DMARDs

Class

100

Name a bio that's an anti-CD20 monoclonal antibody. what should you pretreat with?

Rituximab

- IV infusion- pretreat with acetaminophen and an antihistamine to decrease the incidence and severity of infusion reactions

200

This drug is an anti-IL-6 monoclonal antibody that inhibits IL-6 mediated signaling

Tocilizumab

300

Name a targeted synthetic DMARD in the JAK family

tofacitinib, baricitinib, upadacitinib

400

this TNF blocker selectively binds soluble TNF-a and TNF-B

etanercept

500

this is a human IgG4-k monoclonal antibody that binds to the IL-17A and IL-17A/F heterodimers

ixekizumab

MOA

100

This drug causes an accumulation of adenosine which suppresses T-cell activation, and reduces cytokine production

For extra 100 pts, name 3 ADRs

Methotrexate

ADRs: 

• common: nausea, stomatitis, dose-related liver enzyme elevations —> add folic acid
• Interstitial lung disease (MTX pneumonitis)
• Leukopenia, anemia, GI ulceration, alopecia due to inhibition of cell proliferation
• Highly teratogenic

200

This drug inhibits dihydroorotate dehydrogenase reducing activated T and B lymphocyte proliferation

leflunomide

300

This drug inhibits antigen presentation, cytokine release, and T-cell activation

stabilizes lysosomal enzymes and interferes with type 1 IFN signaling

hydroxychloroquine

400

this is an alkylating agent that crosslinks DNA - associated with hemorrhagic cystitis leading to bladder cancer

cyclophosphamide

500

this drug is metabolized in the colon by gut bacteria into active metabolites.

for extra 100: _____ acetylators experience more toxicity

sulfasalazine

slow acetylators

ADRs

100

What's the most serious ADR of hydroxychloroquine?

retinal toxicity (extensively accumulates in melanin-rich tissues)

others: GI upset, skin hyperpigmentation, QT prolongation

200

What's the most serious ADR of leflunomide or name 2 common

For extra 100: what can be used to accelerate its elimination

• most serious: hepatotoxicity
• Common: diarrhea, HTN, bone marrow suppression, mild alopecia, weight gain
• CI: highly teratogenic

Cholestyramine

300

This drug increases the risk of EBV in renal transplant pts particularly in combo with prednisone

Tofacitinib

400

This drugs ADRs include bone marrow suppression, hemolysis in pts with G6PD deficiency, reversible infertility in men and benign orange colored urine and sweat

Sulfasalazine

500

this agent causes thiopurine methyltransferase (TPMT) deficiency --> increased risk of severe myelosuppression

azathioprine

Misc

100

name 3 highly teratogenic DMARDs

leflunomide, MTX

200

What's the triple therapy in RA?

MTX, sulfasalazine, hydroxychloroquine

300

Name 2 DMARDs that are relatively safe in pregnancy

sulfasalazine, etanercept, certolizumab

400

this JAK inhibitor has a higher incidence of herpes zoster reactivation, elevated creatine phosphokinase levels, and thrombocytosis

upadacitinib

500

Name purine synthesis inhibitor is used more for pts with RA-associated vasculitis or interstitial lung disease

Azathioprine