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Rheumatoid Arthritis
Pharmacotherapy II-Spring 2012
| Question | Answer |
|---|---|
| How are joints affected in RA, OA? | RA: symmetrical, OA, per joint |
| What are some extre-articular involvements | Rheumatic nodules, vascultiis, eye inflammation, nero dysfxn, CVD, lymphadenopathy, splenomegaly |
| RA is common in what population | F>M 3:1 genetic predisposition the same |
| Inflamed, proliferating synovium | pannus |
| Onset and path of the dz | insidious, prodrome, stiffnes w/ swelling, small joints in hands, wrists and feet, waxing and wayneing can result in premature death from other RA problems |
| Classifications of RA | mild to severe: I-IV→no self care |
| Main tx goals of RA | prevent loss of joint fxn, control systemetic complications, protect joints, eliminate pain, improve QOL |
| Non-pharm tx | Rest, OT, PT, P ted, assistive devices, wt reduction, surg, support groups |
| Main tx approach to RA | start DMARD w/I 3m of dx |
| 4 common medication classes to tx RA | NSAIDS, glucocorticoids, nonbio DMARDS, bio DMARDS |
| Three main things affecting the tx decisions of RA | Dz activity, Dz duration, prognosis |
| What is the initial drug therapy for RA, problem? | NSAIDS, DO NOT prevent joint destruction or slow dz progression, should NOT be used alone long term |
| What is the role of corticosteroids as RA tx | bridging therapy, steroid injections, but bad for LT effects |
| What is the main concern w/ long term corticosteroid use | risk of osteroporosis |
| What can help with the osteoporosis risk of corticosteroid use | 1500mg calcium/day, and 4-800IU vit D /day |
| How do biologic DMARDS work? | inhibit TNF-alpha, and interleukin-1, deplete peripheral beta cells, inhibits full T-cell activation, |
| When do we use biologic DMARDS | when other DMARDS don’t reach adequate response |
| Administration for bio DMARDS | paraentral only |
| Main risk with DMARD administration | serious infection, must stop DMARD during their infx |
| Is a single DMARD adequate to control RA sxs? | NO! combination is best, consult rheumatologist |
| What is the best way to tx RA | DETECT and start tx early!! |
| Are NSAIDS effective for treating RA alone? Why | NO! doesn’t slow dz progression, should NOT be used as monotherapy |
| Typical initial therapy for RA | NSAIDS, nonbio DMARDS, |
| Which drugs are recommended for all pt’s with RA | NSAIDS, MTX and leflunomide |
| Which drugs are recommended for mild dz | minocycline or hydroxchhloroquine |
| Which drugs are for mild to moderate dz | sulfasalazine |
Created by:
streetsmarts
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