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Reumato > Tratament AR > Flashcards

Tratament AR Flashcards

1
Q

Scor DAS28

A

masoara activitatea bolii prin

numararea nr articulatii dureroase si tumefiate

in 28 articulatii ale mb sup si genunchi

+

valori VSH

+

evaluare stare generala pacient

pe scala analogica vizuala

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2
Q

scor DAS28

A

>5,1 activitate inalta

<3,2 activitate scazuta

<2,6 remisiune

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3
Q

Pacienti nou diagnosticati, incepem cu

A

DMARD sintetice conventionale (csDMARD) cu actiune lenta

+

glucocorticoizi cu actiune rapida

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4
Q

Nu reusesc sa atinga activitate scazuta boala + remisiune cu csDMARD

A

DMARD biologice (bDMARD)

→ tot nu: alt bDMARD (switch)

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5
Q

Noua clasa terapeutica

DMARD sintetice tintite (tsDMARDs)

A

inhiba kinazele intracelulare Janus (JAK)

biodisponibilitate orala

debut rapid al actiunii

eficacitate similara cu bDMARD

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6
Q

AINS

Coxibii

A

efecte sec GI pronuntate / >65 ani

dam IPP (prazol)

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7
Q

Glucocorticoizi

A

cauza comuna osteoporoza secundara

→

asociere calciu / vitamina D / bifosfonati

→

⇓ riscul de fractura la pacientii cu trat cu gluco > 3 luni

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8
Q

Injectii intraarticulare

A

cu preparate semicristaline de glucocorticoizi

efect puternic, dar uneori de scurta durata

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9
Q

Injectii intramusculare de depozit

40-120 mg metilprednisolon depozit

A

inducere remisiune in timp ce asteptam ca csDMARD sa intre in actiune

control pusee severe

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10
Q

Glucocorticoizi pe cale orala

A

puternice

controleaza activitatea bolii

efecte adverse:

⇑ G

piele sensibila, usor lezabila

monitoriz DZ, HTA

cataracta

osteoporoza in decurs de 3 luni (osteodensitometrie + Ca / vit D / bifosfonati)

regimuri intensive precoce pe termen scurt → inducere remisiune

boala severa + manif extra-articulare (vasculita)

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11
Q

Medicamente antireumatice modificatoare de boala

A

efect benefic nu este imediat → 2-3 luni

monoterapie - csDMARD efect partial, imbunatatire 20-50% cf criteriilor ACR pentru remisiunea bolii

interventie precoce cu csDMARD in decurs de 3 luni de la debutul bolii imbunatateste rezultatul

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12
Q

Pot fi utilizate combinatii de pana la 4 medicamente

numar redus dupa ce s-a obtinut remisiunea

A

Hai la GSM

hidroxiclorochina

glucocorticoizi

sulfasalazina

metrotrexat

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13
Q

Metotrexat

A

NU IN TIMPUL SARCINII

excludem tuberculoza:

istoric de screening

Rx toracica

test IGRA

VACCINARE ANTI-PNEUMOCOCICA

ANUALA ANTI-GRIPALA

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14
Q

Metotrexat

A

7,5-10 mg oral initial

→ 15-25 mg conform strategiei T2T (treat to target)

bine tolerat

greata / absorbtia digestiva slaba → injectie subcutanata

+ ACID FOLIC oral → ⇓ efectele secundare

monitoriz: hemograma + biochimie hepatica

actiune in 1-2 luni

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15
Q

Sulfasalazina

A

doza initiala 500 mg/zi → doza de intretinere 2-3g/zi

bine tolerata

ok in timpul sarcinii

50% pacienti → raspund in primele 3-6 luni

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16
Q

Hidroxiclorochina

A

200-400 mg/zi

bine tolerata

monoterapie: boala usoara

adjuvant + DMARD

risc de retinopatie ireversibila cu cresterea dozei + duratei → examinare oftalmica formala initiala in decurs de 1 an de la inceperea tratamentului

apoi control oftalmo anual

17
Q

Leflunomida

A

20 mg/zi (10mg daca avem diaree)

previne producerea pirimidinei in limfocitele proliferante prin blocarea enzimei dihidro-orotat-dehidrogenaza

blocheaza expansiunea clonala a lf T

timp de injumatatire 4-28 zile → EVITARE LA FEMEILE CARE PLANIFICA SA PROCREEZE

monitoriz: hemograma, trombocite, biochimie hepatica

debut actiune dupa 4 saptamani + imbunatatire suplimentara la 2 ani

18
Q

Blocanti TNF-alfa

A

dupa ce cel putin 2 csDMARD (metotrexat si sulfasalazina) au esuat

in asociere cu METOTREXAT ⇓ pierderea eficacitatii din cauza formarii Ac anti-medicament

19
Q

Blocanti TNF-a

A

CE GAI

Certolizumab pegol

Etanercept

Golimumab

Adalimumab

Infliximab

20
Q

Etanercept

A

proteina de fuziune IgG1-receptor p75 de TNF-alfa complet umanizata

injectie subcutanata auto-administrata

21
Q

Adalimumab

A

anticorp monoclonal complet uman impotriva TNF-alfa

+ METOTREXAT

22
Q

Infliximab

A

anticorp monoclonal impotriva TNF-alfa

intravenos

+ METOTREXAT

23
Q

Certolizumab pegol

A

fragment Fab al unui anticorp monoclonal umanizat anti-TNF alfa

are grupuri polietilenglicol atasate care ⇓ imunogenitatea si prelungesc timpul de injumatatire

24
Q

Exista o asociere cunoscuta intre AR si

A

limfom non-Hodgkin

25
Q

Reactivarea tuberculozei este mai putin frecventa cu

A

Etanercept

26
Q

Daca sunt prescrise medicamente anti-TNF, infectia cu virus hepatitic B/C necesita

A

analize de risc + monitorizarea regulata a transaminazelor

27
Q

Medicamentele anti-TNF nu trebuie utilizate la

A

pacientii cu IC severa

Reumato (13 decks)

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