Treatment of Rheumatoid Arthritis Flashcards
1
Q
- block the cylo-oxygenase enzymes (COX 1and 2)- less prostaglandin synthesis (less symptoms of inflammation)
- Cox-1 is constitutively expressed
- COX-2 is amplified and sustained in response to inflammation
- prostaglandins cause increased blood flow, pain, enhanced vascular permeability, fever etc
A
NSAIDs
2
Q
what are common side effects of NSAIDS based on systems? GI, Renal, CV, CNS, Derm, Heme,
A
- GI: gastritis, ulcers, hepatitis, pancreatitis
- renal: reduced GFR, edema, kidney failure
- CV: MI, hypertension
- CNS: headache, dizziness, aspetic meningitis
- derm: rashes, photosensitivity
- heme: bruising
others: asthma, can also have drug interaction with warfarin
3
Q
- temporary treatment until other medication have effect
- always affective
- use lowest effective dose, shortest duration
- injections: intra-articular for an active joint, local injections- tendinitis, carpal tunnel syndrome, rheumatoid nodules, I.M injections to stop flare
- dose: prednisone 10-30mg a day
- triamcinolone acetonide 40-120mg IM
A
Corticosteroids
4
Q
side effects of corticosteroids?
A
chronic treatment can lead to
- osteoporosis
- weight gain
- diabetes
- infections
Brief treatment
- few side effects
- if high dose: elevated blood sugar, insomnia, steroid psychosis
5
Q
which medications are DMARDs
A
- hydroxycholorquine
- sulfasalazine
- methotrexate
- Leflunomide
6
Q
what medications are JAK inhibitors
A
- tofacitnib
- barictinib
- upadacitinib
7
Q
- which medications or TNF-alpha inhibitors?
A
- entanercept
- infliximab (infusion every 8 weeks)
- adalimumab (injection every 2 weeks)
- golimumab (injection montly of infusion every 8 weeks)
- certoizumab (injection every 2 weeks)
- enbrel
- remicade
- humira
- cimzia
8
Q
which medications are IL-6 inhibitors?
A
- tocilizumab (injection every 1-2 weeks or infusion every 4 weeks)
- actemra
- sarilumab (injection every 2 weeks)
9
Q
which medication is Anti B cell
A
rituximab (two infusions 2 weeks apart, repeat as needed > 6 months)
rituxan
10
Q
- Analog of folic acid
- blocks dihydrofolate reductase and other enzymes
- inhibits purine and pyrimidine syntehsis
- increases extracellular adenosine
- decreases activity: T-cells, B-cells, monocytes
- Can be given orally or as an injection (always with folic acid 1mg a day)
- peak serum levles within 1-2 hours after dosing
- 6 months to full effect
A
Methotrexate
11
Q
adverse reactions of methotrexate?
A
- usually very well tolerated
- GI: nausea, mouth sores, anorexia
- hepatic: focal necrosis, cirrhosis
- hematopoetic: cytopenias, macrocytosi
- pulmonary: acute interstial pneumonia
- CNS: headaches, fatigue
- teratogenic
- Monitor CBC, transaminases, creatinine every 3 months
12
Q
- Decreases T and B cell proliferation
- decreaes immunoglobulin synthesis
- Active metabolite is tightly bound to plasma protein (steady state reached in 7 week)
- very long half life cholesytramine can be used to speed up elimination, tetratogenic
- clinical use: efficacy similar to MTX
- Side Effects: diarrhea rare- HTN, anorexia, neuropathy
A
Leflunamide
13
Q
- blocks toll like receptors
- pharmacology- extensively tissue bound,, long half-life (40 days) , very delayed action (6 months)
A
Hydroxycholoroquine
14
Q
colonic bacteria metabolize
* sulapyridine
* 5-aminosalicylic acid
Mechanism of action
- inhibits IL-2 induced T-cell proliferation
- changes B lymphocyte function
- reduces pro-inflammatory cytokines
A
Sulfasalazine
15
Q
side effects of hydroxychloroquine
A
- nausea-transient
- rash- early
- pigment changes
- myopathy, cardiomyopathy
- retinopathy- related to cumulative dose (baseline visual field exam and then yearly from the 5th year)
- headache
- depression
