Term
| DMARDs all suppress ______________ even though they are different drugs with different MOAs. |
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Definition
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Term
| DMARDs are considered ___________ drugs bc they slow the progression of the disease. |
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Definition
|
|
Term
| how long does it take DMARDs to start working? |
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Definition
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Term
| Which drugs are Gold Compounds (DMARDs)? |
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Definition
Auranofin - PO
Aurothioglucose - IV
Gold Sodium Thiomalate - IV |
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Term
| Are IV or PO gold compounds more effective? |
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Definition
| IV, and it produces are response faster |
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Term
What percentage of patients on gold compounds have extremely beneficial results?
relatively beneficial results? |
|
Definition
extremely 10%
relatively 30-40% |
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Term
|
Definition
test dose of 10 mg IM
2nd and 3rd wks: dose of 25mg
thereafter, weekly injections of 50mg IM until 0.8 to 1.0 gram is given
continue w/ 25-50mg every 3 wks indefinitely |
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Term
when should you D/C gold salts?
why? |
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Definition
if no improvement after the first gram
bc it stays in the system a long, long time |
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Term
|
Definition
50% will experience D, N, V, flatulence, abd cramps
15-25% will get mucocutaneous rxns: stomatitis, glossitis, conjunctivitis and alopecia
less commonly - nephrotic syndrome and blood dyscrasias |
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Term
| All DMARDs can be combined with _______. This _________ the dose of DMARDs needed. |
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Definition
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Term
|
Definition
stomatitis, gingivitis, glossitis, pharyngitis, tacheitis, vaginitis
severe blood dyscrasias
renal and hepatic damage
rare - anaphylaxis |
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|
Term
| What do you monitor after every injection of gold salts? |
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Definition
|
|
Term
| which DMARD would you use first? |
|
Definition
|
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Term
|
Definition
arachnoiditis
reddening of skin
hyperuricemia, defective oogenesis or spermatogenesis
GI
leukopenia, thrombocytopenia
renal failure, nephropathy |
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Term
| methotrexate's main use is: |
|
Definition
|
|
Term
| what should you take daily when you're on methotrexate? |
|
Definition
|
|
Term
| Methotrexate Contraindications |
|
Definition
teratogenic/preg/breast feeding
kidney, liver and lung disease
moderate to high alcohol intake
immunodeficiency
blood dyscrasias |
|
|
Term
| methotrexate Drug Interactions |
|
Definition
NSAIDs dec clearance
phenytoin, sulfonylureas and sulfonamides displace methotrexate from PB sites |
|
|
Term
| why is the tolerance of methotrexate better in those taking it for RA as opposed to cancer? |
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Definition
| bc the dose is SO much lower and less frequent |
|
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Term
| Sulfasalazine is approved for use in: |
|
Definition
|
|
Term
which DMARD has 2 active metabolites?
what are they? |
|
Definition
Sulfasalazine
sulfapyridine
5-aminosalicylic acid (mesalamine) |
|
|
Term
|
Definition
GI effects
HA
skin rash, discoloration
elevation of liver enzymes
rare hematological rxns, but can be fatal |
|
|
Term
| what allergies do you want to ask about when prescribing sulfasalazine? |
|
Definition
|
|
Term
| what can sulfasalazine cause in infants and children? |
|
Definition
|
|
Term
|
Definition
can inhibit the absorption of cardiac glycosides and folic acid
can dec effectiveness of OCPs
can displace warfarin, phenytoin, methotrexate, sulfonylureas from PB sites |
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Term
| which DMARD is an antimalarial, and a relative of chloroquin? |
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Definition
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Term
| hydroxychloroquin is indicated for: |
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Definition
|
|
Term
|
Definition
| inhibits the function of lymphocytes, monocytes, and macrophages |
|
|
Term
| why is hydroxychloroquin is recommended over chloroquin? |
|
Definition
| bc it has fewer ocular effects |
|
|
Term
|
Definition
HA
skin rashes
mild GI sxs
irreversible retinopathy with blindness |
|
|
Term
| where can hydroxychloroquin accumulate? |
|
Definition
|
|
Term
| when you have a patient on hydrochloroquin what should you inquire about? |
|
Definition
blurred vision
scotomas
night blindness |
|
|
Term
| what are the drug interactions with hydroxychloroquin? |
|
Definition
can inc digoxin and penicillamine levels
+ gold compounds = additive dermatological problems |
|
|
Term
| most DMARDs are contraindicated in ____________ |
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Definition
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|
Term
| how long can leflunomide remain in the body after discontinuation? |
|
Definition
|
|
Term
|
Definition
| prevents RNA and DNA synthesis in immune cells |
|
|
Term
| how many patients on leflunomide get diarrhea? |
|
Definition
|
|
Term
| leflunomide is specifically used to treat _______________ |
|
Definition
|
|
Term
| what are the SEs of leflunomide? |
|
Definition
diarrhea
indigestion, N, V
reversible alopecia, hepatic toxicity |
|
|
Term
| Leflunomide inhibits _____________ |
|
Definition
CYP2C9
which causes a lot of possible interactions, including NSAIDs |
|
|
Term
|
Definition
NSAIDs
rifampin
cholestramine |
|
|
Term
| TNF inhibitors are designed to... |
|
Definition
| interfere with the inflammatory actions initiated by TNF |
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|
Term
| which drugs are TNF inhibitors |
|
Definition
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|
Term
| etanercept, a TNF-inhibitor, is indicated for the txt of: |
|
Definition
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|
Term
| infliximab, a TNF-inhibitor, is approved for... |
|
Definition
| use in adults with RA and Crohn's disease |
|
|
Term
| which drug is a recombinant fusion protein produced in Chinese hamster ovary cells which binds to TNF alpha and beta and forms insoluble complexes and lowers the circulating levels of each? |
|
Definition
|
|
Term
| how is etanercept administered? |
|
Definition
|
|
Term
|
Definition
HA
Injection site rxns
weakens body's response to infectious agents and serious infections and sepsis |
|
|
Term
| etanercept should not be initiated in pt's with... |
|
Definition
|
|
Term
| which kind of vaccines are contraindicated in those using etanercept/infliximab? why? |
|
Definition
live virus vaccines
potential transmission of the virus |
|
|
Term
| which TNF inhibitor only inhibits alpha (not beta) |
|
Definition
|
|
Term
| how do you admin infliximab? |
|
Definition
|
|
Term
|
Definition
acute infusion rxn consisting of fever and chills
HA, N, D
CP, skin rashes
|
|
|
Term
| is infliximab or etanercept more immunogenic? |
|
Definition
|
|
Term
| if a person has known hypersensitivity to murine proteins which drug to you not want to put them on? |
|
Definition
|
|
Term
| which drug is an interleukin-1 antagonist? |
|
Definition
|
|
Term
|
Definition
gold salts
methotrexate
sulfasalazine
hydrocholorquin
Leflunomide
TNF-inhibitors (Etanercept, Infliximab)
Interleukin-1 Antagonist (Anakinra) |
|
|
Term
| Anakinra is used to treat... |
|
Definition
| moderate to severe RA in adults who have not responded to other DMARDs |
|
|
Term
| Interleukin-1 Antagonists can be used in combo with other DMARDs except... |
|
Definition
|
|
Term
| do humans produce interleukin-1ra? |
|
Definition
| yes, but not enough to counteract the high levels of locally produced IL-1 |
|
|
Term
|
Definition
injection site pain and irritation
neutropenia and inc risk of infection
opportunitistic infs |
|
|
Term
| 3rd line therapies for RA |
|
Definition
Immunosuppressive agents (azathioprine, cyclosporine, cyclophosphamide)
and penicillamine |
|
|
Term
| how does axathioprine treat RA? |
|
Definition
| inhibits lymphoctye proliferation and secretion of certain cytokines |
|
|
Term
| Immunosuppressive agents find their major use in treating what? |
|
Definition
|
|
Term
| cyclosporine treats RA by: |
|
Definition
| blocking the transcriptions of genes involved in T-cell activation |
|
|
Term
| which immunosuppressive drug is very toxic and rarely used? |
|
Definition
|
|
Term
| all immunosuppressive drugs have the... |
|
Definition
| potential of bone marrow suppression and other serious problems |
|
|
Term
| what are immunosuppressive drugs indicated for? |
|
Definition
| refractory RA and certain other autoimmune conds |
|
|
Term
|
Definition
maculopapular
pruritic dermatitis
GI distress
loss of taste
blood dycrasias
proteinuria |
|
|
Term
| can you use penicillamine if you are allergic to penicillin? |
|
Definition
|
|
Term
| contraindications of laxative use |
|
Definition
appendicitis, regional enteritis, diverticulitis, UC
pts w/ an acute surgical abdomen
in presence of fecal impaction or obstruction of the bowel (bc you could rupture it) |
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