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DMARDs
Drug | Mechanism | Adverse Effects |
---|---|---|
Methotrexate | DHFR inhibitor; cytotoxic to lymphocytes; 1st line in moderate-severe | Hepatotoxicity, acute renal failure |
Sulfsalazine | Sulfapyridine decreases B cell function; 5-ASA inhibits COX | Hemolysis in G6PD |
Glucocorticoids | Decrease LTs, ILs, PAF | ACTH suppression, cushingoid state, osteoporosis, GI distress, glaucoma |
Gold salts | Decrease lysosomal & macrophage function | Dermatitis, nephrotoxicity, cholestatic jaundice |
Penicillamine | Suppresses T cells & RF (Cu chelator in Wilson's dz) | Proteinuria, autoimmune disease |
Leflunomide | Inhibits pyrimidine synthesis (inhibits DHOD [dihydroorotate dehydrogenase], decreasing UMP, decreasing ribonucleotides); arrests lymphocytes in G1 phase | Alopecia, rash, diarrhea, hepatotoxicity |
Adalimumab | Anti-TNF antibody | Increased risk of infection (screen pt for TB) |
Hydroxychloroquine | Stabilizes lysosomes; decreases chemotaxis | Cinchonism, hemolysis in G6PD, retinal deposits (pts need regular optho exams) |