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dmards
dmards lecture
Question | Answer |
---|---|
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) |