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30 Cards in this Set

  • Front
  • Back
What are the goals of therapy in Rheumatoid Arthritis?
Improve quality of life
Control disease activity and joint pain
Ability to perform daily activities
Slow destruction of joint
Remission
What does DMARD stand for?
Disease Modifying Anti-Rheumatic Drug
Name the four non-biologic DMARDs.
Methotrexate
Leflunomide
Hydroxychloroquine
Sulfasalazine
When is Hydroxychloroquine typically used?
In mild disease or as adjunctive therapy with another DMARD.
What key things do you monitor when a patient in taking hydroxychloroquine?
Baseline eye exam, then every 9-12 months
Rash
Diarrhea
What is considered the gold standard of RA therapy?
Methotrexate
How labs do you want to monitor during Methotrexate therapy?
Baseline - AST/ALT, Alk Phos, Albumin, Total Bilirubin, Hepatitis B/C studies, CBC with platelets, SCr

Maintenance - AST, Albumin every 1-2 months, CBC with platelets every 1-2 months
What side effects do you want to monitor during Methotrexate therapy?
NVD, Stomatitis, Cough, Dyspnea
How could you help prevent adverse effects?
Folic Acid supplementation
When is Methotrexate contraindicated?
Pre-existing liver disease
CrCl < 40 ml/min
Pregnancy
What is the function of NSAIDs and Corticosteroids in RA therapy?
NSAIDs are used for symptomatic relief and are scheduled.

Corticosteroids are used in debilitating disease to bridge the patient as DMARDs may take a while to work.
Low-dose long-term therapy may be used in difficult to control disease
How would you counsel a patient taking methotrexate?
Limit adverse side effects (GI Upset, Stomatitis) by taking folic acid
Avoid alcohol
Take medication once per week
Educate patient on necessary labs
Contraception (known teratogen)
If a patient has compromised renal function, what agent(s) would be acceptable?
Leflunomide
Sulfasalazine
How would you minimize the adverse effects of corticosteroids?
Minimize use of the drug
Use the shortest course possible
If giving Leflunomide, what monitoring is done?
Baseline - ALT, CBC with platelets

Maintenance - ALT, CBC with platelets monthly for 6 months, then every 2 months
If giving Sulfasalazine, what monitoring is done?
Baseline CBC with platelets weekly for a month

Maintenance - CBC with platelets monthly
What side effects would you monitor for in Leflunomide?
NV
Gastritis
Alopecia
Jaundice
What side effects would you monitor for in Sulfasalazine
NVD
Stomatitis
Rash
Urticaria
Photosensitivity
Urine/skin may turn a different color
How would you counsel a patient taking Leflunomide?
GI Upset
Alopecia
Educate on necessary labs
Contraception
How would you counsel a patient taking Sulfasalazine?
GI Upset
Urine/skin may turn orange-yellow
Use sunscreen
If the patient wanted to have a baby, what would be your best option?
Sulfasalazine - Pregnancy category B
If the patient has compromised liver function, what is your best option?
Sulfasalazine
When do you choose a biologic agent?
When you've exhausted other options.
Which biologic agents should we know for the test?
What do these agents do?
Etanercept
Infliximab
Adalimumab

They are anti-TNF agents
How are these administered?
Infliximab - IV
Etanercept -SC
Adalimumab - SC
What is important to know about Infliximab?
It must be administered with Methotrexate because this minimizes adverse effects
How would you monitor someone taking a biologic agent?
Baseline - Tuberculin Skin Test (rule out tuberculosis)

Maintenance - None

Major concern with all biologics is infection
Local Injection site reactions (SC)
Infusion Reactions (IV)
What two drugs have a relative contraindication in CHF?
Infliximab
Etanercept
How could you minimize Infusion reactions when using Infliximab?
Pre-treat with acetaminophen or diphenhydramine or CS's
Slow the rate of infusion
How would you educate a patient taking a biologic agent?
Educate on how to give injection
Contact PCP if you get a reaction