PHRM 864: Therapeutics IV > Arthritis > Flashcards

Arthritis Flashcards

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1
Q

What is the definiation of Rheumatoid Arthritis?

A
  • MOST COMMON systemic inflammatory disease characterized by Symmetrical Joint involvement.
  • CHRONIC
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2
Q

What is the pathophysiology of Rheumatoid Arthritis?

A
  • Chronic Autoimmune
  • Synovial Space in joints becomes inflammed –> leading to death
  • Forming Pannus: going to cause erosions that break the joint
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3
Q

What are some of the clinical presentions of Rheumatoid Arthritis?

A
  • Fatigue, Weakness, Loss of Appetite, Joint Pain, Lowgrade Fever
  • Stiffness & Muscle Ache –> Joint Swelling
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4
Q

In what way is Rheumatoid Arthritis diagnosed?

A
  • Needs a score of 6
  • Joint Involvement: 1 Medium-Large Joint to <10 Small Joints [0-5 points]
  • Serology: +/- for RF or ACPA [0-3 points]
  • Duration of Symptoms: </> 6 weeks [0-1 points]
  • Acute Phase Reactant: CRP or ESR [0-1 point]
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5
Q

What are the most common joints that are affected my Rheumatoid Arthritis?

A
  • Most Common: Hands, Wrists, Feet
  • Other sites: Elbow, Shouldersm Hips, Knees, Ankles
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6
Q

What are the Extra-Articular Manifestations in Rheumatoid Arthritis?

A
  • Rheumatoid Nodules
  • Vasculitis
  • Pulmonary
  • Ocular
  • Cardaic
  • Felty’s
  • Other
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7
Q

What is important to understand about what Rheumatoid Nodules are in Rheumatoid Arthritis?

A
  • On Pressure Points
  • Found within Hands, Wrists, Forearms
  • More common in Erosive disease
  • Asymptomatic? Dont need to treat
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8
Q

What is important to understand about Vasculitis in Rheumatoid Arthritis?

A
  • Inflammation of Small, Superficial Vessels
  • Could lead to necrosis
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9
Q

What is important to understand about Pulmonary in Rheumatoid Arthritis?

A
  • Could cause Pulmonary Embolisms, Pleural Effusions
  • RARE: Inflammation within the lungs or arteries
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10
Q

What is important to understand about Ocular in Rheumatoid Arthritis?

A
  • Inflammation in Sclera, Episclera, Cornea
  • Sjorgens Syndrome: Icthy, Dry Eyes [Keratoconjunctivitis] + Inflammation [RA]
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11
Q

What is important to understand about Cardaic in Rheumatiod Arthritis?

A
  • Increased risk of CV mortality
  • Pericarditis: Inflammed Cardiac Tissue
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12
Q

What is Felty’s within Rheumatoid Arthritis?

A
  • Splenomegaly
  • Neutropenia
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13
Q

What are some clincial features for Rheumatoid Arthritis?

A
  • Any Age, Systemic, Elevated ESR, Inflammation, Bilateral, am Stiffness > 1hour, -Osteophyte, +Pannus +RF, +Nodules,

SE: Malase, Fatigue, Musculoskeletal Pain, Fever

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14
Q

What are some clinical features for Osetoarthritis?

A
  • > 40 yo, ONLY joint, Normal ESR, Slight Inflammation, Uni or Bilateral Involvement, am Stiffness < 30mins, +Osteophyte, -Pannus, -RF,

SE: Deep, aching pain

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15
Q

What are the two adjunct therpies?

A
  • NSAIDS
  • Corticosteroids
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16
Q

How are NSAIDs used in Rheumatoid Arthritis?

A
  • Great at reducing pain, swelling, stiffness
  • Does NOT alter disease progression
  • Used WITH DMARDS
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17
Q

How are Corticosteroids used in Rheumatoid Arthritis?

A
  • Used for anti-inflammatory & immunosuppressive
  • NOT a monotherpay [same as NSAIDs]
  • Used in combo WITH DMARDs
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18
Q

What are the adverse effects fo corticosteroids?

WILL BE ON THE EXAM!!

A
  • Short Term: Hyperglycemia, Increased BP, Gastritis, Mood Swings
  • Long Term: Cataracts, Obesity, Osetoporsis, Growth Failure, Apestic Necrosis

Monitor: BP & BG

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19
Q

What is DMARDs and what do they help do?

A
  • Disease Modifying Anti-Rheumatic Drugs
  • Decreased/prevent joint damage DOES NOT reverse it
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20
Q

What are some of the Traditional DMARDS [Conventional Synthetic DMARDs] that are used in Rheumatoid Arthritis?

A
  • Methotrexate
  • Sulfasalazine
  • Hydroxychoroquine
  • Leflunomide
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21
Q

What is important to know about Methotrexate in Rheumatoid Arthritis?

MOA? Indication?

A
  • DMARD of choice
  • MOA: inhibit dihydrofolic acid reductase
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22
Q

What is the dosing of Methotrexate in Rheumatiod Arthritis?

WILL BE ON THE EXAM!!

`

A
  • 7.5 mg per WEEK PO or IV
  • May need to tirate up
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23
Q

What are some of the adverse effects of Methotrexate in Rheimatoid Arthritis?

Study These Flashcards
A
  • Bone Marrow Suppression, N/V/D, Mucositis [should give folic acid]
  • Hepatic, Pulmonary, Skin issues
  • Teratogenic

CONTRAINDICATION: Pregnancy, Chronic Liver Disese, CrCl < 40

24
Q

What are some of monitoring for Methotrexate in Rheumatoid Arthritis?

Study These Flashcards
A
  • CXR, CBC, SCr, LFTs, Albumin
25
What is important to know about Leflunomide in Rheumatoid Arthritis? | MOA? Indication?
- Prodrug - MOA: **Inhibits cell cycle progression** - Should have loading dose THEN maintenance dose
26
What are some of the adverse effects of Leflunomide in Rheumatoid Arthritis?
- Diarrhea, Rash, Alopecia, Increased LFTs, Teratogenicity
27
What is some of the monitoring for Leflunomide in Rheumatoid Arthritis?
- CBC, SCr, LFT
28
What MOA for Sulfasalazine in Rheumatoid Arthritis?
- MOA: Inhibits IL-1; **prodrug** that is cleased in the colon to Sulfpyradine and 5-ASA
29
What are the adverse effects of Sulfasalazine in Rheumatoid Arthritis?
- N/V/D, Anorexia, Rash, Hypersensitivity [**SULFA Allergy**]
30
What is some of the monitoring for Sulfasalazine in Rheumatoid Arthritis?
- CBC, SCr, LFT
31
What is the MOA for Hydroxychoroquine in Rheumatoid Arthritis?
- MOA: Modification to cytokine infiltration in joints - Possibly great to use in **New Onset** or **Low Disease Therapy**; so maybe start --> DONT switch to it
32
What are some of the Advere Effects of Hydrochoroquine in Rheumatoid Arthritis?
- **NO myelosuppression** - **Retinal Toxicity** - N/V/D [Take with food], Rash, Increased Skin Pigment
33
What is the monitoring for Hydroxycholorquine in Rheumatoid Arthritis?
- **VISION EXAM** | 6-12 months
34
What are the TNF Neutralizers that are used in Rheumatoid Arthritis?
- Etanercept - Infliximab - Adailmumab - Golimumab - Certolizumab
35
What are some of the general Warnings/Precautions for the TNFs in Rheumatoid Arthritis? | Same as IBD!
- Increased infection risk - **DO NOT** use with other TNFs or Biologics - **BLACK BOX**: Demylination, CHF Exacerbation, NO live vaccines
36
What are some of the general Adverse Effects for TNFs in Rheumatoid Arthritis?
- Headache & Rash - Risk of Infection [Upper Respiratory] - CHF Exacerbation - Demylination - Malignancies
37
What is important to know for Etanercept in Rheumatoid Arthritis? | MOA? Dosage Form?
- MOA: **Binds to and inhibits TNF**; binds to the surface and causes inflammation - **SUBQ** once weekly
38
What is important to know about Infliximab in Rheumatoid arthritis? | MOA? Dosage Form?
- MOA: **Inhibits TNF**; Chimeric - **IV** - Usually **taken with** Methotrexate
39
What is important to know about Adalimumab in Rheumatoid Arthritis? | MOA? Indication? Dosage form?
- MOA: **Inhibits TNF** by blocking p55 and p75 in those that **failed** other TNFs - Used **ALONE or COMBO** - **SUBQ** every OTHER week
40
What is important to know about Golimumab in Rheumatoid Arthritis? | MOA? Dosage Form? Monitoring?
- MOA: **Inhibits TNF** For **Mod-Severe RA**; use with Methotrexate - **SUBQ** once monthy - **CXR, LFTs**
41
What is important to know about Certolizumab in Rheumatoid Arthritis?
- MOA: **Inhibits TNF** For **Mod-Servere RA** - Used **ALONE or COMBO** with non-BRM DMARDs? - **SUBQ**
42
What is important to know about Anakinra in Rheumatoid Arthritis? | MOA? Dosage Form?
- MOA: **Blocks IL-1 receptors** In **Mod-Severe RA** for those that failed one or more DMARD - **ALONE or COMBO** - **SUBQ**
43
What are some of the Advere Effects for Anakinra in Rheumatoid Arthritis?
- **Headache, N/V/ Flu-like symptoms** - Injection site reactions, Hypersensitivity, Increased Infections, **Decreased Neutrophils**
44
What is the monitoring for Anakinra in Rheumatoid Arthritis?
- **Neutriophil Count**
45
What is important to know about Abatacept in Rheumatoid Arthritis? | MOA? Dosage Form? When?
- MOA: **Inhibits t-cell activation** in **Mod-Severe RA** in those that failed one or more DMARDs - **ALONE or COMBO** [not with TNF or IL-1] - **IV**
46
What are some of the warnings for Abatacept for Rheumatoid Arthritis?
- **DO NOT** use with TNF or IL-1 - Increased Infection Risk - **NO** Live Vaccines - Caution in **COPD**
47
What are some of the Advere Effects of Abatacept in Rheumatoid Arthritis?
- Headache, Nausea, Upper Respiratory Infection, Nasopharingitis
48
What is important to know about Tocilizumab & Sarilumab in Rheumatoid Arthritis? | MOA? Dosage Form? When?
- MOA: **Bind and Inhibit IL-6** for **Mod-Servere RA** for those that failed one or more DMARDs - Use **ALONE or COMBO** with Methotrexate or other DMARDS - **IV** [Tocilizumab] & **SUBQ**[Sarilumab]
49
What are some of the warnings and contraindications for Tocilizumab & Sarilumab in Rheumatoid Arthritis?
- **BLACK BOX**: Infections - **Contraindication**:Liver Toxicity, Thrombocytopenia, Neutpenia
50
What are some of the Adverse Effects of Tocilizumab & Sarilumab in Rheumatoid Arthritis?
- Serious Infections, Liver Toxicity, Thrombocytopenia, Neutpenia, **Lipid Abnormalities**
51
What are some of the Monitoring for Tocilizumab & Sarilumab in Rheumatoid Arthritis?
- Neutrophil count, Platelet count, LFTs, Lipid Profile
52
What is important to know about Rituximab in Rheumatoid Arthritis? | MOA? Dosage Form? When?
- MOA: **Binds to CD20** [B-cells] in **Mod-Severe RA** for those that failed TNF - **COMBO** with Methorexate - **IV** | **Give Methylprednisolone 30 mins before infusion**
53
What are some of the monitoring for Rituximab in Rheumatoid Arthritis?
- CBC, Creatinine, Vital Signs
54
What is important to know about the JAK Kinase Inhibitors in Rheumatoid Arthritis? | MOA?
- MOA: **Inhibits Janus Kinase** - **Mod-Severe RA** for those that failed TNF - **ALONE or COMBO** with Methotrexate or other DMARD - **ORAL** | **NOT with BRM, Azathiprine, or Cyclosporine**
55
What are the JAK Inhibitors that are used in Rheumatoid Arthritis?
- Totacitinib, Baricitinib, Upadacitinib
56
What are some of the Warnings for the JAK inhibitors in Rheumatoid Arthritis? | A LOT!
- P450 interactions - Risk of Infection & Malignancy - CV Issues - Thrombosis - NO Live Vaccines
57
When shoud you NOT used JAK Inhibitors in Rheumatoid Arthritis?
- Hgb < 8mg/dL - ANC < 1000 cells/mm^3 - ALC < 500 cells/mm^3
PHRM 864: Therapeutics IV
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