• Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

A key: Read text to speech.a key

image

Play button

image

Play button

image

Progress

1/38

Click to flip

38 Cards in this Set

  • Front
  • Back
TNF in RA stimulates the production of _____________________
T Lymphocytes
What is a normal ESR value?
<20-30 mm/h

RA is elevated
What is the normal C-reactive Protein level?
<0.8 mg/dL

Elevated in RA
Step 1 in RA diagnosis
History

1. Morning Stiffness
2. involves >3 joints
3. Arthritis in hands
4. Bilateral Movement
5. Rheumatoid nodules
6. (+) Rheumatoid factor
7. Radiographic evidence of RA
step 2 in Diagnosis
Physical exam of joints

1. edema
2. effusion
3. warmth
4. Tenderness on palpation
step 3 in RA diagnosis
RA Panel

1. ESR >30
2. C-reactive protein >0.8
3. RF >15
4. Cyclic citrullinated antibodies (anti-CCP) >25
If you have Rheumatoid factor you have RA T/F
False

found in 5% healthy ppl who nvr get RA
normal RF level
<15

RA >15
This if found confirms RA diagnosis
anti-CCP

Normal <25
normal anti-CCP
(Cyclic citrullinated antibodies)
<25
step 4 in RA diagnosis
Imaging

Xray
CT scan
MRI

to see deformities, erosions, soft tissue swelling
after diagnosis, start ____ within 3 mo of diagnosis
DMARD
if inadequate response after 3 mo of MAXIMAL therapy, what would be your next step?
Add or change DMARD
This is not recommended in RA patients with CHF Bleeding ulcer, SCr > 2.5mg/dl, or hypovolemia
NSAID
This RA med relieves symptoms within days and may slow rate of joint damage
Glucocorticoids
What are the ADR of glucocorticoids?
Osteoporosis
wt gain/HTN
hyperglycemia
You would use this DMARD early in mild disease.

It is the Least toxic however it takes 1-6 monthe to achieve benefit and it does NOT slow radiologic damage
Hydoxychoroquine
This DMARD can relieve symptoms in as little as 4 weeks. It also slows radiographic progression.
Sulfasalazine
when should a pt be reviewed for efficacy with sulfasalazine?
4 months
what are the SE and Contraindications for Sulfasalazine?
SE: GI, blood, Rash

Contraindications: Sulfa allergies. Intestinal or urinary obstructions
this is the DMARD of choice
Methotrexate
What must be supplimented with MTX?
Folate
What is the dose of MTX?
7.5-15 EVERY WEEK!
This inhibits cytokine production, PURINE synthesis

(inhibits formation of T lymphocytes)
MTX
What must you monitor on a pt on MTX?
signs of infection

LFT monthly for first 6 mo then every 1-2 months thereafter

CBC

Creatinine
This inhibits de novo PYRIMIDINE synthesis by inhibiting dihydrooratate dehydrogenase
Leflunomide (Arava)
Must D/C Arava if LFTs > 3x UNL and give ______ 8 grams TID for 11 days
cholestyramine
This is an IL-1 receptor antagonist.

(can damage bone)
Kineret (Anakinra)
when can you use Anakinra
when TNF inhibitor cant be used
Name the 5 TNF-Inhibitors
1. Cimzia (certolizumab pegol)
2. Simponi (Golimumab)
3. Humira (adalimumab)
4. Remicade (Infliximab)
5. Enbrel (Etanercept)
this is used commonly after MTX failure or even in MTX naive patients
TNF I
Improvement in symptoms, labs, pain scale should be seen in _____ weeks when on a TNF
12 weeks
Which TNF I can you use in young patients?
Humira, Enbrel
This TNF is mainly used in Combination with DMARDS
Remicade
MOA: Targets and depletes CD20-positive B cells
Rituximab (Rituxan)
Use this in combination with MTX in adults with moderate to sever RA who had inadequate response to > 1 TNF inhibitor
Rituximab (Rituxan)
What is the dosing for Rituximab?
two IV infusions seperated by 2 weeks

Premedicate w APAP/Benedryl.

IV methylprednisone 100mg administered 30 min b4 each infusion
This is used in adults with moderate to severe RA with inadequate response to DMARDS including MTX or TNFIs
Abatacept (Orencia)