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