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11 Cards in this Set
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NSAIDs
Indomethacin Diclofenac Prioxicam Ibruprofen |
Control initial inflammation and pain
Do not alter disease progression Inhibit cyclooxygenase activity Reduction of inflammatory mediators (inhibition of neutorphil activation) (inhibition of leukotrine production) Inhibition of T and B cell proliferation) May require switch to different NSAID Always combine with DMARD Interference with membrane associated processes activity of NADPH oxidase in neutorphils and activity of phospholipase C in macrophages |
Indication:
Antipyretic Analgesic Anti-inflammatory Indomethacin used to close PDA Contra/Side Effect: Renal damage Aplastic Anemia GI distress Ulcers |
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Glucocorticoid
Prednisone |
Oral glucocorticoids retard disease progression (reduces erosion) More efficient then NSAID’s for management of pain and stiffness. Continuous oral background therapy, large oral pulses, intraarticular injections, intravenous pulses during flare. Decrease production of leukotrienes and prostaglandins
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Dmards
Methotrexate |
First line of treatment in RA
Inhibition of dihydrofolate reductase Decrease : lymphocyte proliferation, chemotaxis, RhF production, cytokine productions |
Indicated: RA
Contraindicated in pregnant women, immunocompramised patient, in renal failure, hepatic failure Counsel patients to avoid alcohol and take folic acid as directed Hepatotoxicity and pulmonary fibrosis |
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Dmards
Hydrocloroquine |
Antimalerial , Inhibit lymphocyte function, stabilize lysosomal membranes, reduce chemotaxis and phagocytosis, reduce production and release of IL-1
Can give to renal or hepatic compromised patients |
Indication: Acute/Chronic RA
Side Effect: Long elimination half life 3-4 days, 4-6 months for steady state concentration, delayed effect (6 months) |
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Dmards
Leflunomide |
Inhibition of mitochondrial dihydroorotate dehydrogenase and therefore inhibition of T-lymphocyte response, metabolized to active metabolite,
Half life 19 days, commence with loading does followed by maintenance dose |
Can be used with methotrexate
Contraindicated in: Hepatic dysfunction |
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BRM
Etanercept |
TNF Antagonist, start with this one least amount of side-effects
SC admin. twice weekly, half-life 5 days, symptomatic improvement in 1-4 weeks |
Effective in monotherapy
Can combine with DMARD but not Anakinra S/E: Injection site reaction, headache, dizziness |
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BRM
Infliximab |
TNF Antagonist,
IgG1 Monoclonal Antibody IV infusion 4-8 wks Half-life 9 days, symptomatic relief 1-4 weeks |
Combine with methotrexate
S/E Headache, pain, nausea, fever dizziness rash |
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BRM
Adalimumab |
TNF Antagonist, reduction of TNF-a by macropahges
half-life 10 d SC administered every 2 weeks, symp relief within 1 week |
Monotherapy or combine with Dmards
Infection, fever, rash |
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BRM
Anakinra |
IL-1 Receptor Antagonist,
daily SC admin, half-life 4-6 hr |
Mono or combine
S/E Infection, headache, nausea, diarrhea |
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BRM
Abatacept |
Costimulation blocker,
blocks T cell signaling/activation, IV over 30 min every 4 weeks, Half-life 13 days |
Mono or combine
Contraindicated with TNF-antagonists and Anakinra Anaphylaxis, headache, dizziness |
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BRM
Rituximab |
Anit-CD20 Monoclonal Antibody,
rapid and sustained depletion of B lymphocyte, half life 60-150hrs, therapeutic effects 40 wks |
Mono or combine therapy
S/E: Angioedema, Antihypertensive therapy should be withheld 12 hrs prior to admin |
