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RxPrep

Rheumatoid arthritis

QuestionAnswer
RA is what type of disease? Chronic progressive autoimmune disease
RA typically affects what joints? Small joints symmetrically
Classic RA symptom after rest? Morning stiffness
First-line therapy for most RA? Methotrexate
When use biologics? Moderate–severe disease or MTX failure
Should biologics be combined together? No — never combine biologic DMARDs
Methotrexate boxed warnings? Hepatotoxicity, myelosuppression, teratogenicity
Methotrexate contraindication? Pregnancy
Methotrexate major ADRs? Box warnings: Hepatotoxicity, myelosuppression, teratogenicity Major ADRs: GI upset, stomatitis, ↑ LFTs, pneumonitis
Methotrexate hematologic ADR? Bone marrow suppression
Which drug can cause pneumonitis? Methotrexate
Methotrexate dosing frequency? Once weekly for RA, never dose daily for RA
Supplementation required for methotrexate? Folic acid
MTX monitoring? CBC, LFTs
Can patients drink on MTX? No, increase hepatotoxicity
Which drugs increase levels of MTX? NSAIDs and beta-lactams
Which drug(s) can increase toxicity with MTX? Alcohol and sulfonamides
Warnings for hydroxychloroquine? Retinopathy, QTc prolongation, bone marrow suppression, hepatotoxic
Sulfasalazine contraindication? Sulfa allergy
Sulfasalazine major ADRs? GI upset, dyscrasias, SJS/TEN
Unique side effect of sulfasalazine? Orange/yellow skin/urine
Monitoring for sulfasalazine? CBC, LFTs
Leflunomide boxed warning? Hepatotoxicity
Leflunomide contraindication? Pregnancy
Leflunomide major ADR? Hepatotoxic, myelosuppression, peripheral neuropathy,
Which drug has a very long half-life and can require a washout with cholestyramine? Leflunomide
Leflunomide monitoring? CBC, LFTs
Which drugs are the TNF-a inhibitors? Adalimumab (Humira), Etanercept (Enbrel), Infliximab (Remicade), Certolizumab pegol (Cimzia), and Golimumab (Simponi)
TNF inhibitors boxed warning? Serious infections including TB
TNF inhibitors malignancy risk? Lymphoma
TNF inhibitors contraindication? Active infection
TNF inhibitors major risks? HF, demyelinating disease, infection, lymphoma
Monitoring for TNF inhibitors? TB screening
Counseling point for TNF inhibitors? NO LIVE vaccines
What is Enbrel? Etanercept
What is Humira? Adalimumab
What is Remicade? Infliximab
What is Cimzia? Certolizumab
What is Simponi? Golimumab
Common TNF inhibitor ADR? Injection site rxns, infections, increased LFTs
Rituximab boxed warning? Infusion reactions, PML ( Progressive Multifocal Leukoencephalopathy)
Rituximab ADRs? HBV reactivation, infusion rxns
Monitoring for Rituximab (rituxan)? HBV screening
Rituximab drug class? anti-CD20
What is Anakinra? Kineret, IL-1 antagonist
Which drug requires renal dosing? Anakinra, If CrCl < 30, switch to every other day
Abatacept MOA? unique risk? T-cell inhibitor, can worsen COPD
Which drugs fall into the IL-6 inhibitors? Tocilizumab and sarilumab
Unique ADR of IL-6 inhibitors? Neutropenia, increased lipids.
IL-6 contraindication? Low ANC or platelets
JAK inhibitor examples? Tofacitinib, baricitinib, upadacitinib (Rinvoq, Xeljanz, Oluminant)
JAK inhibitor BOX warnings? Serious infections, malignancy, thrombosis
JAK inhibitor other risks? Boxed warnings: Serious infections, malignancy, thrombosis CV death, cytopenias, increase-lipids
Which RA drugs increase lipids? IL-6 inhibitors and JAK inhibitors
Which RA drugs need renal dosing? Anakinra, Baricitinib, tofacitinib
This RA drug must be avoided at CrCl < 30 Baricitinib
Which drug(s) can reactivate TB? TNF-a inhibitors
What is the treatment alogrithim for RA in terms of drug choices? MTX (first line)→ TNF inhibitor → other biologic/JAK
How do hydroxycholoroquine and sulfasalazine fit into the RA treatment algorithm? Used as an alternative for MTX, but only appropriate in milder RA, OR they can be used with MTX
Can you combine non-biologic DMARDs? Yes, you can combine MTX, HCQ, and sulfasalazine.
Which drug(s) can cause demyelinating disease? TNF-a inhibitors
Which drug(s) can cause lymphoma? TNF-a inhibitors
Which drugs can increase risk for HF? TNF-a inhibitors
Which drugs require avoidance of live vaccines? All biologics + JAK inhibitors
Created by: cdaughtry
 

 



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