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30 Cards in this Set
- Front
- Back
What are the goals of therapy in Rheumatoid Arthritis?
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Improve quality of life
Control disease activity and joint pain Ability to perform daily activities Slow destruction of joint Remission |
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What does DMARD stand for?
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Disease Modifying Anti-Rheumatic Drug
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Name the four non-biologic DMARDs.
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Methotrexate
Leflunomide Hydroxychloroquine Sulfasalazine |
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When is Hydroxychloroquine typically used?
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In mild disease or as adjunctive therapy with another DMARD.
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What key things do you monitor when a patient in taking hydroxychloroquine?
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Baseline eye exam, then every 9-12 months
Rash Diarrhea |
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What is considered the gold standard of RA therapy?
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Methotrexate
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How labs do you want to monitor during Methotrexate therapy?
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Baseline - AST/ALT, Alk Phos, Albumin, Total Bilirubin, Hepatitis B/C studies, CBC with platelets, SCr
Maintenance - AST, Albumin every 1-2 months, CBC with platelets every 1-2 months |
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What side effects do you want to monitor during Methotrexate therapy?
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NVD, Stomatitis, Cough, Dyspnea
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How could you help prevent adverse effects?
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Folic Acid supplementation
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When is Methotrexate contraindicated?
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Pre-existing liver disease
CrCl < 40 ml/min Pregnancy |
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What is the function of NSAIDs and Corticosteroids in RA therapy?
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NSAIDs are used for symptomatic relief and are scheduled.
Corticosteroids are used in debilitating disease to bridge the patient as DMARDs may take a while to work. Low-dose long-term therapy may be used in difficult to control disease |
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How would you counsel a patient taking methotrexate?
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Limit adverse side effects (GI Upset, Stomatitis) by taking folic acid
Avoid alcohol Take medication once per week Educate patient on necessary labs Contraception (known teratogen) |
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If a patient has compromised renal function, what agent(s) would be acceptable?
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Leflunomide
Sulfasalazine |
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How would you minimize the adverse effects of corticosteroids?
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Minimize use of the drug
Use the shortest course possible |
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If giving Leflunomide, what monitoring is done?
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Baseline - ALT, CBC with platelets
Maintenance - ALT, CBC with platelets monthly for 6 months, then every 2 months |
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If giving Sulfasalazine, what monitoring is done?
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Baseline CBC with platelets weekly for a month
Maintenance - CBC with platelets monthly |
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What side effects would you monitor for in Leflunomide?
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NV
Gastritis Alopecia Jaundice |
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What side effects would you monitor for in Sulfasalazine
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NVD
Stomatitis Rash Urticaria Photosensitivity Urine/skin may turn a different color |
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How would you counsel a patient taking Leflunomide?
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GI Upset
Alopecia Educate on necessary labs Contraception |
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How would you counsel a patient taking Sulfasalazine?
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GI Upset
Urine/skin may turn orange-yellow Use sunscreen |
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If the patient wanted to have a baby, what would be your best option?
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Sulfasalazine - Pregnancy category B
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If the patient has compromised liver function, what is your best option?
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Sulfasalazine
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When do you choose a biologic agent?
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When you've exhausted other options.
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Which biologic agents should we know for the test?
What do these agents do? |
Etanercept
Infliximab Adalimumab They are anti-TNF agents |
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How are these administered?
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Infliximab - IV
Etanercept -SC Adalimumab - SC |
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What is important to know about Infliximab?
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It must be administered with Methotrexate because this minimizes adverse effects
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How would you monitor someone taking a biologic agent?
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Baseline - Tuberculin Skin Test (rule out tuberculosis)
Maintenance - None Major concern with all biologics is infection Local Injection site reactions (SC) Infusion Reactions (IV) |
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What two drugs have a relative contraindication in CHF?
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Infliximab
Etanercept |
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How could you minimize Infusion reactions when using Infliximab?
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Pre-treat with acetaminophen or diphenhydramine or CS's
Slow the rate of infusion |
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How would you educate a patient taking a biologic agent?
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Educate on how to give injection
Contact PCP if you get a reaction |