pharmacology of DMARD's
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| methotrexate | mechanism of action probably relates to secondary effects of polymorphonuclear chemotaxis secondary to inhibition of aminoimidazolecarboxamide transformylase and thimidylate synthase inhibition
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| methotrexate | decreases the rate of appearance of new erosions in RA, evidence supports its use in juvenile chronic arthritis, polymyositis, wegner's, SLE, and vasculitits
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| methotrexate | side effects: nausea and mucosal ulcers are the most common side effects. progressive dose related hepatoxicity occurs frequently
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| chlorambucil | cross-links DNA, therby preventing cell replication.
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| chlorambucil | most common toxicity is dose realted bone marrow supression. infertility with azoospermia and amenorrhea also occurs. the risk of neoplasia is increased with the relative risk of leukemia increased about 10 fold after more than 3 years of use
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| cyclophosphamide | cross links DNA to prevent cell replication
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| cyclophosphamide | causes significant dose related inferility in men and women as well as bone marrow suppression, alopecia, hemorrhagic cystitis, and rarely bladder carcinoma
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| cyclosporine | regulates gene transcription to inhibit IL1 and IL@ receptor production and secondarily inhibits macrophage T cell interaction and T cell response
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| cyclosporine | grapefruit juice increaes its bioavailability up to 60%
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| cyclosporine | has significant nephrotoxicity, and its toxicity can be increased by drug interactions with diltiazem, K sparing diuretics, and other drugs inhibiting CYP3A
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| azathioprine | suppresses inosinic acid synthesis, B cell and T cell function, immunoglobulin production, and IL-2 secretion by 6-Thioguanine which is the major merabolite
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| azathioprine | toxicity includes bone marrow suppression, gastrointestinal disturbances and some increase in infection risk
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| mycophenolate mofetil | inhibits cytosine monophosphate dehydrogenase and secondarily inhibits T cell lymophocyte proliferation
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| mycophenolate mofetil | effective for the treatment of renal disease due to systemic lupus erythematosus and may be useful in vasculitis and Wegener's granulomatosis
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| mycophenolate mofetil | side effects similar to azathioprine with a possibly decreased incidence of fungal infections
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| Gold | alters the morphology and functional capabilities of macrophages
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| Gold | IM compounds also alter lysosomal enzyme activity, reduce histamine release from mast cells, inactivates the first componant of complement and suppresses the phagocytic activitys of PMN's
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| Gold | tends to concentrate in synovial membranes, liver, kidney, spleen, lymph nodes and bone marrow after IM administration
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| Gold | adverse effects: pruitic skin rash sometimes associated with eosinophilia. stomatitis and a metallic taste in the mouth are common. hematologic abnormalities may occur
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| sulfasalazine | IgA and IgM rheumatoid factor production are decreased
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| sulfaslazine | adverse effects incluse nausea, vomiting headache, and rash. hemolytic anemia and methemoglobinemia also accur but rarely. reversible infertility occurs in men.
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| adalimumab | anti TNF monoclonal antibody; down regulates macrophage and T cell function
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| adalimumab | has a half life of 9-14 days
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| adalimumab | can reactivate latent TB. anti-dsDNA and anti ANA has been documented
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| inflixamib | adverse reactions: URI, nausea, headache, sinusitis, rash, and cough are common. can reactivate latent TB
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