RA

Question 1

When do you need to start prescribing DMARDS for RA dx?

Answer 1

within 3 months of diagnosis

Question 2

T/F NSAIDS and and corticosteroids are considered adjunctive therapy with DMARDS

Answer 2

TRUE

Question 3

What is first line therapy for RA?

Answer 3

DMARDS

usually methoxtrexate choosen first

Question 4

What is MOA of methoxtrexate?

Answer 4

• blocks cytokine production
• blocks purine synthesis
• stimulate release of adenosine

Question 5

Which nutrient is deficiency when giving methotrexate

Answer 5

folic acid

Question 6

Who should no receive methotrexate?

Answer 6

pregnant women
chronic liver disease 
immunodeficient
leukopenia
CrCl <40

Question 7

What toxicities are associated with methotrexate?

Answer 7

pulmonary fibrosis
hematologic thromobocytopenia
hepatic elevated liver enzymes
stomatitis

Question 8

What labs could you monitor for methorexate?

Answer 8

CBC

ALT/AST

Question 9

What is MOA if leflunomide?

Answer 9

blocks pyrimidine synthesis and decreases lymphocyte proliferation and modulation of inflammation

Question 10

What is a contraindication for leflunomide?

Answer 10

liver disease
teratogenic
long half life 14-16 days

Question 11

What toxicities are associated with leflunomide?

Answer 11

GI, hair loss, liver, bone marrow toxicity

Question 12

Which drug can be given to lower leflunomide levels in the body?

Answer 12

Cholestyramine: binds it and can clear it

Question 13

What is MOA of hydroxychloroquine?

Answer 13

dampens ab-antigen response at site of inflammation

Question 14

what is the clinical use of hydroxychloroquine?

Answer 14

mild RA

combination therapy with DMARD for progressive disease

Question 15

What are ADE with hydroxychloroquine?

Answer 15

• myelosuppression
• N/V/D
• ocular: decreased night or peripheral vision
• rash, alopecia
• neuro: vertigo insomnia

Question 16

T/F Hydroxychloroquine lacks heaptic and renal toxicities

Answer 16

True

Question 17

T/F Sulfsalasizne is cleaved in the colon

Answer 17

TRUE

Question 18

Which two active substances does sulfsalaszine produce

Answer 18

sulfapyridine and 5-aminosalicylic acid

Question 19

Which two diseases is sulfsalazine used for?

Answer 19

Cronh’s and RA

Question 20

What are ADE of sulfasalazine?

Answer 20

elevated liver enzymes
may turn skin yellow
con potentiate warfarins effect

Question 21

T/F Sulfasalazine absorption is decreased if abx destroy colonic bacteria

Answer 21

TRUE

Question 22

T/F Sulfasalazine is cleaved in the colon into a pro drug

Answer 22

TRUE

Question 23

T/F Iron can limit the absorption of sulfasalazine

Answer 23

TRUE

Question 24

What drug class is used to tx high activity and presence of poor prognostic factors of RA?

Answer 24

Biologics
Anti-TNF
Non- TNF

Question 25

T/F Methotrexate is more effective than biologic monotherapy

Answer 25

TRUE

Question 26

What are some examples of initial combination therapy with methotrextae and biologics?

Answer 26

Methotrexate and etanercept sulfasalazine and prednisone infliximab and methotrexate

Question 27

What are pharmacotherapy options for moderate to high disease activity?

Answer 27

methotrexate and hydroxyquinilone methotrexate and leflunomide methotrexate and sulfasalazine

Question 28

What is triple combination therapy?

Answer 28

methotrexate and sulfasalazine, hydroxyquinilone

Question 29

What is a JAK inhibitor? What is MOA?

Answer 29

JAK is a tyrosine kinase, it suppresses the immune system by modulating or reducing the cytokine signal downstream

Question 30

what are ADE of of JAK

Answer 30

- serious infections - lymphomas - elevated liver enzymes, - live vaccines should not be given

Question 31

What is the clinical use of JAK-I?

Answer 31

moderate to severe RA who have failed wiht methotrexate

Question 32

Name 2 JAK-I?

Answer 32

Tofacitinib and Baricitinib

Question 33

What are biologic agents?

Answer 33

genetically engineered molecules that block pro inflammatory cytokines

Question 34

Name drugs that are TNF-alpha?

Answer 34

Infliximab, Etanercept, Adalimumab,

Question 35

Name IL-6 blocker?

Answer 35

Tocilizumab, Sarilumab

Question 36

Which drug depletes peripheral b-cells?

Answer 36

Rituximab

Question 37

Which drug is a T-cell costimulator blocker?

Answer 37

Abatacept

Question 38

What is MOA of TNF-alpha?

Answer 38

blocks cytokine TNF-alpha

Question 39

What are contraindications for TNF-alpha?

Answer 39

CHF

Question 40

What are ADE of TNF-alpha?

Answer 40

MS like illness or exacerbates MS | increased risk of lymphoproliferative cancer

Question 41

Name 2 TNF-alpha? how do they differ with MOA?

Answer 41

entanercept: binds TNF to inactivate it,it is a fusion protein infliximab: chimeric antibody, binds TNF

Question 42

What should be given with infliximab to prevent ab production against infliximab?

Answer 42

methotrexate

Question 43

What is MOA of Tocilizumab, Sarilumab?

Answer 43

attaches to IL-6 receptors and prevents cytokines from binding with IL-6

Question 44

What are ADE of Tocilizumab, Sarilumab?

Answer 44

``` risk of infection elevated plasma levels elevated liver enzymes risk of GI perforation inducer of CYP450 34A don't give live vaccination ```

Question 45

What is MOA of Rituximab?

Answer 45

binds b -cells and nearly completes depletion of peripheral B cells

Question 46

when do you use Rituximab?

Answer 46

when patient fails methotrexate and TNF_alpha tx | -but continue rituximab tx with methotrexate

Question 47

What are ADE of Rituximab?

Answer 47

No vaccines

Question 48

What is MOA of Abatacept?

Answer 48

binds CD80/86 on t -cells to prevent the co stimulation needed to fully activate T cells

Question 49

What are ADE of Abatacept?

Answer 49

``` nasopharyngitis back pain -dyspepsia -UTI rash extermity pain ```

Question 50

If patient with RA needs a vaccine, which form is not accepted to be given?

Answer 50

Live vaccines are not acceptable only killed ones