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IPDM I WK 7 RA Part 2

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alchemist04's version from 2016-06-02 14:51

Section

Question Answer
3 things about Corticosteroids (1)(1) for symptomatic relief only
3 things about Corticosteroids (2)(2) Does not impact disease progression
3 things about Corticosteroids (3)(3) May be used as a bridge therapy w/ DMARDS and biologics or while they are in effect
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Question Answer
T or F? Celecoxib is NOT contraindicated in sulfa allergyFalse, it is contraindicated in sulfur allergy
What are the adverse effects of CorticosteroidsCUSHINGOID
What are the short term side effects of Corticosteroid?(1) HTN, (2) Glucose elevated, (3) GI upset, (4) Insomnia, (5) Mood change
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Question Answer
What are the recommendations for Glucocorticoids? (1)(1) Take w/ food bc it causes ulcer [GUSHINGOID]
What are the recommendations for Glucocorticoids? (2)(2) Add PPI if taking high dose bc it causes ulcer [GUSHINGGOID]
What are the recommendations for Glucocorticoids? (3)(3) Take in the morning bc it causes Insomnia [GUSHINGGOID]
What are the recommendations for Glucocorticoids? (4)(4) Monitor high blood sugar bc it raises glucose level
What are the recommendations for Glucocorticoids? (5)(5) Monitor blood pressure bc it causes fluid retention and high BP
What are the recommendations for Glucocorticoids? (6)(6) Take VIt. D + Calcium, add bisphosphonate if needed bc it causes Osteoporosis
What are the recommendations for Glucocorticoids? (7)(7) Monitor symptoms of infections bc it increase risk of infection
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Question Answer
What is the MOA of MTX? (1)(1) Competitively inhibits dihydrofolate reductase
What is the MOA of MTX? (2)(2) Inhibit cytokine production
What is the MOA of MTX? (3)(3) Inhibits purine biosynthesis
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Question Answer
What is the effective time of MTX?4-8 wks
What is the initial dosing of MTX?7.5 mg PO/SC qweek
What is the preg cat for MTX?Cat X
True of false? MTX can only be mono or combo w/ any Anti-RA drug?True, MTX can be used mono of combo with any Anti-RA drug, including other DMARD
T or F MTX can be used at any activity stage of RATrue, good for low, mild or severe activity
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Question Answer
What is the monitoring plan to evaluate the safety and efficacy of MTX regimentMonitor (1) LFTs, (2) CBC w/ differential (3) SCr
What are the 3 baseline monitors for MTX (1)(1) Every 2-4 wks monitor Rx for 3 mo after initiation or dose increase [Hint: 2,4,3]
What are the 3 baseline monitors for MTX (2)(2) Every 8-12 wks Monitor Rx for 3-6 months of treatment
What are the 3 baseline monitors for MTX (3)(3) Every 12 wks beyond 6 months of treatment.
T or F? take 1 mg of Folic acid when not on MTX?True, remember dihydrofolate reductase inhibitor (MOA of MTX)
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Question Answer
T or F? Leflunomide can be alternated with other DMARD except w/ MTXTrue
Which drug is contraindicated for Pregnacy and severe hepatic impairment?Leflunomide
In PT on Leflunomide, what shd be monitored?(1) LFTs base line, (2) BP (3) CBC at base line
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Question Answer
Which of the DMARDs is contraindicated for Sulfa allergies, causes yellow urination and Transaminitis?Sulfasalazine
T or F? Pt needs to wear sunscreen and sunglasses when wearing SulfasalazineTrue, same for Hydroxychloroquine
T or F? Sulfasalazine is preg. category B?Trie, women who want to get pregnant can use Sulfasazine
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Question Answer
Which DMARD needs monitoring for ophthalmologic exam at baseline and every 12 months?Hydrochloroquine
What is the Preg category for Hydrochloroquine?Category B, it safe to use in pregnacy.
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Question Answer
Which biologics bind directly to TNF?Monoclonial antibodies
------------Binds to circulating TNFi and prevents it from interacting w/ a cell receptor?TNFi
T or F? The disadvantage of monoclonial antibodies is that they CANNOT form neutralizing antibodies that can negatively impact their efficacyFalse, they actually form neutralizing antibodies that can negatively impact their efficacy.
In general, TFNi is contraindicated for wh/ patients?(1) CHF (2) NYHA class III and IV
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Question Answer
Which drug is 1st biosimilar in the market?Neupogen
Which drug is 1st biosimilar approved for RA?Infliximab (Inflectra)
Which biosimilars are in the pipeline?(1) Enbrel (2) Humira (3) Rituxan
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Question Answer
Which RA drug is Janus Kinase inhibitorTofacitinib
T or F? Tofacitinib cannot be combined with BiologicsTrue, only in combination w/ DMARD
T or F? NSAIDs and Corticosteroid shd not be used monotherapyTrue
Always star DMARD in new RA patient w/n ----- month of diagnosis to reduce joint erosion3 mo
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