Therapeutics - RA 5

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kyleannkelsey
ID:
282088
Filename:
Therapeutics - RA 5
Updated:
2014-09-04 13:12:50
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Therapeutics RA
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Therapeutics - RA 5
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Therapeutics - RA 5
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  1. Why does the American college of rheumatology not recommend Tocilizumab?
    Not updated their recommendations since 2012
  2. What is the MOA of Anakinra?
    IL-1 inhibitor
  3. Should Anikinra be combined with a TNF-alpha inhibitor, why or why not?
    No, causes increased infection rates
  4. When is is recommended to use Anakinra?
    Only if you have failed on TNF-alpha inhibitors
  5. What is the dosage form of Anakinra?
    SQ
  6. What is the onset of symptom relief for Anakinra?
    1-3 weeks
  7. What are the AE for Anakinra?
    • Injection site reactions
    • Infection
  8. How should Anakinra be administered?
    At room temperature
  9. What is the dose for Anakinra?
    100 mg SQ QD
  10. What are the dosage forms available for Anakinra?
    Prefilled syringe
  11. What is the dose for Tofacitinib?
    • 5 mg PO BID
    • Renal impairment (Child-Pugh > or = to 7) OR potent 3A4 inhibitor OR moderate 3A4 inhibitor and potent 2C19 inhibitor: 5 mg PO QD
  12. What are the adverse effects of Tofacitinib?
    • Infection (Black box)
    • Malignancy
    • Neutropenia
    • Anemia
    • Elevated lipids
  13. Why should you get a CBC when on Tfacitinib?
    To monitor for Neutropenia and Anemia
  14. Does Tofacitinib need to be adjusted for renal impairment?
    Yes, give 5 mg PO QD (normally BID)
  15. What RA drugs need to be adjusted for renal impairment?
  16. What RA drugs are CI in renal impairment?
    Methotrexate
  17. What RA drugs are CI or cautioned in liver impairment?
    • CI: Leflunomide
    • Cautioned: Sulfasalazine, Rituximab
  18. What RA drugs are teratogens?
    • Leflunomide
    • Abatacept is category C
  19. What is the MOA of Abatacept?
    Inhibits T cell interaction and activation by modulating Co-stimulation
  20. What is the role of Corticosteroids in RA therapy?
    • Bridging therapy – Symptom relief before onset of DMARD
    • Control of acute disease flares or difficult to control disease
  21. How long does it take to receive symptom relief with corticosteroids?
    Rapid
  22. What is the role of a high dose of corticosteroid in RA?
    Used to control acute disease
  23. What is the role of a continuous low dose of corticosteroids in RA?
    Used to control difficult to control disease
  24. What is the MOA of corticosteroids in relieving symptoms of RA?
    Interfere with antigen presentation and inhibit prostaglandin and leukotriene synthesis
  25. By what route are corticosteroids administered for RA relief?
    Oral or intra-articular, IM or IV
  26. What is a low dose of corticosteroids for RA?
    < or = to 7.5 mg of prednisone
  27. Under what conditions would you use IV corticosteroids for RA?
    Very severe symptoms
  28. What forms of Corticosteroids are available for the treatment of RA?
    IM, Intra-articular and IV
  29. How often can you repeat Intra-articular corticosteroid injections in RA, and why?
    • Max: Q 3 months
    • Risk of accelerated joint destruction and tendon atrophy with more injections than 2-3 a year
  30. Which route of corticosteroid administration is a good choice for a non-adherent patient and why?
    • IM
    • Long-acting and provides physiologic taper
  31. Which route of corticosteroid administration is a good choice if you want to reduce systemic side effects?
    Intra-articular
  32. When are intra-articular corticosteroid injections a good choice?
    When a small number of joints are affected
  33. What are the AE of corticosteroid injections?
    • HPA suppression
    • Cushing’s
    • Osteoporosis
    • Myopathies
    • Glaucoma
    • Cataracts
    • Delirium/Hallucinations
    • HYPERglycemia
    • HTN/fluid retention
    • Electrolyte disturbances
    • Hirsutism
    • Skin atrophy
    • Fungal infections
    • Insomnia
  34. Should NSAIDs be used as a monotherapy in RA?
    No
  35. Do NSAIDs alter disease progression in RA?
    No
  36. What is the role of NSAIDs in RA?
    • Used for symptomatic relief while Biologics are kicking in
    • Analgesia/anti-inflammatory, reduce stiffness
  37. What are the AE of NSAIDs in the treatment of RA?
    • Peptic ulceration and bleeding
    • Renal insufficiency
    • CV effects
  38. According to the American College of Rheumatology, therapeutic recommendations ahould be based onwhat factors?
    • Disease duration
    • Disease activity (low, mod, high)
    • Prognosis (good/poor)
  39. What triple therapy has been shown to be efficacious for RA?
    • Methotrexate
    • Sulfasalazine
    • Hydroxychloroquine
  40. What pharmacologic therapies are considered adjunctive for the treatment of RA?
    Corticosteroids and NSAIDs
  41. What dual therapies are available for RA?
    • Methotrexate + leflunomide
    • Methotrexate + hydroxychloroquine
    • Methotrexate + sulfasalazine
    • Methotrexate + TNF alpha inhibitor
    • Sulfasalazine + hydroxychloroquine
  42. If a patient has a poor prognosis and an inadequate response to an oral DMARD, what treatment would you susggest?
    DMARD + Biologic
  43. What treatment plan should be used for a patient with High disease activity and a poor prognosis?
    • Anti-TNF ± MTX
    • OR
    • Combination DMARD therapy
  44. What treatment plan should be used for a patient with High disease activity and a good prognosis?
    • DMARD monotherapy
    • OR
    • HCQ + MTX
  45. What treatment plan should be used for a patient with Low disease activity?
    DMARD monotherapy
  46. What treatment plan should be used for a patient with Moderate disease activity and a good prognosis?
    DMARD monotherapy
  47. What treatment plan should be used for a patient with Moderate disease activity and a poor prognosis?
    Combination DMARD therapy (double & triple therapy)

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