DMARDs

Question 1

Clinical signs of RA

Answer 1

Stiffness/ pain lasting 1 hours+ in bouts

• becomes progressively worse
• symmetrical pain
• NSAIDs are no longer working

Question 2

Corticosteroid side effects

Answer 2

Numerous

• can inhibit hypothalamic-pituitary adrenal system by mimicking cortisol
  ( cant stop cold turkey)
• can increases osteoporosis
  (must prescribe Vit. D and calcium vitamins with use)
• can cause Cushing disease

Question 3

Which DMARDs are teratogens?

Answer 3

Methotrexate and Lefulnomide

-Methotrexate disables dihydrofolate reductase enzymes which are used to make both cytokines and purines/thymine residues

Question 4

What DMARDs can also be used as a cancer treatment?

Answer 4

Methotrexate

Azothioprine

Leflunomide

Question 5

What is the first line traditional DMARD?

Answer 5

Methotrexate

if patient cant handle it or is pregnant, then usually Tolcilizumab is first line

Question 6

What DMARD is the prodrug to 6-mercaptopurine (6-MP) and is also used to prevent transplant rejection?

Answer 6

Azothioprine

• 6-MP produces PPRP amidotransferase which inhibits purine synthesis and disables antibodies

Question 7

What DMARD is associated with malignancies and raises sensitivity to the sun?

Answer 7

Azothioprine

Question 8

What traditional DMARDs are completely safe for pregnant patients?

Answer 8

Hydroxychoroquine

Sulfasalazine

Question 9

What biological DMARDs are The most safe for pregnant patients?

Answer 9

Anakinra (BEST CHOICE)

All TNF-a inhibitors (“MABs” and etanercept)

Question 10

What DMARD is a prodrug for 5-aminosalicylate and is cleaved in small intestines to produce drug?

Answer 10

Sulfasalazine

• helps to treat IBDs
• makes urine hello-orange and is contraindicated in patients with sulfa allergies

Question 11

What DMARD is contraindicated for sulfa-allergic patients and also may present yellow-orange urine/skin?

Answer 11

Sulfasalazine

Question 12

What DMARD is a pyrimidine synthase inhibitor and is the only DMARD to require a loading dose?

Answer 12

Leflunomide

• contraindicated in liver disease patients due to build up of liver enzymes

Question 13

What DMARD is a purine synthase inhibitor?

Answer 13

Methotrexate

Question 14

What DMARD can produce Stevens-Johnson syndrome

Answer 14

Leflunomide

Question 15

What DMARDs inhibit the JAK/STAT pathway?

Answer 15

Tofacitinib

Tocilizumab

Question 16

What DMARDs do you have to monitor cholesterol with?

Answer 16

Tofacitinib and tocilizumab

• contraindicated in patients with high cholesterol

Question 17

What TNF-a inhibitor also inhibits TNF-b?

Answer 17

Etanercept

• super high half life at 102 hrs

Question 18

What DMARD inhibts IL-1 receptors?

Answer 18

Anakinra

Question 19

What DMARD is an IL-6 inhibitor?

Answer 19

Tocilizumab

• competitive inhibition of both membrane bound and free soluble IL-6 receptors

Question 20

What DMARD can produce false glucose readings and also can worsen COPD symptoms?

Answer 20

Abatacept

Question 21

Pharmacological targets of DMARDs

Answer 21

Inhibt gene expression

Inhibit intracellular signaling

Decrease T-cell stimulation by down regulating stoking receptors and neutralizing cytokines

Deplete naive and active T-cell levels

Inhibit APCs

Question 22

What two DMARDs can also be used to treat lupus?

Answer 22

Azothioprine and aminoquinoline

Question 23

What is the receptor on T-cells that binds usually to CD80/86 receptors on APCs?

Answer 23

CD28

Question 24

What NSAID is given often times with methotrexate to alleviate pain?

Answer 24

Naproxen