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26 Cards in this Set
- Front
- Back
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Do DMARDs have analgesic activity?
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No
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DMARDs are (slow/fast)-acting.
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Slow
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What is the MOA of DMARDs?
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Anti-inflam actions in many CT dzs
Inhibit wide variety of cytokines including ILs, IFNs, and TNF (IL-1, IL-6, and TNF-alpha) |
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What is the 1st line drug in RA?
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Methotrexate
1x weekly doses until symptoms improve |
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What drug inhibits BOTH purines and pyrimidines by inhibiting dihydrofolate reductase?
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Methotrexate
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With methotrexate, you should counsel patients to avoid ______ and take ________ as needed.
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Alcohol; folic acid
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What are some serious adverse rxns to methotrexate?
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Hepatotoxicity (essential to monitor liver fx)
Pulm fibrosis |
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Which drug can be used for mild cases of acute and chronic RA and is an anti-malarial?
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Hydroxychloroquine
CI in renal dysfx and elderly |
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How long does it take to reach the steady state with hydroxychloroquine?
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4-6 mos
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Which DMARD can't be used long-term because of its significant GI effects?
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Sulfasalazine
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Which drug can be used as an add-on to methotrexate when it is not working well alone?
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Sulfasalazine
The therap effect can take up to 2 months, and it needs colonic bacteria to be converted to sulfapyridine (antibacterial) and mesalamine (antiinflammatory) Leflunomide can also be used instead, but is not 1st line |
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Which DMARD inhibits pyrimidines by inhibiting mitochondrial dihydroorotate dehydrogenase?
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Leflunomide
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With leflunomide and methotrexate together, there is a high risk of what?
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Hepatotoxicity
Active metabolite has a long half-life |
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When are Biological Response Modifiers contraindicated?
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Acute, serious infection
Immunocompromised (especially AIDS w/ CD4 below 500) those w/ TB |
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What drug shouldn't be taken with Etanercept?
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Anakinra
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How early do symptoms improve with Etanercept?
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within 1-4 wks
taken SC 2x wkly with a long half-life of 5 days |
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Which biological agent is given by IV for 4-8 wks and has a long half life of 9 days?
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Infliximab
Can cause dizziness! |
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Infliximab is an ____ monoclonal antibody that binds to what?
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IgG1
soluble and bound TNF-alpha |
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What is the only IL-1 receptor antagonist?
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Anakinra
compliance issue d/t daily SC injection |
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Which biological agent has been known to cause anaphylaxis?
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Abatacept
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Which biologic agent blocks T cell signaling and activation?
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Abatacept
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How is Abatacept administered?
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IV over 30 mins every 4 wks (compliance issue)
long half life = 13 days |
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Which biological agent causes rapid and sustained depletion of B cells?
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Rituximab
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Anti-HTN therapy should be withheld prior to administration of what biological agent/DMARD?
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Rituximab
particularly ACE inibitors and direct vasodilators, not so much diuretics |
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What are some SEs of Rituximab?
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Angioedema, fatigue, nasuea, vomiting, headache, bronchospasm, urticaria, rash
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Which biological agent's effects last >40 weeks after initial tx (if effective)?
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Rituximab
IV over 4 hrs, then at 2 weeks, long half life of 60-150 hrs |
