT getting antiviral treatment, what should they get

A

same as someone without condition

if not being treated - reccomend DMARD over TNFa antagonist

65
Q

which RA therapy is CONTRAINDICATED in congestive heart failure patients

A

TNFa antagonists

66
Q

if a patient is taking TNFa antagonist and devleops signs of worsening heart failure, what should be done

A

discontinue therapy and recommend combination DMARDS, non TNF biologics, or tofaticinib

67
Q

in general, patients with treated or untreated skin cancer or lymphoma disorders, what is recommended

which type of treated cancer gets treated the same

A

DMARDS over biologics

solid organ malignancy

68
Q

patients with previous serious infections should use ___ over ____ and ______ over ______

A

DMARDS over TNFa antagonists

abatacept over TNFa antagonists

synthetics preferred over biologics

69
Q

it is recommended that patients _____________ for at least 6 months prior to tapering down the dose

A

at target – low disease activity or remission

70
Q

true or false

it is recommended to abruptly discontinue DMARDS

A

false - gradual tapering is preferred

just reducing the dose is even better

71
Q

explain what a biosimilar is

A

a biologic product HIGHLY SIMILAR to a reference product

no clinically meaningful differences in efficacy/adverse effects/immunogenicity

72
Q

what is the treatment for NODULES - an extra-articular manifestation of RA

A

NONE

73
Q

what is the treatment for vasculitis - an extra-articular manifestation of RA

A

aggressive treatment of the inflammatory process

74
Q

what is the treatment for ocular extra-articular manifestations of RA
(keratoconjunctivitis sicca of sjogren’s syndrome)

A

articifical tears

75
Q

what is xerostomia

A

dry mouth

an extra-articular maifestation of RA

76
Q

how is xerostomia treated

A

pilocarpine or cevimeline

77
Q
A

Intro to D&D Midterm (29 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions