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12 Cards in this Set
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Arava (Leflunomide)
MOA Indication Dose Side effects Black box warning Immunosuppresion Skin rxn Drug elimination recommended? |
MOA: leflunomide is an immunodulatory agent that inhibits pyrimidine synthesis, resulting in antiproliferative and anti-inflammatory effects. Leflunomide is a prodrug. For CMV it may interfere w virion assembly
Indication - rheumatoid arthritis; indicated to reduce signs and symptoms, and to inhibit structural damage and IMPROVE PHYSICAL FUNCTION Dose - 100mg q d x 3 days; then 20 mg thereafter Side effects: Hepatotoxicity - initial monthly LFTs; d/c if AST 3x ULN BBW: not for women of child bearing age Immunosuppresion: check wbc, platelet, Hb, hematocrit monthly Skin rxn; SJS is a posibility Drug elimination recs. Use chlolestyramine 8 grams tid x 11 days to help increase leflunomide excretion |
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Rheumatrex, Trexall (Methotrexate)
MOA Indication Dose Side effects Black Box Warning Monitoring Therapeutic response Any supplements? Overdose |
MOA: folate antimetabolit that inhibits DNA synthesis, Methotrexate irreversibly binds to DIHYDROFOLATE REDUCTASE, and THYMIDYLATE SYNTHASE, resulting in inhibition of purine and thymidylic acid synthesis.
*Methotrexate is cell cycle specific for S PHASE Indication DOC for psoriatic arthritis rheumatoid arthritis Dose: 10-25 mg q wk Side effects: ulcerative stomatitis, leukopenia, nausea, abdominal distress, malaise, fatigue, chills, fever, dizziness, alopecia Black Box Warning Can be fatal - monitor for bone marrow, liver, lung and kidney toxicities. Hepatotoiicity, fibrosis and cirrhosis after prolonged use Monitor hematology monthly, LFTs and renal fnx q 1-2 months. Therapeutic Response 3-6 weeks Overdose Use leucovorin Can Supplement with Folic acid |
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Cuprimine (Penicillamine)
MOA Indication Dose Side effects |
MOA: chelates with lead, copper, mercury and other heavy metals to form stable, soluble complexes that are excreted in urine; depresses circulating IgM rheumatoid factor, depresses Tcell but not Bcell activity, combines with cystine to form a compound which is more soluble, thus systine calculi are prevented
Dose 125 or 250 mg/day; increase at 1-3 months *MAX 1.5 gm/day Indication Wilson's Disease - copper tox ACTIVE RA Cystinuria Cystinuria - inherited autosomal recessive disorder, characterized by formation of cystine stones in kidneys, ureter, and bladder Rheumatoid Arthritis - may take 2-3 months before therapeutic activity - sort of last line - restrict to pts with sever, active disease and failed to respond to conventional therapy Side effects Hematological - can be severe - CBC wtih Diff, HB, platelet counts q 2 wks Hematuria up to 15% |
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Plaquenil (hydroxychloroquine)
MOA Indication Not for use in... Dose Side effects Who are incredible sensitive to plaquenil? |
MOA: interferes with digestive vacuole fxn within sensitive malarial parasites by increasing the pH and interfering with lysosomal degradation of hemoglobin; inhibits locomotion of neutrophils and chemotaxis of eosinophils; impairs comlement-dependent antigen-antibody rxns
Indication: Suppression and treatment of acute attacks of malaria; treatment of systemic lupus erythematosus (SLE) and RHEUMATOID ARTHRITIS NOT for use in Psoriatic Arthritis - can cause rash Dose - 400-600mg q d (good response after 4-12 wks) Side effects - Retinopathy **CHILDREN are extremely sensitive to plaquenil...DO NOT GIVE TO CHILDREN |
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Aralen (Chloroquine)
Indication |
Used off label for RA
Indicated for malaria and extraintestinal amebiasis |
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Solganal (Aurothioglucose)
MOA Dose/Adminstration |
GOLD SALT
MOA: gold inhibits the release of HMGB1 by interfering with interferon beta and nitric oxide. HMGB1 (high mobility group box 1) is an abundant chromatin protein that acts as a cytokine Dose: 50 mg deep IM weekly; START with 10mg first week; 25mg second week; 50 mg first week |
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Ridaura (Auranofin)
MOA Dose/Administration |
GOLD SALT
MOA: gold inhibits the release of HMGB1 by interfering with interferon beta and nitric oxide. HMGB1 (high mobility group box 1) is an abundant chromatin protein that acts as a cytokine Dose: ONLY PO GOLD SALT 3mg bid, increase to tid after 6 months |
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Sandimmune, Neoral (cyclosporin)
MOA Indication Dose Side effects Blackbox Warning Labs before treatment Do not give what when taking? |
MOA: Inhibition of production and release of interleukin II and inhibits interleukin II-induced activation of resting T-lymphocytes
Indication Sandimmune; prophylaxis of organ rejection in kidney, liver, heart allogeneic transplants. Always used with adrenal corticosteroids Neoral RA Dose: Neoral for RA - 1.25mg/kg/day BID; may increase to 0.5-0.75 mg/kg/day after 8 wks and again after 12 wks *MAX 4mg/kg/day - stop if no benefit after 16 wks Decrease dose 25-50% if SCr 30% above baseline Onset of action usually 4-8 wks Side effects - renal dysfunction, HTN, HA, GI disturbances, hirsutism/hypertrichosis Blackbox - Neoral and Sandimmune are NOT bioequivelant; Neoral has INCREASED bioavailability compared to Sandimmune Labs before starting: Scr, BP, CBC, LFT DO NOT TAKE LIVE VACCINES |
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Azulfindine En-Tabs (Sulfasalazine)
MOA Indication Dose Side effects Labs DO NOT USE THIS |
MOA: acts locally in the colon to decrease the inflammatory response and systemically interferes with secretion by inhibiting prostaglandin syntesis
Indication: RA, psoriatic arthritis, Ankylosing spondylitis, ulcerative colitis, chron's disease Side effects: stomach upset, N/V, diarrhea, reversible oligospermia, may cuase urine to turn ORANGE, reversible when med is stopped Labs - CBC w diff, LFT before starting, and every 2 weeks for first three months of therapy. Also periodically check renal function DO NOT USE if allergic to other sulfa medications Also, use in caution with severe allergy or bronchial asthma Adequate water must be given to prevent crystalluria and stone formation *this drug is a combination of a Sulfa and a Salicylate |
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Enbrel (entanercept)
MOA Indication Dose Drugs used in conjunction Side effects Black Box Warning Drug Interactions |
MOA - recombinant DNA-derived protein composed of tumer necrosis factor receptor (TNFR) linked to the Fc portion of human IgG1. Etanercept binds TNF and blocks its interaction with cell surface receptors. TNF plays an important role in the inflammatory processes and the resulting joint pathology of RA, JIA, ankylosing spondlitis, and plaque psoriasis
Indication - RA, JIA, AS, plaque psoriasis Dose - 50 mg SC inj. once weekly Drugs used in conjunction - methotrexate and steroids Side effects - chills, cough, fever, sore throat, cloudy urine, pinkish hematuria Black Box Warning - test for TB prior to treatment **FDA has determined that TB is a potential ADR from treatment iwth TNF-alpha antagonists Drug Interactions: NO LIVE VACCINES Anakinra - increased rsk of serious infection Abatacept - increased rsk of ADR Cyclophosphamide - DO NOT DO IT |
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Remicade (infliximab)
MOA Indication Dose Blackbox Warning |
MOA - blocks the immune systems overproduction of TNF-alpha (TNF ANTAGONIST)
Indication: RA, psoriatic arthritis, plaque arthritis, ankylosing spondylitis, chrohns disease, ulcerative colitis Dose - RA - 3mg/kg IV follo with doses at 2 & 6 wks; then q 9 wks Chron's - 5mg/kg at 0, 2, 6 wks, then every 8 wks *if no response by wk 14, D/C BBW: check for TB; invasive fungal infections, opportunistic infections |
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Humira (adalimumab)
MOA Indication Dose BBW |
MOA - TNF antagonist
Indication - RA, JIA, Psoriatic arthritis, plaque psoriasis, alkylosing spondylitis, chron's Dose RA - 40 mg q other wk May be used with MTX, NSAIDs, other DMARDs, glucocorticoids, salicylates BBW: check for TB, invasive fungal, opportunistic infections |
