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Indomethacin
- NSAID; reduce swelling, inflammation, pain; Inhibition of COX → (-) of PG synthesis.
- Also inhib. of PMN adhesion, aggregation, & activation (ramifications uncertain).
- RA
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Celecoxib
- NSAID; selective COX-2 inhibitor
- RA
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Prednisolone
- Glucocorticoid; regulate the transcription of genes with glucocorticoid response elements;
- immunosuppressant, anti-inflammatory;
- SE-infections/ulcers/ hyperglycemia/osteoperosis/ hypernatremia/hypokalemia
- RA
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Prednisone
- Glucocorticoid; regulate the transcription of genes with glucocorticoid response elements; immunosuppressant, anti-inflammatory, given with antihistamines;
- SE-infections/ulcers/ hyperglycemia/osteoperosis/ hypernatremia/hypokalemia
- RA
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Triamcinolone
- Glucocorticoid; synthetic corticosteroid
- RA
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Methylprednisolone
- Glucocorticoid; anti-inflammatory
- RA
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Azathioprine
- DMARD/non-biologic;
- for refractory RA or systemic involvement; rarely used; purine synthesis inhibitor;
- SE-myelosuppression/GI toxicity/carcinogenic
- allopurinol can cause toxicities
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Cyclosporine
- DMARD/non-biologic; limited use; rarely used; immunosuppressant;
- binds calcineurin phosphatatse and decree IL-2;
- SE-neprotoxicity/neurotoxicity/hyperuricemia
- Erythromyocin and grapefruit can slow clearance
- RA
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Methotrexate
- DMARD/non-biologic; inhib dihydrofolate reductase; depletion THF required for purine sin;
- early RA therapy; fastest acting DMARD;
- SE-bone marrow suppression/stomatitis/ pulmonary/teratogenic;
- leucovorin reduce toxicity; avoid alcohol
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Hydroxychloroquine
- DMARD/non-biologic; antimalarial; traps free radicas/stabilizes lysosomal mem;
- mild RA; combo with NSAIDS/methotrexate/ sulfasalazine;
- prolonged response 3-6mo
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Sulfasalazine
- DMARD/non-biologic; antimalarial; anti-inflammatory, immunomodulator;
- mild RA
- combo with methotrexate;
- 2-3mo response; more toxicity than hydroxychloroquine
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Etanercept
- DMARD/biological; TNF-a Inhibitors; fusion protein; binds TNF-a, prevents activation of receptors;
- RA monotherapy or combo with methotrexate;
- SE-skin rxn/infection/malignancy/autoimmune/CHF
- contraindications-SLE/MS/infections/
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Adalimunab
- DMARD/biological; TNF-a Inhibitors; humanized ant-TNF-a monoclonal Ab;
- RA monotherapy or combo with methotrexate;
- SE-skin rxn/infection/malignancy/ autoimmune/CHF
- contraindications-SLE/MS/infections
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Infliximab
- DMARD/biological; TNF-a Inhibitors; chimeric anti-TNF-a monoclonal Ab;
- RA combo with methotrexate for pts who don't respond to methotrexate alone;
- SE-skin rxn/infection/malignancy/autoimmune/CHF
- contraindications-SLE/MS/infections/
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Anakinra
- IL-1 inhibitor; receptor antagonist; inhibits pro-inflam effects;
- RA monotherapy and combo with methotrexate;
- not given with TNF inhibitor; least effective;
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Abatacept
- RA; Selective Costimulation Modulator; fusion protien homologue of CD28 TCR for B7; binds to B7 with higher affinity than CD28;
- inhibits TNF-a/interferion-y/IL-2;
- not given with another DMARD;
- SE-HTN/headache/anaphylaxis/infections
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Rituximab
- CD20 Ab; chimeric monoclonal Ab agains CD20; Bcell specific;
- RA combo with methotrexate or DMARD not recommended;
- black box warning-fatal infusion rxns;
- SE-infection/reactivation of HepB
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