Term
|
Definition
NSAIDs of choice for symptommatic relief of RA
Must combine w/ DMARD |
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Term
|
Definition
| corticosteroid (systemic) of choice for brief relief of RA progression and symptoms |
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Term
| intra-articular injection given for symptomattic relief of RA? |
|
Definition
| triamcinolone (corticosteroid) |
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Term
Methotrexate
MOA? Cellular Effects? Dosing? Can be combined w/ __? Concerns? |
|
Definition
Inhibits Dihydrofolate reductase
decrease lymphocyte proliferation, chemotaxis, RhF production, and cytokine production. Once a week dosing. supplement folic acid. Monotherapy but can be combined w/ sulfasalazine
Watch liver functions! teratogenic. avoid alcohol |
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|
Term
Hydroxychloroquine
also used for ?
cellular effects?
other considerations? |
|
Definition
also used for malaria.
Stabilizes lysosomal enzymes. Reduces chemotaxis and IL-1 production
6 month delayed effect |
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Term
Sulfasalazine
converted to? effects are?
significant side effects?
Dosing? |
|
Definition
converted to sulfapyradine and mesalamine in GI which are anti-bacterials and anti-inflammatories.
Has significant GI effects
Commence w/ low dose |
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|
Term
Leflunomide
MOA?
Cellular effects?
what can you combine it with? side effects of that?
contraindications? |
|
Definition
inhibits dihydroorotate dehydrogenase which prevents T cell response to inflammatory stimuli.
Combine w/ methotrexate but beware of hepatotoxicity.
Contraindicated in hepatic/renal dysfunction |
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Term
| When are biological response modifiers indicated? |
|
Definition
| when combination regimens with DMARDs have failed. Add in the biologics, wait, then remove the DMARDs |
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Term
|
Definition
| etanercept (enbrel), adalimumab (humira), and infliximab (remicade) |
|
|
Term
| Name a IL-1 receptor antagonist |
|
Definition
|
|
Term
| Name a costimulation blocker |
|
Definition
|
|
Term
| Name a anti-CD20 Monoclonal antibody |
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Definition
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|
Term
Etanercept
MOA? dose/administered?typically used with ? How long to take effect? Adverse reactions? |
|
Definition
prevents biding of TNF to receptors. administered SubQ 2/week. Typically used w/ nothing. Effective monotherapy. effective 1-4 weeks. May combine w/ DMARDs but not anakinra.
adverse reactions are injection site reactions, headache, and dizziness |
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|
Term
Adilimumab
MOA? cellular effects? administration?
combine w/? adverse reactions? |
|
Definition
Binds TNF-a and prevents receptor binding. Causes Lysis of TNF expressing cells. SC administration every 2 weeks.
Can be used w/ DMARDS.
Reactions include infections, fever, and rash |
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|
Term
Infliximab
MOA? combine w/? administered? adverse reactions? |
|
Definition
IgG1 monoclonal antibody binding to TNF and inactivates it.
Can be combined w/ methotrexate.
IV infusion 4-8 weeks.
SE's include headache, pain, nausea, fever, dizziness, and rash |
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|
Term
Anakinra
contraindications? |
|
Definition
| IL-1 receptor antagonist. daily SC administration, combine w/ DMARDS is ok. Contraindicated w/ TNF antagonists |
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Term
|
Definition
| Block T-Cell signaling and activation. causes failure to respond to antigens. IV every 4 weeks. Can be combined w/ DMARDs. Contraindicated w/ TNF-anatogists and anakinra |
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Term
|
Definition
causes depletion of B-lymphs by binding to CD20. administered IV w/ long half life.
Indicated as monotherapy or w/ methotrexate
SEs - angioedema, fatigue, N/V, headache, hypotension, bronchospasm. rash urticaria.
Anti-HTN's stopped 12 hours previous to administration |
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|
Term
| biological response modifiers are contraindicated in what situations? |
|
Definition
| pts w/ infections and immunocompromised pts. |
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