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Pharmaco For Pod > wk 10- rheumatology > Flashcards

wk 10- rheumatology Flashcards

1
Q

what is RA

A

chronic autoimmune, systemic inflammation

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2
Q

what are aims for treatment of RA

A
  1. symptomatic relief (pain and stiffness)
  2. maintain level of function
  3. prevent damage to bones, joints and organs
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3
Q

TREAT TO target principle

A

goal is to be in remission or low disease activity with adapted therapy, if its not achieved in 3-6 months then alter therapy to achieve this

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4
Q

how do they monitor RA disease activity

A
  1. measuring inflammation through swollen/tender joint counts and or ESR and or CRP levels
  2. and patient reported outcomes questionaires
  3. joint damage throughout disease course with medical imaging

for activity level and deciding whether to change treatment

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5
Q

drug classes for RA

A
  1. corticosteroids
  2. calcineurin inhibitors
  3. monoclonal antibodies
  4. cytokine modulators
  5. antiproliferative immunsuppressants
  6. Disease Modifying Anti Rheurmatic Drugs
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6
Q

what are DMARDs

A

drugs that stop synovial inflammation and prevent joint damage

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7
Q

length and dosing of DMARDs

A

response should be seen within 12 weeks but can take up to 6 months

once control is achieved, the dose is reduced to lowest effective

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8
Q

types of DMARD therapy

A
  1. conventional synthetic disease modifying ARD
  2. biological disease modifying ARD
  3. targeted synthetic DMARDs
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9
Q

example of CSDMARDS

A

methotrexate
lefluomide
sulfasalazine
hydroxychloroquine

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10
Q

example of BDMARDS

A

abatacept
adalimumab
certolizumab
etanercept

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11
Q

example of targeted synthetic DMARDs

A

tofacitinib

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12
Q

treatment for RA

A

initially is a csDMARDS with or without a corticosteriod

typically
1. methotrexate
2. if MTX not tolerated, then lefluonmide

if remission not achieved with csDMARD then bDMARD or tsDMARD trialled

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13
Q

different severities of RA and initial treatment

A

mild RA- Hydroxychloroquine with or without sulfasalazine

mild-mod RA- MTX

active RA- combination therapy with the 3 above

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14
Q

pre screening before RA treatment, for what?

A
  • active infection
    -tuberculosis
    -vaccination status
  • liver, kidney, bone marrow
    -history of malignancy
  • reproductive health education
  • medication review
  • monitoring regime every 3-6 months
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15
Q

criteria for qualifying for a biologics (cytokine modulators)

A
  1. established severe active RA
  2. 6 more swollen and tender joints, 4 non hand joints or DAS 28 score 3.2 or more
  3. failed to get into remission with 2 stndard DMARDs, MTX being one of them
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16
Q

what do corticosteroids do

A

rapid symptoms control at presentation and control disease through anti inflammatory and DMARD effects

use while waiting for the effects of csDMARD

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17
Q

when to use NSAIDs with RA

A

before DMARD therapy is commenced to control symptoms but do not reduce joint damage

can also be used during flares of joint pain/swelling

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18
Q

MOA methotrexate

A

inhibits dihydrofolate reductase

19
Q

side effects of methotrexate

A

bone marrow suppression
liver toxicity
immunosuppression
folic acid

20
Q

hydroxychloroquine side effects/complications

A

risk of retinopathy with long term use
blood dyscrasias
ototoxicity- hearing/balance issues
major drug interactions with antacids, rosuvastatin, duloxetine, atorvastatin

21
Q

sulfasalazine side effects

A

increased photosensitivity
itching
skin rash
vomiting
drug interactions with aspirin, celecoxib, warfarin, lidocaine

22
Q

leflunomide MOA

A

inhibits dihydroorotate dehydrogenase

23
Q

leflunomide side effects

A

N, V, D
skin rash
alopecia- hair loss
drug interactions with aspirin, celecoxib, etanercept, adalimumab, atorvastaitn

24
Q

bDMARDs and MOA

A
  1. TNF-α: adalimumab, certolizumab, etanercept, golimumab, infliximab (all drugs bind and
    neutralise TNF)
  2. IL-1: anakinra (competitive inhibition of IL-1 receptors)
  3. IL-6: tocilizumab (binds to soluble and membrane-bound IL-6 receptors)
  4. Target B cells: Rituximab
  5. Target T Cells: Abatacept
25
Q

what do bDMARDS target

A

cytokines

26
Q

bDMards are associated with and complications that occur are

A

onychocryptosis
have to cease with nail surgery
increased risk of non serious infections (fungal)

27
Q

tsDMARDs moa

A

inhibit JAK1, 2, 3 to inhibit immune response

28
Q

what is included under spondyloarthropathies

A

psoriatic
reactive arthritis
ankylosing spondylitis

29
Q

treatment for anklyosing spondylitis

A

NSAIDS and exercise to control symptoms

if symptoms not controlled or severe disease, bDMARDs are used

csDMARDs no effect

30
Q

treatment for reactive arthritis and time course

A

commonly resolves within 6 months

  1. NSAIDs mild/mod symptoms
  2. prednisone severe symptoms
  3. local corticosteroid injection for isolated peripheral joint
31
Q

treatment of PsA

A
  1. NSAIDS symptoms
  2. corticosteroids for mono or oligoarticular peripheral arthriitis
  3. DMARD for polyarthritis or severe cases
    csDMARD- avoid hydroxychloroquine causes psorarias flare up
    bDMARD- if standard dont work
    tsDMARD as another option
32
Q

OA mangement/treatment

A
  1. exercise/weight loss
  2. paracetamol
  3. low dose, short acting NSAID as required, consider CSI
  4. higher dose NSAID
  5. oral opioid
33
Q

gout management of an acute attack

A

reduce inflammation through
1. local CSI
2. NSAID
3. prednisone
4. colchicine

34
Q

colchicine MOA

A

inhibits neutrophil motility and disrupts phagocytosis

35
Q

colchicine side effects

A

GI
neutropenia
neuropathy
anaemia
bone marrow suppression
interat with some statins

36
Q

chronic gout management

A

dissolve tophi
prevent future attacks
urate lowering therapy lifelong

  1. allopurinol- 1st line
  2. febuxostat
  3. probenecid
37
Q

allopurinol MOA

A

inhibits xanthine oxidase

38
Q

side effects of allourinol

A

headache
upset stomach
pruritic rash

39
Q

febuxostat MOA

A

inhibits xanthine oxidase

40
Q

adverse effects of febuxostat

A

small risk of CVD events

41
Q

dont change chronic mangement of gout when

A

during an attach can make worse

42
Q

difference between acute and chronic gate mangement

A

acute- symptom and pain relief
chronic- urate lowering to prevent recurrence

43
Q
A

Pharmaco For Pod (10 decks)

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