Msi Week 3: Is Treatment Of Rheumatologic Diseases

Front 1

List 7 drugs/ groups of drugs that can be used for symptomatic relief of rheumatologic diseases.

Back 1

1. Acetaminophen
2. Salicylates
3. NSAIDs
4. Codeine, opiods
5. Tramadol
6. Topical analgesics
7. Corticosteroids (also DMARD)

Front 2

What is Tramadol?

Back 2

Drug used for symptomatic treatments of rheumatologic diseases.

Front 3

List 8 non-biologic disease-modifying treatments.

Back 3

1. Methotrexate
2. Cyclophosphamide
3. Cyclosporine, Minocycline, tacrolimus, gold D-penicillamine
4. Sulfasalazine
5. Hydroxychloroquine
6. Leflunomide
7. Azathioprine
8. Mycophenolate

Front 4

What type of treatment is Leflunomide?

Back 4

Non-biologic disease-modifying treatment

Front 5

What type of treatment is Azathioprine?

Back 5

Non-biologic disease-modifying treatment

Front 6

What type of treatment is Mycophenolate?

Back 6

Non-biologic DMARD

Front 7

List 5 Anti-TNF agents.

Back 7

1. Adalimumab
2. Infliximab
3. Etanercept
4. Golimumab
5. Certolizumab

Front 8

Aside from the Anti-TNF agents, list 5 biologic disease-modifying treatments.

Back 8

1. Abatacept
2. Anakinra
3. Belimumab
4. Rituximab
5. Tocilizumab

Front 9

What type of treatment is Golimumab?

Back 9

Anti-TNF biologic disease-modifying treatment

Front 10

What type of treatment is Certolizumab?

Back 10

Anti-TNF biologic disease-modifying treatment

Front 11

In RA, what drug is often used for short-term control ("bridge therapy") while awaiting effects of slow-acting drugs?

Back 11

Oral prednisone
(corticosteroid)

Front 12

What drug is often helpful for symptom control in low doses (<10 mg/day) in RA, and may have a disease modifying effect?

Back 12

Oral prednisone
(corticosteroid)

Front 13

What type of diseases require high-dose treatments of prednisone?

Back 13

1. SLE
2. Polymyositis
3. Vasculitis

*Once control of activity is achieved, the dose is slowly lowered.

Front 14

With high doses of prednisone, what type of side effects might ensue?

Back 14

1. Infection
2. Diabetes
3. Hypertension
4. Cushing's syndrome (hypercortisolism)

With long term use:
1. Osteoporosis
2. Cataracts

Front 15

What 2 supplements are often given along with prednisone to mitigate some of its side effects?

Back 15

1. Calcium
2. Vitamin D

Front 16

What treatment is used for severe diseases, such as lupus nephritis?

Back 16

Methylprednisolone (pulsed dose)
(corticosteroid)

Front 17

What type of treatments are injected into the joints, bursae, tendon sheaths, or soft tissues for longer-duration local effects w/ less systemic side effects?

Back 17

Intraarticular corticosteroids
1. Triamcinolone acetonide
2. Depo-methylprednisolone

Front 18

What treatment is often used in RA when one or two joints remain active or initially if severely affected? Also, this treatment is used sometimes to control acute gout, tendinitis or bursitis, or other localized rheumatic conditions.

Back 18

Intraarticular corticosteroids

Front 19

Which DMARD increases adenosine, thereby decreasing inflammation?

Back 19

Methotrexate
(folate antagonist; inhibits purine/pyrimidine synthesis)

Front 20

Methotrexate is FDA-approved for which 3 rheumatologic diseases?

Back 20

1. Rheumatoid arthritis
2. Juvenile idiopathic arthritis
3. Psoriasis

Front 21

How is methotrexate eliminated?

Back 21

Primarily by the kidneys
(retained in kidneys for several weeks, and in the liver for months)

Front 22

What is methotrexate converted to in the body?

Back 22

MTX polyglutamates in RBCs

Front 23

What is the timeline for the onset of effect and maximum effect of methotrexate?

Back 23

Onset: 3-6 weeks
Max. effect: 3-6 months

(disease may flare within 1 month if discontinued)

Front 24

What is the most common side effect of methotrexate?

Back 24

GI problems (nausea, diarrhea)

Front 25

What are some of the toxic effects of Methotrexate?

Back 25

1. Hepatotoxicity (fibrosis and cirrhosis may occur)
2. Acute hypersensitivity pneumonitis
3. Nephrotoxicity
4. Myelosuppression
5. Increased risk of infection
6. Fetal abnormalities

Front 26

Why should you be concerned about prescribing Methotrexate to a patient with a pre-existing lung disease?

Back 26

Can result in acute hypersensitivity pneumonitis

Front 27

To decrease Methotrexate toxicity, what supplement is often prescribed?

Back 27

Folic acid
(Decreases risk of stomatitis, liver toxicity, hematologic toxicity)

Front 28

Methotrexate can be used to treat which 3 diseases?

Back 28

1. Rheumatoid arthritis
2. Juvenile idiopathic arthritis
3. Psoriasis

Front 29

Sulfasalazine can be used to treat which 2 disease?

Back 29

1. Rhematoid arthritis
2. Juvenile idiopathic arthritis

Front 30

Leflunamide (along w/ Methotrexate) can be used to treat which disease?

Back 30

Rheumatoid arthritis

Front 31

Hydroxychloroquine can be used to treat which 2 diseases?

Back 31

1. SLE
2. Rheumatoid arthritis

Front 32

Leflunamide is used to treat which disease?

Back 32

Rheumatoid arthritis

Front 33

Azathioprine can be used to treat which 4 diseases?

Back 33

1. SLE
2. Rheumatoid arthritis
3. Polymyositis
4. Dermatomyositis

Front 34

Mycophenolate is used to treat which disease?

Back 34

SLE

Front 35

Which 4 drugs can be used to treat SLE?

Back 35

1. *Hydroxychloroquine
2. Azathioprine
3. *Mycophenolate
4. Cyclophosphamide

*= FDA approved

Front 36

Which 5 drugs can be used to treat juvenile idiopathic arthritis?

Back 36

1. Methotrexate
2. Sulfasalazine
3. Etanercept
4. Adalimumab
5. Abatacept

Front 37

Which 4 diseases can both Etanercept and Adalimumab be used to treat?

Back 37

1. Rheumatoid arthritis
2. Juvenile idiopathic arthritis
3. Psoriatic arthritis
4. Ankylosing spondylitis

(pretty much every form of arthritis!)

Front 38

Which drug is an investigational drug formulated to treat lupus?

Back 38

Belimumab`

Front 39

Which biologic DMARD inhibits the CD20 antigen on B cells?

Back 39

Rituximab

Front 40

Which biologic DMARD inhibits T cell activation by blocking the CD80/CD86 - CD28 interaction?

Back 40

Abatacept

Front 41

Which biologic DMARD inhibits IL-1 receptor (IL-1Ra)?

Back 41

Anakinra

Front 42

Which biologic DMARD inhibits IL-6 receptor?

Back 42

Tocilizumab

Front 43

Which biologic DMARD inhibits soluble B-lymphocyte stimulator (BLyS)?

Back 43

Belimumab

Front 44

Which diseases can Etanercept and Adalimumab approved to treat?

Back 44

1. RA
2. JIA
3. Psoriatic arthritis
4. Ankylosing spondylitis

Front 45

Which diseases is Golimumab approved to treat?

Back 45

1. RA
2. Psoriatic arthritis
3. Ankylosing spondylitis

Front 46

Which biologic DMARDs are only FDA approved for treating Rheumatoid arthritis?

Back 46

1. Infliximab
2. Certolizumab Pegol
3. Anakinra
4. Rituximab
5. Tocilizumab

Front 47

What 2 diseases is Abatacept approved to treat?

Back 47

1. RA
2. JIA