Arthritic Disease

Front 1

Drugs against circulating Pro-Inflammatory Cytokines

Back 1

Infliximab
Adalimumab
Etanercept
Anakinra

Front 2

Miscellaneous Drugs

Back 2

Penicillamine
Hydroxychloroquine/Chloroquine
Sulfasalazine

Front 3

Cytotoxic Drugs

Back 3

Methotrexate
Azathioprine
Leflunomide
Cyclosporine

Front 4

MoA of Infliximab

Back 4

Human/Mouse chimeric IgG1 monoclonal antibody; binds to soluble and transmembrane forms of TNF-alpha, preventing it from binding to its receptors on cells;
RoA: IV infusion every 8 weeks;
Clinical Uses: RA (w/ methotrexate), Crohn's disease, ulcerative colitis, ankylosing spondylitis, psoriatic arthritis, IBD

Front 5

AE of Infliximab

Back 5

Abdominal pain, fatigue, headache, infusion reactions, upper respiratory infections, urinary tract infections, hypersensitivity reactions, TB, lymphoma, and CHF

Front 6

MoA of Adalimumab

Back 6

Fully humanized monoclonal IgG1 antibody; blocks interaction of TNF-alpha with TNF receptors on cell surfaces; reduces levels of CRP, IL-6, ESR, MMP1, and MMP3;
RoA: SC injection every 14 days;
Clinical Uses: RA, ankylosing spondylitis, Crohn's disease, psoriasis with arthropathy

Front 7

AE of Adalimumab

Back 7

BLACK BOX WARNING: TB, invasive fungal infections, other opportunistic infections;
AEs: exacerbates CHF, serious infections, lupus-like syndrome

Front 8

MoA of Etanercept

Back 8

Recombinant fully human TNF receptor; acts like the receptor itself, tricking TNF-alpha & TNF-beta to bind to it instead of it's real receptors;
RoA: SC injection every week;
Clinical Uses: RA, psoriatic arthritis, juvenile arthritis

Front 9

AE of Etanercept

Back 9

AE: injection site rxns, autoantibody formation, hypersensitivity rxns, serious infections, increased risk of cancer;
CI: documented hypersensitivity, MS, sepsis, concurrent live vaccination

Front 10

MoA of Anakinra

Back 10

Recombinant human IL-1 receptor antagonist; binds to IL-1 and prevents it from binding to cells to produce inflammatory cytokines;
RoA: SC injection, every day;
Clinical Uses: RA

Front 11

AE of Anakinra

Back 11

Headache, injection site rxn, GI distress, infections, decreased white cell count, antibody formation to Anakinra

Front 12

MoA of Penicillamine

Back 12

Uncertain of MoA, chelates copper;
RoA: oral;
Clinical Uses: Wilson's disease, RA (if other drugs have failed)

Front 13

AE of Penicillamine

Back 13

Cutaneous lesions, blood dyscrasias/bone marrow suppression (may be fatal!), hypersensitivity rxns, myasthenia gravis;
CI: Goodpasture's Syndrome

Front 14

MoA of Hydroxychloroquine/Chloroquine

Back 14

Suppresses response of T-cells, decreases leukocyte chemotaxis, stabilizes lysosomal membranes, inhibits DNA/RNA synthesis, traps free radicals therefore reducing ROS;
RoA: Oral
Clinical uses:
Hydroxychloroquine - RA
Chloroquine - prophylaxis for malaria and malaria treatment, SLE, porphyria cutanea tarda

Front 15

AE of Hydroxychloroquine/Chloroquine

Back 15

Irreversible retinal degeneration (EYE EXAM is recommended EVERY 6 months!!), dermatitis, myopathy, GI irritation, and nightmares

Front 16

MoA of Sulfasalazine

Back 16

Salicylates class; inhibition of COX enzymes along with decreased PG synthesis;
RoA: oral;
Clinical Uses: ONLY NSAID used in RA and ulcerative colitis

Front 17

MoA of Methotrexate

Back 17

Usually anchor drug in combo therapy with anti-TNF-alpha agents (i.e. infliximab);
RoA: oral
Clinical Uses: RA (most commonly prescribed DMARD)

Front 18

AE of Methotrexate

Back 18

GI-related: nausea, vomiting, anorexia, diarrhea; leukopenia, MTX lung (hypersensitivity rxn), hepatotoxicity;
CPCs and LFTs are MANDATORY!!

Front 19

MoA of Leflunomide

Back 19

Inhibits pyrimidine synthesis by blocking dihydrotate dehydrogenase, also inhibits T & B- cell proliferation;
Clinical Uses: moderate to severe RA, psoriatic arthritis

Front 20

AE of Leflunomide

Back 20

GI toxicity, increased transaminases, rash & allergic rxns, reversible alopecia, headache, renal impairment; TERATOGENIC!