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Rheumatoid Arthritis Background & Treatment
Rheumatoid Arthritis Background & Treatment
50
Pharmacology
Professional
09/16/2012

Additional Pharmacology Flashcards

 


 

Cards

Term
What is rheumatoid arthritis?
Definition
RA is an autoimmune disease.
Term
What does RA do physiologically to the body?
Definition

causes chronic inflammation of the joints and other organs in the body, including the kidneys, eyes, heart and lungs.

 

Inflammation leads to cartilage and bone destruction, resulting in the classic symptoms of RA: joint swelling, stiffness, pain and, eventually, bone deformity

Term
RA typically presents first in the?
Definition
hands and feet
Term
Diagnostic Criteria for RA?
Definition
[image]
Term
What is the treatment goal after one is diagnosed with RA?
Definition

The goal is to have the patient on a Disease-Modifying Antirheumatic Drug (DMARD) within 3 months of diagnosis.

 

Term

Those with severe cases of RA may require use of newer biologic agents. What are they and what are their benefits, if any?

Definition

Etanercept, adalimumab and infliximab. Each can be used with methotrexate. Said biologics have adverse effects, are costly, and do not work well for everyone but for many patients they significantly increase mobility and the quality of life

Term
Name non-DMARD agents used for pain and inflammation?
Definition

Ibuprofen;

Celecoxib;

Prednisone

 

Term
Brand name for ibuprofen
Definition
Motrin, Advil
Term
Brand name for Celcoxib?
Definition
Celebrex
Term
Brand name for Prednisone
Definition
Deltasone
Term
What is ibuprofen?
Definition

NSAID

 

Term
The otc dose of ibuprofen?
Definition
200-400 mg Q 6-8 hours
Term
What is the Rx dose of Ibuprofen?
Definition
600 - 800 mg TID for moderate pain or inflammation, such as with RA
Term
Black box warning with NSAIDs
Definition

Cardiovascular risk: NSAIDs may cause an increase risk of serious CV thrombotic events, MI, and stroke, which can be fatal

 

Gastroinetestinal: NSAIDs cause an increased risk of serious GI adverse events including bleeding, ulceration, and perforation of the stomach

Term
Contraindication for ibuprofen (and NSAIDs)
Definition
peri-op pain in the setting of CABG surgery
Term
ibuprofen is often recommended for what?
Definition
menstrual cramps & mild pain
Term
What is celecoxib?
Definition
COX-2 Selective Inhibitor
Term
Contraindication of Celecoxib?
Definition
sufla allergy
Term
Black box warning of Celecoxib?
Definition
same as NSAIDs
Term
Pregnancy category of celecoxib?
Definition

Pregnancy cat C prior to 30 weeks

Pregnancy cat D starting at 30 weeks

Term
Are steroids meant to be used long term?
Definition

No. For acute inflammation use only - steroids are not supposed to be used long-term - however, many patients use chronically due to severity of disease

Term
What should be done if steroids are used long term?
Definition

assess bone density and consider use of biphosphonates, optimize calcium and vitamin D intake

Term
Should steroids be tapered off?
Definition

Yes. If used longer than 2 weeks, taper dose off to avoid withdrawal symptoms

Term
Short-term side effects of steroid use?
Definition

Fluid retention, emotional instability (euphoria, mood swings, depression, insomnia), if high dose, can get an acute rise in blood glucose, possible rise in blood pressure.

 

 

Term
Long-term side effects of steroid use
Definition

Adrenal suppression/Cushing's syndrome, impaired wound healing, hypertension, hyperglycemia, cataracts, osteoporosis &c.

Term
[image]
Definition
Statement. Not a question.
Term

Name the Non-biologic Disease-Modifying Anti-rheumatic drugs (DMARDs) of note

Definition

Methotrexate;

Hydroxychloroquine

 

Term
Brand name of methotrexate
Definition
Rheumatrex
Term
Brand name for Hydroxychloroquine?
Definition
Plaquenil
Term
How does Methotrexate work?
Definition
Folate antimetabolie that inhibits DNA synthesis
Term
Is methotrexate taken daily?
Definition

NO. Used in low weekly doses for RA, or split into smaller doses. NEVER DAILY

Term
Black box warning for methotrexate
Definition
MANY!
Term
Pregnancy category of methotrexate?
Definition
Category X
Term
[image]
Definition
Statement. Not a question.
Term
Brand name for leflunomide?
Definition
Arava
Term
Leflunomide and pregnancy?
Definition

Must have negative pregnancy test before starting this medicine and use 2 forms of birth control.

 

If want to get pregnant, wait 2 years after discontinuation or give cholestryamine

Term
Name the biologic DMARDs of note?
Definition

Etanercept;

Adalimumab;

Infliximab;

 

[image][image][image][image]

Term
How do biologic DMARds work?
Definition
Tumor Necrosis Factor (TNFα) inhibitors
Term
Brand name for Etanercept
Definition
Enbrel;Enbrel Sureclick
Term
Brand name for Adalimumab
Definition
Humira, Humira Pen
Term
Brand name for Infliximab
Definition
Remicade
Term

Which of the biologics are self-injectable and considered first within the biologics?

Definition
Enbrel and Humira (they are SC injections)
Term
Can biologics be left out in room temperature?
Definition

NO! Requires refrigeration (biologics will denature if hot). DO NOT FREEZE

Term
Are biologics normally used as first line therapy?
Definition

No. usually, MTX is used 1st line and these agents are add-on therapy. However, if the initial presentation is severe, these can be started as initial therapy

Term
Can biologics be used in combination?
Definition
NO!
Term
Can live vaccines be given when one is on a biologic?
Definition
NO!
Term
MedGuides are dispensed with biologics. Why?
Definition

All TNF inhibitors carry a black box warning for risk of serious infections

Term
All TNF-blockers require what test prior to therapy initiation?
Definition
TB test
Term
[image]
Definition
Statement. Not a question.
Term
What are some other biologic DMARDs
Definition
[image]
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