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Therapeutics 3 Ex3 - Rheumatology
Terms in this set (43)
Negative prognostic factors for RA?
more joints involved, more debilitating effect on activities, higher CCP and RF, higher ESR, extra-articular disease
What are the goals for RA treatment?
Control inflammation, restore QOL, prevent joint and bone distruction and complications
Definition of RA remission?
1 or fewer joints tender, 1 or fewer joints swollen, CRP 1 or less mg/dL, global assessment 1 or 0
Minimium ibuprofen anti-inflam dose?
1600mg per day
Time to maximal effect of NSAIDS for anti inflam effect?
Are NSAIDS DMARDs?
No, only treat symptoms
What drugs are useful in patients allergic/intolerant of ASA and other NSAIDs?
diflunisal and salsalate (non-acetylated)
Risk factors for complication when using NSAIDs?
hx of PUD, over age 65, smoking, tx beyond 3mo, concurrent steroids, daily asa or anticoag
High risk patient needs NSAID, what therapy can help prevent ADEs?
misoprostol, High dose H2-blocker, PPI, choose celecoxib
After diagnosis of RA when should DMARD be started?
within 3 months
What RA classification requires only 1 DMARD?
Low activity OR Moderate activity without poor prognostic factors OR potentially high activity without poor prognostic factors
What RA classification requires more than 1 DMARD?
Moderate activity with poor prognosis OR high activity without poor prognostic factors
What RA classification requires Anti-TNF +/- DMARD?
High activity with poor prognostic factors
How long after therapy intitiated should you consider insufficient response and add a drug?
What DMARDs are contraindicated in pregnancy?
Contraindications for MTX/Leflunomide
AST >2X ULN, pregnancy, chronic hep B or hep C
Contraindications for anti-TNF for RA
(+) PPD, (+) Hep B or Hep C
MTX and Leflunomide ADEs
myelosuppression, liver toxicity, teratogenic effects, lung fibrosis
Hydroxycholoroquin major ADE
delayed retinopathy -> monitor near initiation of therapy
Azathioprine major ADE
anti-TNF biologicals ADEs
infection risk, injection reaction, lymphoma risk, demylinating disease risk, heart failure, myelosuppression
What is Tofacitinib?
JAK inhibitor for RA, ADEs include neutropenia, anemia, infection risk, lymphompa, infection risk,
Goals for Ank Spond
relieve symptoms, restore normal function/activity, prevent spinal complication, minimize spread to other organs
What drugs are approved for Ank Spond tx?
NSAIDs (naproxen adn indomethacin are best and non-acetylateds don't work), anti-TNF, sulfasalazine
What drugs are not approved but help with Ank Spond?
MTX, Anakinra, Pamidronate
Treatments for Osteoarthritis?
topical NSAID, APAP (beware liver issues), topical capsaicin, intraarticular steroid **
Physical Therapy and Weight reduction
SLE diagnostic criteria
100% clinically based (NOT lab value), constitutional complaints (fever fatigue, weight loss), arthritis/arthralgia, malar "butterfly" rash, hypertension, kidney disfunction etc.
Drugs that can induce lupus?
Hydralazine, Procainamide, INH, Minocycline, Methyldopa, Captopril, atenolol, L-dopa, statins, sulfasalazine, allopurinol
Diagnostic criteria of gouty arthritis
more than 1 attack, presence tophi, max pain in less than 24h, hyperuricemia, asymmetric swelling on x-ray, subcortical cysts on x-ray, redness, podagra, sterile synovial fluid, one joint, MTP joint involved
Acute gout therapy
NSAID (not aspirin) 5-10 days, colchicine (low dose, avoid CKD), steroid (prednisone 35mg/kg X 7 days, or inject into joint if large enough)
Definition of refractory gout
no decrease in pain score in 24 hours (<20% untreated, or <50% if has treatment)
Two therapies for chronic gout therapy?
colchicine 0.6mg daily, ibuprofen 200mg bid
Nonpharmacologic therapy for chronic gout prevention?
diet changes (low purine), less than 2 drinks ETOH daily
When appropriate to use XOI for gout prevention?
if more than one attack per year and presence of tophi. Use allopurinol (renal dose!, hypersensitivity), or febuxostat (probenecid if XOI intolerant but contraindicated CrCl less than 50)
Target UA level to prevent gout (with and without tophi)?
<6 without tophi, <5 with tophi
Probenecid contraindications for gout prevention?
avoid with CrCL < 25, avoid if presence of urate kidney stones
increases azathioprine and mercaptopurine levels, increases rash risk with ampicillin
Indication for pegloticase?
gout UNRESPONSIVE to highest doses of XOI
What cholesterol and BP drugs can lower UA?
fenofibrate and losartan
avoid in CrCl less than 30, diarrhea, myelosuppression, rhabdo
How to ID pseudogout?
calcium pyrophosphate crystals -> treat like acute gout (steroid injection, NSAIDs, maybe colchicine)
How to ID infectious arthritis
IVDA -> risk factor, synovial aspiration, WBC > 50K from synovial fluid, usually staph or strep, maybe GNR
Sets with similar terms
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NAPLEX GERD + PUD
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