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55 Cards in this Set
- Front
- Back
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4 major proinflammatory cytokines
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TNF-alpha
IL-1 IL-6 IL-17 |
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what role do NSAIDs play in RA treatment?
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used early on for pain relief only
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what are the 4 NSAIDs used in RA?
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indomethicin
diclofenac piroxican ibuprofen |
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what should NSAIDs always be combined with in the treatment of RA?
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a DMARD
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what can be injected into swollen joints to avoid systemic effects? (3)
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corticosteroids:
triamcinolone methylprednisone betamethasone |
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what drugs do no have an analgesic activity in RA?
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DMARDs
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what is methotrexate?
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DMARD
both a purine and pyrimidine inhibitor |
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what is the first line DMARD?
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methotrexate
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what does methotrexate decrease? (4)
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lymphocyte proliferation
chemotaxis RhF production cytokine production |
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what is the treatment plan for methotrexate?
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once weekly doses until symptomatic improvement occurs (max = 20mg/week)
along with supplemental folic acid |
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what must be avoided with methotrexate?
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alcohol
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two major side effects of methotrexate?
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hepatotoxicity
pulmonary fibrosis |
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what is the least effective DMARD?
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hydroxychloroquine
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how does hydroxychloroquine work? (3)
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inhibits lysosomal function
stabilizes lysosomal membranes reduces chemotaxis and phagocytosis |
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how long does it take for hydroxychloroquine to become effective?
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up to 6 months
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how should you treat patients not responding to methotrexate?
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add on sulfasalazine
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what is sulfasalazine?
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a DMARD
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where is sulfasalazine converted and what does it convert to? (2)
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converted in intestine to sulfapyradine (anti-bacterial) and mesalamine (anti-inflammatory)
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what happens to sulfasalazine metabolites?
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they become highly sequestered in tissues and released over time
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what limits the used of sulfasalazine?
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GI effects
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how long does it take to see a response with sulfasalazine?
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up to 2 months
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how should you treat patients not responding to sulfalazine + methotrexate?
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add on leflunomide
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what is a major side effect of leflunomide?
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high risk of hepatotoxicity
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what can biological response modifiers be considered?
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DMARDs
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how do biological response modifiers work?
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target inflammatory mediators directly to decrease response
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who are biological response modifiers contraindicated in?
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immunosuppressed patients and those with TB or serious acute infection
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what is etanercept?
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biological response modifier
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how does etanercept work?
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prevents binding of TNF to receptors (does not solubilize TNF)
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how is etanercept administered?
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SC admin twice weekly
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how long til etancercept becomes effective?
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1-4 weeks
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what should etanercept not be combined with?
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anakinra because of very high risk of immunosuprpession and hepato-dysfunction
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how might an injection site reaction with etanercept be reduced?
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anti-histamines
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what is infliximab?
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IgG1 monoclonal antibody that binds to soluble and bound TNF-alpha to prevent it from binding to its receptor
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what is infliximab combined with?
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methotrexate
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how is infliximab administered?
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IV infusion for 4-8 weeks
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what is the only IL-1 receptor antagonist?
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anakinra
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what is anakinra?
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the only IL-1 receptor antagnoist
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who is anakinra contraindicated in?
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patients also taking TNF antagnoists
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how is anakinra administered?
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daily SC administration
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what biological response modifier has the shortest half life?
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anakinra
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what is abatacept?
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biological response modifier
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who is abatacept contraindicatred in?
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patient taking TNF-antagonists or anakinra
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how does abatacept work?
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blocks T-cell signaling and t-cell activation
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how is abatacept administered?
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IV over 30 minutes every 4 weeks
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what is rituximab?
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biological response modifier
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how long can the therapeutic effects of rituximab last?
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up to 40 weeks because of sequestration in tissues
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how does rituximab work?
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Anti-CD20 monoclonal antibody
causes rapid and sustained depletion of b-lymphocytes |
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what are the adverse effects of rituximab? (5)
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angioedema
hypotension bronchospasm rash urticaria |
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what patients are a concern with rituximab?
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patients on ACE inhibitors or vasodilators
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how do you deal with patients undergoing anti-hypertensive therapy and rituximab?
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anti-hypertensive therapy should be withheld 12 hours prior to the administration of rituximab
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how long can the therapeutic effects of rituximab last?
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up to 40 weeks because of sequestration in tissues
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how does rituximab work?
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Anti-CD20 monoclonal antibody
causes rapid and sustained depletion of b-lymphocytes |
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what are the adverse effects of rituximab? (5)
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angioedema
hypotension bronchospasm rash urticaria |
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what patients are a concern with rituximab?
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patients on ACE inhibitors or vasodilators
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how do you deal with patients undergoing anti-hypertensive therapy and rituximab?
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anti-hypertensive therapy should be withheld 12 hours prior to the administration of rituximab
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