Pharm Spring Final - Ra

Front 1

RA is characterized by...

Back 1

symmetrical arthritis
joint deformity/erosions

Front 2

extra articular effects of RA

Back 2

pericarditis
pleurisy
episcleritis and scleritis

Front 3

__ % of the population is affected by RA

Back 3

1

Front 4

RA is __ times more prevalent in women than men until...

Back 4

3X
after 5th decade it becomes 1:1

Front 5

t/f about half of pts w/ advanced RA will have shortened lifespans by as much as 18 years

Back 5

T

Front 6

structural damage occurs w/in the ______ years w/ RA

Back 6

first 2-3

Front 7

poor prognosis indicators for RA

Back 7

fxnl limitation
extra-art. dz
+ RF
+ CCP
bony erosions on x-ray

Front 8

t/f autoimmunity and genetics are established etiologies of RA

Back 8

t

Front 9

what plays a suspected role in the etiology of RA

Back 9

infectious dz
-HTLV-1
-rubella
-viral illnesses
-mycobacteria

Front 10

t/f RA tx is based on trying to reverse changes

Back 10

F, changes can't be reversed
just try to stop from progressing

Front 11

non-pharm tx of RA includes...

Back 11

rest
exercise
diet/weight control
physical therapy

Front 12

t/f analgesic and anti-inflamm drugs do not modify the dz progression

Back 12

T

Front 13

____ effect of NSAIDs is quick but the ____ effect may take ___ weeks

Back 13

analgesic
anti-inflamm
4-6

Front 14

role of corticosteroids in RA tx

Back 14

-initial, while waiting for DMARDs to work
-combo w/ NSAIDs when DMARDs aren't adequate
-for acute flares, dec. inflamm

Front 15

____ dose of corticosteroids should be used to avoid

Back 15

lowest effective
ADRs

Front 16

long term prednisone use can lead to...

Back 16

bone loss

Front 17

which roid is preferred to use for RA

Back 17

prednisone

Front 18

toxicities of long-term steroid use

Back 18

bone loss (50% of pts)
cataracts
atherosclerosis

Front 19

t/f long term low-dose glucocorticoids may be effective for many years

Back 19

F
dec. in anti-inflamm effect after 1st year

Front 20

t/f cytokines are produced in large amounts and work systemically

Back 20

F

Front 21

what cytokine plays a role in the destructive proces in bone

Back 21

IL-1

Front 22

TNF stimulates...

Back 22

-growth of rheumatoid synovial tissue
-neutrophils, fibroblasts and chondrocytes
-induces macrophage production of other pro-inflamm cytokines

Front 23

t/f tx w/ anti-TNF prevents joint destruction and returns the joint to a more normal state

Back 23

T

Front 24

t/f MTX alone is as effective as MTX + steroid w/ taper and TNF inhibitor

Back 24

F
the combo resulted in earlier fxnl improvement and less radiographic damage after 1 year

Front 25

advantages of dmards

Back 25

-reduce signs and symptoms of RA
-reduce fxnl disability
-retard radiographic progression

Front 26

what is the most commonly used non-biologic dmard and the most common choice for initial monotherapy

Back 26

mtx

Front 27

name the recommended nonbio. dmards

Back 27

mtx
leflunomide
hydroxychloroquine
sulfasalazine
minocycline

Front 28

what is the DOC for moderate to severe dz/aggressive dz

Back 28

mtx

Front 29

MOA of mtx

Back 29

dec. TNF-alpha
inc. IL-10
*acts by inhibiting AIRCR
*can affect chemotaxis
*folate antagonist (enters cell w/ reduced folate carrier)

Front 30

ADRs of mtx

Back 30

-GI upset
-hepatofibrosis and cirrhosis
-myelosuppression
-interstitial pneumonitis
-stomatitis (responds to folic acid)
-alopecia

Front 31

what ADR of mtx gets better when given folic acid

Back 31

stomatitis
but may dec. anti-rheumatoid effect

Front 32

what do you need to monitor w/ mtx

Back 32

CBC q 4 mos.
LFTs q 8-12 mos.

Front 33

what's in sulfasalazine

Back 33

sulfapyradine and ASA

Front 34

MOA of sulfasal.

Back 34

-antimicrobial portion (sulfa) is activated in small intestine
-suppresses TNF-a, IL1
-inhibits chemotaxis and neutrophil migration
-enhances adenosine release (dec. inflamm)

Front 35

t/f sulfasal. has ADRs but they are not severe

Back 35

F
25% of pts d/c therapy due to ADRs

Front 36

ADRs of sulfasal

Back 36

-GI distress (enteric coating dec. it)
-rash
-hepatitis
-blood dyscrasias (rare)

Front 37

t/f you need to check CBCs and LFTs on sulfasal

Back 37

T
check q 2-4 weeks for first 3 mos
then q 3 mos. after

Front 38

sulfasal may be combo'd w/....

Back 38

mtx
hydrochloroquine

Front 39

t/f sulfasal works better than gold

Back 39

T

Front 40

MOA of leflunomide

Back 40

prevents CD4 T cells prolif. in early RA
alter IL-2 and growth factor conc.
inhibits leukocyte adhesion

Front 41

who is leflunomide good for and why

Back 41

pts who can't tolerate mtx
it's $$$$

Front 42

how long can benefit from leflunomide be sustained

Back 42

at least 2 yrs

Front 43

what nonbio. dmard requires a loading dose

Back 43

leflunomide

Front 44

which nonbio dmard was designed to target T-cells, making it more selective

Back 44

leflunomide

Front 45

metab, half-life and onset of leflunomide

Back 45

-rapid conversion in intestine and plasma and then extensive metab in liver
-2 week half life
-rapid onset (faster than mtx)*

Front 46

ADRs of leflunomide

Back 46

rash
diarrhea
alopecia
inc. LFTs

Front 47

CIs of leflunomide

Back 47

preggos
lactating*
childbearing age w/o contraception

Front 48

MOA of hydroxychloroquine

Back 48

supress lysosomal enzymes
inhibit B and T cells
inhibit IL release

Front 49

hydroxychloroquine is indicated for...

Back 49

mild dz

Front 50

ADRs of hydroxychloroquine

Back 50

BM suppression
in eye disorders can cause irreversible retinopathy--screen q 6 mos.

Front 51

time to response for hydroxychloroquine

Back 51

can take up to 4 mos
if no response in 6 mos then d/c

Front 52

who is azathioprine good for?

Back 52

pts w/ severe, active, erosive dz that is NOT responsive to other agents
-*also good for pt's who are steroid dependent (can even dec. roid dose)

Front 53

efficacy of azathioprine

Back 53

similar to parenteral gold and penicillamine BUT inc. toxicity
inferior to mtx

Front 54

DDI of azathioprine w/ steroids

Back 54

steroid sparing
can even dec. steroid dose

Front 55

ADRs of azathioprine

Back 55

bone marrow suppression (aplastic anemia, thrombocytopenia)
hepatic inflamm
lymphoprolif. cancer

Front 56

do you need to monitor azathioprine

Back 56

yep
LFTs and CBCs q 2-4 weeks

Front 57

onset of action w/ azathioprine

Back 57

1-3 months
if no response w/in 3 mos. -->d/c

Front 58

t/f the bone marrow ADRs are the same at all doses of azathioprine

Back 58

F
dec. in ADRs w/ a dec. in dose

Front 59

MOA of penicillamine

Back 59

inhibits T cell fxn and chemotaxis of phagocytes
dec. RF
comparable in efficacy to gold
*metabolite of pcn

Front 60

ADRs of penicillamine

Back 60

bone marrow suppression
proteinuria
autoimmune (SLE, polymyositis, etc.)
taste disturbance
*more toxic than mtx

Front 61

time to onset and DDI of penicillamine

Back 61

3-4 weeks
6 months to determine efficacy
-impedes absorption of other drugs

Front 62

what is the most commonly used ABX used in RA

Back 62

minocycline
*used early in dz
*add-on for refractory pt

Front 63

what drug is a chimeric monoclonal Ab and what does chimeric mean?

Back 63

infliximab
part mouse part human

Front 64

MOA of infliximab

Back 64

binds to TNFa w/ high affinity and specificity

Front 65

indications and half life of infliximab

Back 65

RA (w/ mtx)
crohn's/UC
psoriatic arth.
plaque psoriasis
ankylosing sponylitis
half life is 8-10 days
injxns q month/6 weeks

Front 66

ADRs of infliximab

Back 66

infusion rxns in 20% (1% severe - hypotension)
resp: upper resp. tract infxn
-sinusitis
-cough
-pharyngitis
development of ANAs
infxn
develop Abs to ds-DNA

Front 67

t/f if a pt develops and Ab to biologic dmards then the drug becomes ineffective

Back 67

T

Front 68

DDI of anakinra

Back 68

anti-TNF agents inc. risk of serious infxn when combo'd w/ anakinra
-also seen w/ etanercept

Front 69

DDI of infliximab

Back 69

dead org. vaccine - inflix. dec. the effect of vax

Front 70

t/f immunosuppresants may enhance the adverse/toxic effects of dead org. vaccines

Back 70

F
live vaccines

Front 71

MOA of etanercept

Back 71

soluble TNFa receptor human Ig complex -->binds TNF and lymphotoxin

Front 72

what kind of protein is etanercept

Back 72

recombinant fusion protein
less immunogenic

Front 73

onset, dosing and other combos of other drugs w/ etanercept

Back 73

onset in 14-90 days
dosing is subQ so pt can inject at home*
can combo w/ mtx

Front 74

ADRs/CIs of etanercept

Back 74

CIs/precautions
-allergic rxns
-*avoid live vaccines*
-immunosuppression
ADRs
-injxn site rxn
-infxn

Front 75

MOA of adalimumab

Back 75

TNFa antagonist Mab

Front 76

t/f adalimumab is fully human

Back 76

T

Front 77

t/f adalimumab inhibits progression of RA and dec. structural damage

Back 77

T

Front 78

t/f adalimumab must be given as monotherapy

Back 78

F
may be combo w/ mtx or other dmards

Front 79

dosing and onset of adalimumab

Back 79

subQ dosing q 2 weeks
onset w/in 3 mos

Front 80

DDI of adalimumab

Back 80

anakinra
inc. hypersens.
hematologic probs

Front 81

MOA of anakinra

Back 81

directly blocks IL-1

Front 82

what drugs can be combo'd w/ anakinra

Back 82

other dmards EXCEPT TNF blocking agents

Front 83

ADRS of anakinra

Back 83

injxn site rxn

Front 84

CI of anakinra

Back 84

-infxn that requires abx
-allergy to proteins made from e. coli or any ingredient in kineret
-concurrent TNF inhibitor

Front 85

t/f anakinra is safe for preggos

Back 85

T
(you can let your anaconda loose if she's already preggo)

Front 86

t/f 80% of anakinra is excreted in urine in 1 day

Back 86

T

Front 87

MOA of abatacept

Back 87

soluble CTLA-4 Ig (cytotoxic T-lymphocyte associated Ag 4)
-dec. cytokine release
-dec. b-cell activation --> dec. Ab production

Front 88

what drug may enhance toxicity of abatacept

Back 88

infliximab
inc. risk of serious infxn

Front 89

MOA of rituximab

Back 89

anti CD20 Chimeric Mab
-depletes B cells that have CD 20 on surface
-used in B cell lymphoma
-give w/ mtx and roids on days 1 & 15

Front 90

ADRs of rituximab

Back 90

hypersens. rxn*
-can be dec. w/ roids

Front 91

what are the benefits of an ideal combo therapy for RA

Back 91

-no inc. in toxicity
-long-term outcome more favorable
-superior efficacy to single dmard

Front 92

arthritis affects __ americans and costs an average $___/ month

Back 92

58 million (18% of pop)
$200/month

Front 93

risk factors for OA

Back 93

obesity- esp. hip
repetitive use
genetic (2x risk if dz in mom)
osteoporosis

Front 94

what is the most prevalent rheumatoid dz in pop. over 60

Back 94

OA

Front 95

OA is more commen in men or women

Back 95

women are 2x more likely to have OA

Front 96

3 sites of pain in OA

Back 96

synovium
ST around joints
bone

Front 97

t/f nsaids are popular therapy for OA

Back 97

T*
use caution in elderly due to kidney ADRs

Front 98

drug therapy of OA is directed at...

Back 98

relief of symptomatic pain and inflamm

Front 99

MOA of sodium hyaluronate

Back 99

polysaccharide compound - forms viscoelastic sol'n in water
-fxns as tissue/joint lube

Front 100

CI of Na hyaluronate

Back 100

egg/feather allergy*

Front 101

route of Na hyaluronate

Back 101

intra-articular injxn for pts who fail other OA tx
given q 6-8 months
***do not inject into area of active inflamm or infxn

Front 102

where shouldn't you inject sodium hyaluronate

Back 102

into area of active inflamm or infxn

Front 103

dietary supplements for OA

Back 103

omega 3 fatty acids - dec. inflamm
capsaicin - topical/temp.
SAM - as effective as nsaids, can inc. serotonin levels
*all have slow onset

Front 104

MOA of glucosamine sulfate

Back 104

building block necessary for making new cart
-may not be effective*
-slow onset*

Front 105

ADRs of glucosamine sulfate

Back 105

inc. in blood glucose in DM
GI
drowsiness
HA
-limited info on ADRs