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56 Cards in this Set
- Front
- Back
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First line therapy for osteoarthritis
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Acetaminophen
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What is not an MOA of Acetaminophen?
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anti-inflammatory
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max daily dose Acetaminophen
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4g
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moderate to severe OA knee pain
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glucocorticoids/ hyaluronic acid injections
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non-biologic DMARDS
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MTX, leflunomide, hydroxychloroquine, sulfasalazine
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1st line for active RA
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MTX
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1st line for early/mild RA
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Hydroxychloroquine, sulfasalazine
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MTX MOA
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dihydrofolate reductase inhibitor (DNA synthesis inhibitor)
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how often is MTX dosed?
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SC/IM Q week
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MTX ADE
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Myelosuppression, hepatotoxicity
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What labs need to be checked with MTX?
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CBC, SCr, LFT; liver biopsy after 3.5-4g, then every 1.5 g after
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What patient populations should not use MTX?
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Pregnancy cat x
hepatic insufficiency |
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What needs to be given with MTX?
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folic acid (1mg/day)
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MTX drug interactions
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NSAIDS --> increase MTX
Theophyline --> increase THEO Bactrim/septra --> Increased myelosuppression risk |
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Leflunomide MOA
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Pyrimidine synthesis inhibitor (inhibits T cell activity)
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Leflunomide ADE
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diarrhea, immunosuppression, hepatotoxicity
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What labs should be checked with leflunomide?
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CBC, SCr, LFT (Q6mo)
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What pt populations should not use leflunomide?
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pregnancy
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What is Cholestryamine?
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Overdose antidote for Leflunomide
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Leflunomide dosing
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???LD: 100mg PO qd x3
Then: 10-20mg PO qd |
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What should be checked prior to hydroxychloroquine initiation?
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baseline opthalmic exam - drug causes retinal damage
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Sulfasalazine MOA
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prostaglandin inhibition
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Sulfasalazine should be avoided for?
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pts with known sulfa allergy
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What labs need to be checked with sulfasalazine use?
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CBC q 2-4wks x3mo; then q3mo.
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TNF alfa inhibitors?
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Infliximab, adalimumab, etanercept, certolizumab pegol, golimumab
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what TNFa inhibitor cannot be used as mono tx? why?
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Infliximab; 25% mouse, causes Ab rxn - leads to less efficacy of med
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infliximab dosing
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3-10mg/kg IV q 8wks
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What test should be done before using ANY TNFa inhibitor? why?
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PPD TB test; all TNFa inhibitors cause reactivation TB
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ADE of TNFa Inhibitors
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TB, HA, liver tox, other infx (meningitis), CA such as lymphoma
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Adalimumab dosing
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40mg SC every other week
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Etanercept dosing
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25mg SC twice weekly or 50mg weekly
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Certolizumab pegol onset
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2-7days!
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certolizumab pegol dosing
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400mg SC Q 2wks x 3 --> then 200 Q 2wks or 400 Q month.
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Golimumab onset
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2-6 days!
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golimumab dosing
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50mg SC Q month
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why can't you use a TNFa and IL agent together to treat RA?
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makes pt too immunocompromised --> kills them
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When is it appropriate to use a biologic (TNFa or IL) agent in RA?
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when pt has failed MTX and 1 or 2 other DMARDs.
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For what condition is it appropriate to begin immediate therapy with biologic agents?
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Ankylosing spondylitis
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IL inhibitors?
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Anakinra (IL 1)
Ustekinumab (IL 12, 23) Tocilizumab (IL 6) |
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Why is Tocilizumab not widely used?
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anaphylaxis rxn
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Anakinra place in therapy?
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mono tx or in combination with MTX or ORAL DMARDS
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Anakinra dosing
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100mg SC q day
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Anakinra ADE
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Neutropenia and severe infx
NO TB reactivation!! |
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Ustekinumab place in therapy
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plaque psoriasis
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Ustekinumab dosing?
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weight based SQ at 0 and 4 wks; then every 12 weeks
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labs needed for Ustekinumab
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PPD
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Abatacept MOA
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selective co-stim modulation (prevents full T-cell activation)
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Abatacept dosing
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weight based IV Q 2wks x3; then q 28 days after
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Abatacept labs?
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PPD
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can you combine abatacept with other biologic agents?
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NO
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Rituximab MOA
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chimeric monoclonal Ab --> targets CD20 B lymphocytes
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Rituximab place in therapy
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effective for RA refractory to TNFa agents (may be in combo with MTX)
CA also |
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Tofacitinib MOA
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JAK inhibitor
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Tofacitinib dosing
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5mg PO BID
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Tofacitinib ADE
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hypotension, HA
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what should be done if RA remission is obtained?
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taper drugs
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