T4- Rheumatoid Arthritis

Question 1

What does the synovial membrane do?

Answer 1

Synovial membrane normally surrounds joints (360) like a donut

Question 2

What does the articular cartilage?

Answer 2

On ends of bones normally keeps motion smooth and painless (no friction or grinding)

Question 3

In a healthy adult, there is almost ___ friction.

Answer 3

Zero

Question 4

What happens in RA?

Answer 4

In RA, the immune cells are too active, and they release cytokines which cause inflammation

Overtime the synovial membrane overgrows into the cartilage and takes over the joint–you will hear grinding noises–bones will fuse together eventually

Question 5

What is meant by ulnar drift/deviation?

Answer 5

Swelling/inflammation in the big knuckles of your hand causes bones to become displaced and to drift toward the ULNAR bone –ulnar drift; bones have slipped off each other

Question 6

What are the 3 major medication groups given to RA patients?

Answer 6

• NSAIDS
• Glucocorticoids
• Disease modifying anti-rheumatic drugs (DMARDs)

Question 7

Which two RA drugs give rapid relief?

Answer 7

NSAIDs

Glucocorticoids

Question 8

Which RA drug is given daily?

Answer 8

DMARD

Question 9

NSAIDs

Speed of onset: _____. Decrease inflammatory response.

Answer 9

Rapid relief

Question 10

NSAIDs. Does it slow down the disease progression? Does it prevent joint damage?

Answer 10

No, it does not slow disease progression

No it does not prevent joint damage

Question 11

NSAIDs are more ___ than glucocorticoids.

Answer 11

Safer

Question 12

NSAIDs

Safer drug= less vigorous monitoring (safer than ___ & ____)

Answer 12

Glucocorticoids and DMARDs

Question 13

Glucocorticoids

Speed of onset: _____ (decrease inflammatory response)

Answer 13

Rapid relief!!

Question 14

Glucocorticoids ______ disease progression.

Answer 14

Can slow

Question 15

What is the issue with glucocorticoids?

Answer 15

TOXICITY with long-term use…good for an acute flare up ONLY

Question 16

DMARDS speed of action= ____ (months to start working)

Answer 16

Slow

Question 17

DMARDs _____ disease progression (and reduce joint destruction)

Answer 17

Slows

Question 18

DMARDs: start taking this drug within ___ of RA diagnosis (aggressive treatment)

Answer 18

3 months

Question 19

Can you stay on DMARDs long term without toxicity?

Answer 19

Yes!

Question 20

Identify at which stage of RA it’s appropriate to start a client on an NSAID.

Answer 20

Immediately (along with DEMARD

*stay on NSAID until DMARD has had time to work, after which the NSAID can be withdrawn

Question 21

What are the 3 DMARDs?

Answer 21

Methotrexate
Hydroxychloroquine
TNF Blockers

Question 22

Methotrexate is a well known cancer drug, but often used for ____. It is the “___”

Answer 22

RA; drug of choice

Question 23

What is the MOA of methotrexate?

Answer 23

1. Folic acid is essential to making DNA
2. DHFR enzyme changes folic acid into adenine and guanine, which is transferred into DNA
   * without A & G, DNA can’t be built

The MOA of the drug is blocking the DHFR enzyme

Question 24

Methotrexate:
DNA helps make cells. With the blocking of the DHFR enzyme (that helps make DNA), then we worry about the decrease in ____ cells. Without these cells what happens?

Answer 24

WBC; without these cells inflammation is not suppressed, which is what is needed to help slow the progression of RA

Question 25

How often do we take methotrexate?

Answer 25

Only ONCE A WEEk; not daily--this will help reduce side effects There are 11 BBW associated with this drug!!!

Question 26

What are the adverse effects of methotrexate?

Answer 26

- N/D= most common - GI ulceration - Decrease bone marrow - Pneumonitis (inflammed lung) - Hepatotoxicty - Renal failure - Infection (immunosuppression) - Severe Rash

Question 27

What is the MOA of hydroxychloroquine?

Answer 27

Unknown

Question 28

What is hydroxychloroquine combined with?

Answer 28

Methotrexate (not as strong)

Question 29

Do you take hydroxychloroquine with food?

Answer 29

Yes

Question 30

Hydroxychloroquine causes a risk of _____

Answer 30

Retinal damage

Question 31

Educate a client regarding the need for eye exams while taking hydroxychloroquine and what S/S to report immediately?

Answer 31

Risk for retinal damage with this drug Need to have an eye exam BEFORE taking to get baseline, and then every year after Stop taking medication immediately if vision changes or vision loss occur

Question 32

T/F: Hydroxychloroquine is less toxic and less effective than methotrexate?

Answer 32

True

Question 33

What is the MOA of TNF blockers?

Answer 33

Bind to the TNF-alpha and block it *TNF alpha is a cytokine involved with inflammation

Question 34

What are the 3 TNF blockers?

Answer 34

- Infliximab (IV/SQ) - Adalimumab (SQ) - Etanercept (SQ) *All work equally well

Question 35

Explain why it is essential to check a client's immunization status before beginning RA drugs like tumor necrosis factor inhibitors.

Answer 35

TNF inhibitors suppress the immune system - bodys normal fighting mechanism is not working - can get infection, diseases, and even cancer much easier without body fighting it off

Question 36

TNF is contraindicated for what patients?

Answer 36

- Demyelinating disorders - Severe HF - Active infections (TB and HBS infections)

Question 37

TNF exercise caution in what patients (6)

Answer 37

- HIV meds - Taking immunpsuppressing drugs - Diabetes - Mild HF - Liver dysfunction - Latent TB

Question 38

What are adverse effects of TNF?

Answer 38

- Injection site reactions (irritation, weakness, itching, pain, swelling) - Infections (pneumonia, flu, TB)

Question 39

What are the rare adverse effects of TNF?

Answer 39

- severe allergic (stevens johnson) reactions - HF (do not take TNF if you have HF!!) - Hepatotoxicty (JAUNDICE) - Cancer (immune system normally fights cancer, but TNF weakens the immune system)

Question 40

Explain why a client taking a TNF inhibitors should report being exposed to a communicable disease to their doctor.

Answer 40

There is an increased risk of infection while taking these drugs--pneumonia, TB, flu *immune system is suppressed and the body can't fight