Rheumatoid Drugs

Front 1

Rheuatoid Arthritis

Back 1

Autoimmune response
Production of cytokines especially in tumor necrosis fact TNF-alpha, and interleukin-1 (IL-1), prostaglandins (PG), leukotrienes (LT) and destructive enzymes.

Front 2

Cytokines effect on RA

Back 2

Intercellular messengers for immune system
IL-1 and TNF are most abundant
Proliferate in RA

Front 3

Actions Glucocorticoids

Back 3

Antiinflammatory steroids
Relieve sxs but not the progression.
Serious side effects.
Controls flare-ups before DMARDs can take effect.
Intra-articular administration possible.

Front 4

Mechanism of Disease-Modifying antirheumatoid drugs (DMARDs)

Back 4

Slow or halt advancement even pathological changes.
Inhibit the immune response.
Inhibit function of T and B lymphocytes responsible for intitiating joint inflammation and destruction.
Efficacious but toxic.

Front 5

Mechanism of NSAIDs

Back 5

COX inhibitors, decrease PG formation. Prevents the PGE2 formation for increasing blood flow and permeability and chemoatactic effects on leukocytes.

Front 6

Mechanism of Glucocorticoids

Back 6

Inhibit phospholipase A2 and liberation of arachidonic acid.
Decreaes PG and LT production.
Decrease inflammatory response.
Inhibit synthesis of cytokines and enzymes
Inhibits macrophages, T lymphocytes.

Front 7

What is arachadonic acid?

Back 7

The precursor for both PGs and LTs.

Front 8

Side effects of Glucocorticoids

Back 8

Osteoporosis and tendon rupture.
Skin and muscle wasting.
Diabetes aggravation and hypertension.
Suppression of adrenal-pituitary axis.

Front 9

Class and disadvantage of Hydroxychloroquine (Plaquenil)

Back 9

Antimalarial Drug
Has retinal toxicity and a half life of 40 days.

Front 10

Class, Indication, and Disadvantages of Azathioprine (Imuran)

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An immunosuppressant used after organ transplants to prevent rejection.
Has side effects of fever, chills, sore throat, nausea, bone marrow suppression, liver and kidney failure.
Has high toxcitiy.

Front 11

Class and disadvtages of Etanercept (Enbrel)

Back 11

Tumor Necrosis Factor Inhibitor.
Must be given sc twice a week and may increase risk of fungal infection.

Front 12

Indications and disadvantages of infliximab (Remicade) and adalimumab (Humira)

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Monoclonal anti-TNF antibodies.
Bind TNF and prevents its destruction.
It may increase risk of infection and malignancies.

Front 13

Class and Disadvantages of Gold Auranofin (Ridaura, po) and aurothioglucose (Solganal, im)

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First to be recognized as DMARDs.
Have GI distress by Ridaura, skin rashes, blood dyscrasias.

Front 14

Leflunomide (Arava)

Back 14

Adverse effects are GI distress, rashes, and hair loss.

Front 15

Mechanism of Methotrexate (Folex, Rhumatrex)

Back 15

Inhibits the synthesis of folic acid and thus DNA.
May decrease phagocyte, lymphocyte proliferation.
May also stimulate adenosine release, an inhibitor of the immune response.

Front 16

Advantages of Methotrexate (Folex, Rheumatrex)

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Greatest effects if given during the first two years of diagnosis.
Reduces mortality by protecting against cardiovascular events.

Front 17

Disadvantages of Methotrexate (Folex, Rheumatrex)

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Loss of appetite, nausea
Hair loss and mucosal ulcers
Pulmonary and hepatic dysfunction, bone marrow suppression.

Front 18

Sulfasalazine (Azulfidine)

Back 18

Treat inflammatory bowel disease.
Goes at 5-amino salicylic acid metabolite for antiinflammatory action in GI.
N/V

Front 19

Anakinra (Kinert)

Back 19

Gentically engineered IL-I receptor antagonist.
Have increased risk of infection.
Do NOT use with TNF inhibitors