Pharm - rheumatoid arthritis RA
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| Three classes of drugs to tx RA | NSAIDs---DMARD = disease modifying anti-rheumatic drug-----gluco/cortio/steroids
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| role of NSAIDs in RA | treat symptoms only ---DO NOT SLOW PROGRESSION OF DISEASE
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| role of DMARDs in RA | used to slow progression of RA
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| role of steroids in RA | used to 'bridge' while waiting for DMARDs onset. only used ST and/or for severe sxs until they are releived by DMARD or NSAID
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| DMARDs take weeks/months for onset to decrease inflamm and dec progression. What is normal admin route | this class generally given orally. (mothotrexate does have an inj form)
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| Name 3 oral DMARDs | methotrexate---hydroxychloroquine---sulfasaline---leflunomide
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| what oral DMARD used first and why | methotrexate ---it only takes 3-6 WEEKS for its onset
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| moethotrexate ADRs - serious but less prevalent than other DMARD ADRs | hepatic fibrosis---bone marrow suppression---GI ulceration---pneumonitis
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| name oral DMARD whose onset is 3-6 MONTHS | Hydroxychloroquine ----also used to tx malaria
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| ADR concern for hydroxychloroquine | toxicity--> RETINAL DAMAGE. monitor with ophtalmogic evaulations
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| what oral DMARD has onset of 1-3 MONTHS | sulfasalazine ---but it is least effective in class
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| unusual ADRs sulfasalazine | compliance limiting GI & dermatologic---hepatitis and BMD are rare
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| DMARDs that are biological agents, MOA | suppresses various components of immune system
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| very important ADR of biological DMARDS | by suppressing immune system --> SUSCEPTIBLE TO INFECTION, INCLUDING SEPSIS
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| are biological DMARDs first line? | no, but are useful if oral DMARDs not successful
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| leflunomide is an oral DMARD, classified as non-biological but it decreases Tcell prolif, so is likely to have this ADR | LEST LIKELY infection in pseudo-class --- along with d/n---rash/alopecia
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| what are the IV admin biological DMARDs | infliximab---tocilizumab
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| what are the SQ injectible 'mab DMARD-biological | adalimumab---golimumab---rituximab
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| what are the SQ injectble 'cept DMARD-biological | etanercept---abatacept
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| what is the 'oddball named' SQ DMARD-biological | anakinra
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