Disease modifying antirheumatic meds and immune modulators.txt

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Disease modifying antirheumatic meds and immune modulators.txt
2013-10-31 12:43:30
Pharm Final

Week 11
Show Answers:

  1. What is most commonly used DMARD
  2. DMARD stands for
    disease modifying antirheumatic drug
  3. How long is methotrexate effective in
    2-6 weeks
  4. What is cornerstone of tx for RA
    early diagnosis and aggressive treatment
  5. MOA of DMARDS
    exact is unknown but do have antinflammatory effects that slow progression of RA and preserve the joint
  6. MOA of hydroxychloroquine
    mimics the parent compound chloroquine.

    Antiinflammatory properties by inhibiting conversion of arachidonic acid to prostaglandin F2
  7. Sulfonamides MOA

    Is anti-inflammatory and reaches high concentrations in serous fluids and connective tissue
  8. Methotrexate MOA
    anti-inflammatory and immunosuppressive properties.

    Impairs DNA synthesis.

    Inhibitory on cytokines especially interleukin 1 and arachidonic acid

    antiproliferative effect on synovial cells.
  9. Immunomodulators MOA
    cytokines (TNF and IL) are released during inflammation. These agents have been cloned and given to immunodeficient patients for RA.

    Some are given for MS
  10. Cytokine blockers MOA
    block cytokines from stimulating cartilage degrading enzymes  
  11. Corticosteroids MOA
    inhibit production of interleukins

    immunosuppressive and antiinflammatory
  12. JAK inhibitors
    interfere with enzymes that contribute to tissue inflammation
  13. First line tx for RA
    DMARDS- methotrexate

    COX 2 selective NSAID should be used with this.
  14. If DMARDs do not provide pain relief then add?
  15. Low dose oral glucocorticosteroids (predinisone) should only be given _____?
    short term.

    May need to add calcium supplement to decrease risk of osteoporosis
  16. What can be used for intense flare ups of RA and OA, but can only be repeated 3 times per year
    intra-articular injections
  17. Add opioids only if
    inadequate pain relief with other drugs first
  18. DMARDs are only prescribed by
  19. Hydroxychlorquine should be used in caution with patients with

    These drugs can cause _______?
    • renal or hepatic impairment
    • or history of ETOH abuse

    Irreversible retinal damage, patients should be advised to wear sunglasses due to photosensitivity
  20. Pts who are candidates for immunomodulator therapy should be screened for
    TB risk
  21. What is used to monitor disease activity over time
    ESR and C-reactive protein
  22. monitoring of methotrexate
    cbc, albumin, creatinine, and LFTs at baseline and monthly for 6 months. and 1-2 months thereafter.

    Also alkaline phosphatase, chest x-ray, and hepatitis b and c in high risk patients.
  23. Pregnancy and Lactation
    B- sulfasalazine, TNF inhibitors, IL-1 receptor antagonist.

    C- hydroxychloroquine (lactation prob safe), abacept

    X- methotrexate, leflunomide
  24. Methotrexate black box warning

    Drug interactions
    • toxic effects, potentially serious at all dosages.
    • Deaths have occurred from this medication

    NSAIDS, sulfonamides, tetracycline, chloramphenicol, phenytoin, and cyclosporine may interfere with elimination of this drug.
  25. Vitamins containing folic acid may ______ response of methotrexate but can give to reduce toxicity without compromising therapeutic effect