Pharm Spring 2023 > RA > Flashcards

RA Flashcards

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1
Q

what are the 2 types of pharmacologic therapy?

A

symptomatic treatment and chronic disease management

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2
Q

what drugs are included in symptomatic treatment for RA?

A
  • NSAIDs
  • steroids (oral and intra-articular) –> lowest effective dose
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3
Q

do NSAIDs slow RA disease progression?

A

No
*just help with pain

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4
Q

what are chronic treatment options for RA?

A
  • non-biologic DMARDs
  • anti-TNF (biologic) DMARDs
  • non-TNF (biologic) DMARDs
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5
Q

what are the conventional non-biologic DMARDs?

A
  1. methotrexate
  2. hydroxychloroquine
  3. leflunomide
  4. sulfasalazine
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6
Q

what are the target-specific non-biologic DMARDs?

A
  1. tofacitinib
  2. upadacitinib
  3. baricitinib
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7
Q

what is the MOA & dose of methotrexate?

A

MOA: folate antimetabolite
Dose: 7.5mg - 25mg PO,IM SQ

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8
Q

what are the ADRs of methotrexate?

A

Thrombocytopenia, leukopenia
GI: nausea, vomiting, diarrhea,
liver damage, stomatitis, alopecia, renal damage, folic acid deficiency

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9
Q

what is the onset of methotrexate?

A

3-6 weeks
- steroids might be used as a bridge

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10
Q

what are CI of methotrexate?

A
  1. Pregnancy (including male patients)
  2. alcoholism
  3. liver disease
  4. preexisting blood dyscrasias
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11
Q

what labs to get to monitor methotrexate?

A

CBC with diff, LFTs, sCr, Hep B & C, TB serology
Labs baseline, 2-4 wks for 3 mo, and continue to increase interval

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12
Q

what supplement do patients on methotrexate need?

A

folic acid
- 1 mg daily
- also folic acid 5 mg Q week

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13
Q

what are the ADRs of Leflunomide?

A
  1. Headache
  2. alopecia
  3. rash
  4. diarrhea
  5. nausea
  6. increased LFTs
  7. URTI
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14
Q

what are CIs of leflunomide?

A

pregnancy
- contraceptives for both males and females

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15
Q

if females become pregnant, what can be used to pull leflunomide out of the body?

A

cholestyramine

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16
Q

what are the labs for monitoring for leflunomide?

A
  1. pregnancy tests prior to initiation
  2. CBC
  3. LFTs
  4. hepatitis
  5. TB
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17
Q

what are the ADRs of sulfasalazine?

A
  1. GI side effects
  2. Headache
  3. rash
  4. nausea
  5. dyspepsia
  6. anorexia
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18
Q

what are CI are sulfasalazine?

A
  1. Hypersensitivity to sulfa or salicylate preparations, GI or GU obstruction
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19
Q

what are monitoring for sulfasalazine?

A
  1. CBC
  2. LFTs
  3. renal function
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20
Q

what is the onset of sulfasalazine?

A

more than 1 month

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21
Q

what is the onset of Hydroxychloroquine?

A

3-4 weeks

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22
Q

what are the ADRs of Hydroxychloroquine?

A
  1. retinopathy
  2. nausea
  3. vomiting
  4. diarrhea
  5. rash
  6. pigmentation changes
  7. increased LFTs
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23
Q

what are the warnings of Hydroxychloroquine?

A

1.cardiomyopathy
2. bone marrow suppression

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24
Q

what to monitor when taking Hydroxychloroquine?

A
  1. CBC
  2. LFTs
  3. sCr
  4. eye exams
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25
Can a patient be on more than one csDMARD?
yes, could be on all 4
26
what is the onset of Tofacitinib? (Target specific non-biologic DMARDs)
2 weeks
27
what are the ADRs of Tofacitinib?
1. *infection* 2. diarrhea 3. nausea 4. headache
28
what are the warnings of Tofacitinib?
1. bone marrow suppression 2. decreased HR 3. GI perforation 4. hepatotoxic
29
what to monitor when taking Tofacitinib?
1. CBC 2. LFTs 3. sCr 4. lipids 5. hepatitis 6. TB
30
what is the BBW of Tofacitinib? (Oral drug)
1. serious infection 2. lymphoma and other malignancies 3. *thrombosis* 4. increased all cause mortality 5. TB
31
what are the ADRs of Upadacitinib?
1. URTI 2. neutropenia 3. nausea 4. thrombosis 5. increased lipids
32
what is the dose of Upadacitinib?
Daily
33
What to monitor for Upadacitinib?
1. CBC 2. LFT 3. Lipids
34
What are the BBW of Upadacitinib?
1. Serious infection 2. Malignancies 3. Thrombosis
35
What are the ADRS of Baricitinib
1. URTI 2. Nausea 3. Thrombosis 4. Increased LFTs 5. Lipids
36
What to monitor for Baricitinib
1. CBC 2. LFTs 3. Lipids
37
What are the BBW of Baricitinib
1. Serious infections 2. Malignancies 3. Thrombosis
38
can a patient take both Methotrexate and tofacitinib?
Yes
39
can a patient take both Tofacitinib and baracitinib?
No
40
can a patient take Methotrexate, leflunomide, sulfasalazine, hydroxychloroquine and tofacitinib?
Yes
41
what is the MOA of anti-TNF DMARDs?
monoclonal antibody that binds and inhibits tumor necrosis factor alpha (TNFα)
42
what is the dose of Infliximab (Remicade)?
3mg/IV
43
what are the ADRs of Infliximab (Remicade)?
1. Headache 2. abdominal pain 3. anemia 4. increased LFTs 5. flushing skin rash 6. infection
44
what is the dose of Adalimumab (Humira)?
40mg sub q
45
what are the ADRs of Adalimumab (Humira)?
1. Headache 2. rash 3. infection 4. abdominal pain 5. nausea vomiting 6. increased CPK
46
what are the CI/warnings of Inflixima (Remicade)?
less than 5 mg/kg in heart failure
47
what labs to monitor for Infliximab (Remicade)?
1. vitals every 2-10 minutes during infusion 2. TB and HBV 3. CBC 4. LFT
48
What is the place in therapy for Infliximab (Remicade) (indication)?
combination with methotrexate
49
what is the CI/warnings of Adalimumab (Humira)?
Precaution in HF patients
50
what labs to monitor for Adalimumab (Humira)?
1, CBC 2. TB 3. HBV
51
when is Adalimumab (Humira) indicated?
Combination with monotherapy
52
what are common warnings of anti-TNF DMARDs?
- Don't use with HF - Cardiovascular/cerebrovascular reactions - Hematologic disorders - Hepatic reactions - Hepatitis B reactivation
53
all anti-TNF DMARDs BBW is?
- *Severe infections - Lymphomas or other malignancies* - Tuberculosis
54
what are the other TNF DMARDs?
- Etanercept (Enbrel) - Golimumab (Simponi) - Certolizumab Pegol (Cimzia) - all subQ, have same side effects
55
what are the non-TNF DMARDs?
- Rituximab (Rituxan) - Tocilizumab (Acetemra) - Abatecept (Orencia) - Anakinra (Kineret) - Sarilumab (Kevzara)
56
when are non-TNF DMARDs used?
when there are other CIs
57
What are the ADRS for Rituximab (Rituxan), Tocilizumab (Acetemra), Abatecept (Orencia)
R: increased LFT T: Increased cholesterol and LFT A: headache, nausea, infections, URTI
58
What are the ADRS for Anakinra (Kineret), Sarilumab (Kevzara)
A: headache, vomiting, infection, arthralgia, nausea S: increased LFTs
59
what are the csDMARDs? (Non-biologic DMARD)
1. Methotrexate 2. sulfasalazine 3. hydroxychloroquine 4. leflunomide
60
What are the tsDMARD (non biologic DMARD)
1. Tofacitinib 2. Upadacitinib 3. Baricitinib *All JAK inhibitors
61
What are the BDMARDS? (Anti-TNF)
1. Infliximab (remicade ) 2. Adalimumab (Humira) *etanercept (enbrel) *Golimumab *certolizumab
62
What are the bDMARDS (non TNF)
1. Rituximab 2. Tocilizimab 3. Abatecept 4. Anakinra 5. Sarilumab
63
what are the treatment guidelines for RA?
1. methotrexate 2. combo of synthetic DMARDs or add biologic 3. change to alternative bDMARD or tsDMARD
64
if there is a CI to methotrexate, what to use?
another csDMARD - sulfasalazine, hydroxychloroquine, leflunomide
65
all patients with RA (low and high-disease activity) should be started on?
methotrexate (unless CI)
66
what drugs are recommended to be combined for RA?
csDMARDs are recommended in combination with bDMARDs or tsDMARDs
67
T/F. biologic DMARDs should not be used in combination with other bDMARDs or tsDMARDs.
T
68
can 2 bDMARDs be used together?
No
69
can a JAK inhibitor and bDMARD be used together?
No
Pharm Spring 2023
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