Therapeutics - RA 2

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Author:
kyleannkelsey
ID:
282085
Filename:
Therapeutics - RA 2
Updated:
2014-09-04 13:07:51
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Therapeutics RA
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Therapeutics - RA 2
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Therapeutics - RA 2
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  1. What is the brand name for Leflunimide?
    Arava
  2. What is the brand name for Hydroxychloroquine?
    Plaquenil
  3. What is the brand name for Sulfasalazine?
    • Azulfidine
    • Sulfazine
  4. What is a DMARD?
    disease modifying antirheumatic drug
  5. All pharmacologic therapy for RA should contain one _________.
    Oral DMARD
  6. DMARDs include what drug classes?
    Conventional agents for RA and Biologics
  7. What are the benefits of DMARDs?
    • Control signs and symptoms
    • Improve functional status
    • Slow erosions
  8. What is the frequency of methotrexate administration?
    Weekly
  9. What is the usual dose of Methotrexate?
    7.5-15 mg PO, IM or SQ
  10. What is the OOA for Methotrexate?
    2-3 weeks
  11. When is the maximum benefit of Methotrexate observed?
    6 months
  12. How often should you titrate methotrexate?
    Q6months
  13. What is the First line therapy for RA?
    Methotrexate
  14. How is Methotrexate excreted?
    80% renal
  15. Is Methotrexate protein bound?
    Yes, 35-65%
  16. What is the oral bioavailability of Methotrexate?
    • 70%
    • Decreases with increasing doses ( give IM or SQ w/ high doses)
  17. What is the MOA of Methotrexate?
    Anti-inflammatory properties due to its inhibition of cytokine production, purine biosynthesis, and stimulation of adenosine
  18. What are the AEs of Methotrexate?
    • GI
    • Bone marrow suppression
    • Pulmonary
    • Hepatitis
    • Photosensitivity
    • Folic acid deficiency
  19. GI adverse effects of Methotrexate generally resolve in what time period after DC?
    2-3 weeks
  20. Concomitant folic acid replacement reduces what AEs of Methotrexate use?
    • GI
    • Hepatic
    • Hematologic (BMS)
  21. All patients on Methotrexate should receive what other concomitant therapy?
    Folic acid
  22. Does Folic acid supplementation effect efficacy of Methotrexate?
    No
  23. What Laboratory monitoring should be done for a patient on methotrexate for RA?
    • Baseline: AST, ALT, alk phos, albumin, total bilirubin, HBV, HCV, CBC, SCr
    • Routine (every 1-2 months): CBC, ALT, AST, albumin
  24. What are the Contraindications for Methotrexate in the treatment of RA?
    • CrCl < 30 mL/min
    • Teratogenic
    • Liver impairment
    • Pleural effusions
    • Leukopenia/thrombocytopenia
    • NSAIDs w/ high dose
  25. Why should NSAIDs be avoided with high dose Methotrexate?
    May increase methotrexate serum concentration
  26. What is the black box warning for Methotrexate?
    • Avoid NSAIDs
    • They may increase Methotrexate conc.
  27. How does the efficacy of Leflunomie and Methotrexate compare?
    Approx. Equal
  28. What is the usual dose of Leflunomide?
    • Loading: 100 mg PO QD x 3 days
    • Maintenance: 20 mg PO QD
  29. When should you expect symptom relief for RA with Leflunomide?
    1 month after loading dose
  30. What are the AE of Leflunomide?
    • GI distress
    • Hepatitis
    • Bone marrow suppression
    • Alopecia and dyspepsia (omit loading dose to reduce risk)
  31. Does Leflunomide have a long or short half-life and why?
    • Long
    • Enterohepatic circulation
  32. What is the elimination half-life of leflunamide?
    14-16 days
  33. What lab monitoring needs to be done when a patient is treated with Leflunomide for RA?
    • Baseline: AST, ALT, CBC
    • Routine: AST, ALT, CBC monthly x 6 months, then every 6-8 weeks
  34. What are the CIs of Leflunomide in the treatment of RA?
    • Liver impairment
    • Pregnant/Nursing (teratogen)
  35. Do you need to adjust the dose of Leflunomide for Renal dysfunction?
    No
  36. What situation is Hydroxychloroquine used to treat RA?
    Mild RA as a monotherapy
  37. Does Hydroxychloroquine slow radiographic progression?
    No
  38. Symptom relief should occur in ________ with Hydroxychloroquine.
    6 weeks

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