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dmards lecture

What are the 3 classes of drugs used in RA? NSAIDS, Glucocorticoids and DMARDs
What do the magic DMARDs basically do? modify the disease process, slow rate of joint damage and don't just suppress pain and swelling.
What is the schematic for RA management? 1)Methotrexate 2)Add sulfasalzine/leflunomide 3)Biological therapy
What choice is methotrexate as a dmard? first choice!
What is methotrexate's MOA? 1)Antiproliferative effect(folate pathway) 2)Anti-inflammatory effect
What do you give alongside methotrexate? folic acid
What are the side effects of methotrexate? Myelosuppression, macrovesicular fatty change in liver, mucositis
What is the MOA of leflunomide? 1)Inhibits DHODH, therefore antiproliferative activity 2)Antiinflammatory - inhibits NFkappa B etc
What are the adverse effects of leflunomide? GI, diarrhea, weight loss, hepatotoxicity, embryotoxic
In sulfasalazine, which is the active moeity? sulfapyridine (5-ASA for IBd)
What is the MOA of sulfasalazine? decreases RF, scavenges the toxic oxgen metabolites produced by neutrophils, suppressives T cell responses and inhibits B cell proliferation.
What are the adverse effects of sulfasalazine? GI disturbances, malaise, headache, skin reactions, leucopenia
What is the MOA of gold? Decreases B cells, immune complexes, RF etc
What are the side effects of gold? skin+mucous membranes;rash, erythema Kidney; proteinuria Blood; thrombocytopenia, leukopenia
What are the biological DMARDS? Infliximab, Adalimumab, Etanercept
What are the anti TNF antibodies? Infliximab, adalimumab
What are the soluble TNF receptors? Etanercept
What is the anti IL1 drug? Anakinra
What is the anti-CD20 drug? Rituximab
What is the costimulation modulator drug? Abatacept
What are the side effects of Dmards? 1)risk of macrophage dependent ifection, systemic infections, 2)autoantibody production, 3)excessive immunosuppression
What are the predisposing factors to increased uric acid concentration? 1)food intake - alcohol, purine rich foods 2) drugs - thiazide diuretics, cytotoxic drugs 3)impaired excretion of uric acid - nephropathies
What are the 3 gout drugs? Colchicine, Probenecid, Allopurinol
What is the mech of action of allopurinol? competitive inhibitor of xanthine oxidase.
What are the adverse effects of allopurinol? Allergic rxns, may precipitate acute gout, drug interaction
What is the moa of probenecid? Increases uric acid excretion by inhibition of organic acid transport across epthelial barriers
What are teh side effects of probenecid? Renal insufficiency, GI irritiation, ulcer, hypersensitivity
What is the MOA of colchicine? Depolymerizes microtubules, impairs leukocyte chemotaxis and degranulation.
What are the side effects of colchicine? GI. (indomethacin is less toxic and given in acute gout)
Created by: villagejoker