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Flashcards in Rheum- RA COPY Deck (61)
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1

Which group of meds is used in treatment of RA but not in the treatment of OA?

DMARDs

(Disease modifying antirheumatic drugs)

2

What are the 4 deformities of rheumatoid arthritis?

1. Marked ulnar deviation

2. Swan-neck deformity

3. Active Synovitis

4. Nodules 

3

Goal of RA treatment:

  • Early aggressive treatment to prevent what 2 things

irreversible joint damage and disability

4

Which RA patients can be treated with oral agents as monotherapy?

Patients w/ less active disease and good prognostic indicators

5

Which RA patients are candidates for combination therapy and biologics to suppress inflammation

Patients with high disease activity and/or poor prognostic features

6

Within how many months of the diagnosis of RA should DMARDs be started?

3 months

7

Which 2 meds should be considered adjunctive therapy to DMARDS early in the course of treatment of RA?

NSAIDS and/or corticosteroids

(needed if sxs are not adequately controlled w/ DMARDs)

8

Which med is first line tx for RA?

DMARDs either as monotherapy or in combination

***Methotrexate (DMARD) often chosen

 

9

What is important to monitor in a pt taking methotrexate? How will you know if they are deficient?

folic acid

will get stomatitis (mouth sores) if deficient

10

RA treatment options:

What is used in Early disease of high activity and presence of poor prognostic factors

Biologics

(ACR endorses use of anti-TNF biologics regardless of DMARD use)

11

RA treatment options:

American College of Rheumatology (ACR) now endorses the use of _______ biologics in patients regardless of previous DMARD use

anti-TNF BIologics

12

Which 2 biologic agents have proven effective for patients who fail treatment with other DMARDs

Anti-TNF (TNFi) and non-TNF biologic agents (B cell inhibitors, IL-inhibitors, co-stimulation modifiers)

13

What are the 2 options if one DMARDs is ineffective or not adequately effective to induce response

  • combination therapy with two or more DMARDs
  • DMARD plus biologic agent may be used (ex: Methotrexate + Infliximab)

14

T/F: Methotrexate is less effective than biologic monotherapy

FALSE
Methotrexate is more effective

15

Why is Infliximab given in combo w/ Methotrexate?

to prevent development of infliximab antibodies that may reduce drug efficacy or induce allergic reactions.

16

Non Biologic RA combination treatment examples:

Initial combo therapy w/ either:

  • Methotrexate with _____
  • Sulfasalazine plus ______
  • Infliximab plus ______

  • Methotrexate with etanercept
  • Sulfasalazine plus prednisone
  • Infliximab plus methotrexate

17

For patients with moderate-to-high RA disease activity, ACR recommends dual DMARD combinations of:

  • methotrexate plus ________
  • methotrexate plus ________
  • methotrexate plus ________

Hydroxychloroquine

Leflunomide

Sulfasalazine

18

Non Biologic Combination Treatment Examples:

ACR recommends a triple combination of .....

Methotrexate, sulfasalazine, and hydroxychloroquine

19

Methotrexate:

Results as early as how long?

2-3 weeks

20

MOA of Methotrexate:

  • **Inhibits ______ production, inhibits _______biosynthesis, and may stimulate release of adenosine--leads to its antiinflammatory properties
  • Cytotoxic to rapidly dividing immune cells due to inhibition of dihydrofolate reductase

Inhibits cytokine production, inhibits purine biosynthesis

21

Which non-biologic DMARD is a folic acid antagonist- leading to deficiency? What could you give with it to reduce this adverse rxn?

Methotrexate

may be given w/ folic acid 1-5mg/week

22

What are the 6 contraindications of Methotrexate?

 

  • Pregnancy-teratogenic and nursing women
  • Chronic liver disease
  • Immunodeficiency
  • Pleural or peritoneal effusions
  • Leukopenia, thrombocytopenia,
  • CrCl <40ml/min

23

Toxicities of which med? Which may you see first?

–GI-N/V/D

–hematologic-thrombocytopenia

–pulmonary fibrosis and pneumonitis

–hepatic-elevated liver enzymes

–Stomatitis

Methotrexate

may see stomatitis first

24

If you have a patient take Methotrexate and they develop stomatits, what does this mean?

Folate deficiency

25

What are the 4 "work horses" of RA?

1. Methotrexate

2. Leflunomide

3. Hydroxychloroquine

4. Sulfasalazine

26

MOA of which med?

•inhibits pyrimidine synthesis--> decrease in lymphocyte proliferation and modulation of inflammation

Leflunomide

27

What are the 2 contraindications for Leflunomide?

1. Liver disease

2. Teratogenic

28

What is the half life of Leflunomide (non-biologic DMARD_?

14-16days 

(long half life)

29

What are the 4 toxicities of Leflunomide (non-biologic DMARD)?

  • GI
  • hair loss
  • liver
  • bone marrow toxicity

30

Mechanism of which med?

•dampen antigen–antibody reactions at sites of inflammation

Hydroxychloroquine