thera test 1 rheumatology

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coal
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262058
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thera test 1 rheumatology
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2014-02-15 00:48:55
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thera test rheumatology
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thera test 1 rheumatology
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  1. target populations who should be tested for RA
    • have at least 1 joint with definite clinical synovitis
    • synovitis is not better explained by another disease
  2. 4 indicators of a poor prognosis for RA
    • functional limitations
    • extra-articular disease
    • positive RF or anti-CCP antibodies
    • bony erosions on radiograph
  3. role of corticosteroids in RA
    • blunt the inflammatory and autoimmune response
    • bridge therapy to control pain and synovitis while DMARDs are taking effect
    • continuous low dose therapy in pt with difficult to control disease
    • high dose bursts to suppress disease flares
  4. 2 options to alleviate the adverse effects of corticosteroids in RA
    • osteoporosis and fracture = always give supplemental calcium & vitamin D
    • if pt takes > 7.5 mg prednisone for 3 months, start bisphosphonate, check DEXA
  5. mehtotrexate
    rheumatrex
  6. nonbiologic DMARDs
    • methotrexate - rheumatrex
    • leflunomide - arava
    • hydroxychloroquine - plaquenil
    • sulfasalazine - azulfidine
  7. leflunomide
    arava
  8. hydroxychloroquine
    plaquenil
  9. sulfasalazine
    azulfidine
  10. biologic DMARDs
    • etanercept - enbrel
    • adalimumab - humira
    • infliximab - remicaid
    • certolizumab - cimzia
    • golimumab - simponi
    • abatacept - orencia
    • rituximab - rituxan
    • tocilizumab - actemara
    • anakinra - kineret
    • tofacitinib - xeljanz
  11. anakinra
    kineret
  12. tofacitinib
    Xeljanz
  13. golimumab
    simponi
  14. abatacept
    orencia
  15. rituximab
    rituxan
  16. toxilizumab
    actemara
  17. etanercept
    enbrel
  18. adalimumab
    humira
  19. infliximab
    remicaid
  20. certolizumab
    cimzia
  21. TNF inhibitors
    • etanercept - enbrel
    • adalimuab - humira
    • infliximab - remicaid
    • certolizumab - cimzia
    • golimumab - simponi
  22. CI of methotrexate
    • pregnancy and nursing
    • chronic liver disease
    • CrCl < 40 ml/min
    • immunodeficiency
    • preexisting blood disorders
  23. CI of leflunomide (arava)
    • liver disease
    • pregnancy
  24. what would you give to clear leflunomide (arava) from plasma
    cholestyramine
  25. CI of hydroxychloroquine - plaquenil
    pediatric pts
  26. CI of sulfasalazine - azulfidine
    pts with sulfa or salicylate allergy
  27. 3 meds that should be administered with MTX
    • infliximab - remicaid = to prevent the formation of antibodies
    • golimumab - simponi
    • rituximab - rituxan
  28. 5 safety concerns for TNF inhibitors
    • increased risk of serious bacterial & fungal infections
    • associated w/reactivation of TB
    • increased risk of lymphoma & other cancers in pt < 30 yo
    • may increase risk of malignancy in adult pts
    • linked with new or worsening HF
  29. place in therapy for abatacept - orencia
    pt with inadequate response to 1 or more DMARDs
  30. place in therapy for rituximab - rituxan
    combined with methotrexate in pts who have inadequate response to > 1 TNF inhibitors
  31. place in therapy for tocilizumab - actemara
    pts w/inadequate response to TNF inhibitors or DMARDs
  32. place in therapy of tofacitinib - xeljanz
    monotherapy or combined with MTX in pts who have adequate response or intolerance to MTX
  33. which med used the REMS program
    tofacitinib - xeljanz
  34. what is the BBW for tofacitinib - xeljanz
    • risk for serious infections
    • monitor all pts for active TB
    • lymphoma & other malignancies have been observed
  35. what do you need prior to starting DMARDs
    • baseline labs
    • screening for hepatitis B & C
    • TB screening
    • vaccinations
  36. what vaccinations are needed before initiating therapy for RA
    • pneumococcal
    • influenza
    • hep B - if hepatitis risk factors are present
    • HPV
    • herpes Zoster
  37. what vaccinations are needed while taking therapy for RA
    • pneumococcal - 1 time revaccination
    • influenza
    • hep B
    • HPV
    • herpes zoster - NOT for pts on biologic therapy
  38. an NSAID not to be used in gout
    aspirin
  39. CI of colchicine - colcrys
    renal impairment
  40. indications for pharmacologic Tx of gout
    • pts w/ > 2 acute attack/year
    • pt with tophi or nephrolithiasis
  41. CI for pegloticase - krystexxa
    G6PD deficiency
  42. gout Tx algorithm
    • 1st line - XOI, alternative probenecid
    • if serum urate target┬ánot achieved or continued disease activity = add probenecid
    • if serum urate target not achieved or continued disease activity = pegloticase
  43. 5 risk factors for osteoporosis
    • age
    • hormone deficiency
    • body habitus
    • social history
    • medical history
  44. 5 safety concerns of bisphosphonates
    • atypical femur fractures (BBW)
    • osteonecrosis of the jaw
    • GI mucosa irritation
    • hypocalcemia
    • poor renal function
  45. administration of alendronate - fosamax
    • take with 6-8 oz of water in the morning > 30 minutes prior to first food, beverage or other meds
    • stay upright for at least 30 min AND until after the first food of the day
  46. risedronate -atelvia administration
    35mg weekly AFTER breakfast with at least 4 oz of water
  47. administration of ibandronate - boniva
    • take w/ 6-8 oz of water in the morning > 60 minutes prior to first food, beverage or other meds
    • stay upright for at lease 60 min AND until after the first food of the day
  48. safety concerns of raloxifene - evista
    • increase risk of fatal stroke in women w/history of CHD
    • increase risk of VTE
  49. counseling points of raloxifene - evista
    • D/C at least 72 hours prior to & during prolonged immobilization
    • discourage smoking and alcohol consumptio
  50. pt education of teriparatide - forteo
    • discard 28 days after 1st use
    • refrigerate at 36-46 at all times
    • don't use if been frozen
    • change needle with every use
  51. BBW of teriparatide - forteo
    increased risk of osteosarcoma
  52. safety concerns for denosumab - prolia
    • atypical femur fractures
    • increase risk of infections
    • osteonecrosis of the jaw

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