Integrated Pharmacology Module 1.1.2
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Integrated Pharmacology Module 1.1.2

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Questions and Answers

What is a primary symptom of rheumatoid arthritis that typically occurs in the morning?

  • Morning stiffness (correct)
  • Fever
  • Joint swelling
  • Weight gain

    • Which joints are most commonly involved in rheumatoid arthritis?

  • Elbow joints
  • Shoulder joints
  • Metacarpophalangeal (MCP) joints (correct)
  • Distal interphalangeal (DIP) joints

    • Which of the following is NOT a common symptom of rheumatoid arthritis?

  • Fatigue
  • Severe joint pain localized to one joint (correct)
  • Depression
  • Weight loss

    • What is one of the goals of treatment in managing rheumatoid arthritis?

    <p>To relieve symptoms and improve quality of life</p> Signup and view all the answers

    Which of the following symptoms is considered an extra-articular manifestation of rheumatoid arthritis?

    <p>Malaise</p> Signup and view all the answers

    What is a potential adverse effect of treatments for rheumatoid arthritis that requires monitoring?

    <p>Liver dysfunction</p> Signup and view all the answers

    What type of pain pattern is typical in rheumatoid arthritis?

    <p>Symmetrical joint pain</p> Signup and view all the answers

    Which of the following statements about rheumatoid arthritis is true?

    <p>It may lead to morning stiffness lasting more than one hour.</p> Signup and view all the answers

    Which laboratory finding is NOT typically associated with rheumatoid arthritis (RA)?

    <p>High TIBC</p> Signup and view all the answers

    What is the primary goal of treatment for rheumatoid arthritis?

    <p>Achieve and maintain remission</p> Signup and view all the answers

    Which of the following is NOT considered a non-drug intervention in the management of rheumatoid arthritis?

    <p>Corticosteroid therapy</p> Signup and view all the answers

    What does an increase in C-reactive protein (CRP) indicate in the context of rheumatoid arthritis?

    <p>Activation of inflammatory response</p> Signup and view all the answers

    Which of the following is a significant risk factor associated with higher mortality rates in rheumatoid arthritis?

    <p>Extra-articular manifestations</p> Signup and view all the answers

    Which type of anaemia is commonly observed in individuals with rheumatoid arthritis?

    <p>Normocytic/microcytic, normochromic anaemia</p> Signup and view all the answers

    What lifestyle change is recommended to individuals managing rheumatoid arthritis?

    <p>Regular immunisation</p> Signup and view all the answers

    What is a common characteristic of changes observed in joint radiographs of rheumatoid arthritis patients?

    <p>Erosion and joint space narrowing</p> Signup and view all the answers

    What is the primary purpose of biological DMARDs?

    <p>They are reserved for patients who have failed to respond to sDMARDs.</p> Signup and view all the answers

    Which biological DMARD is NOT a TNF-α inhibitor?

    <p>Rituximab</p> Signup and view all the answers

    What should be avoided to minimize risks associated with biological DMARDs?

    <p>Using more than one biological DMARD simultaneously.</p> Signup and view all the answers

    What type of infections should patients on biological DMARDs be monitored for?

    <p>Opportunistic infections including reactivation of hepatitis B and TB.</p> Signup and view all the answers

    Which of the following vaccines is particularly significant for patients on biological DMARDs?

    <p>Influenza vaccine.</p> Signup and view all the answers

    TNF-α inhibitors are contraindicated in which condition?

    <p>Tuberculosis (TB).</p> Signup and view all the answers

    Which of the following is NOT a common adverse effect of TNF-α inhibitors?

    <p>Acute kidney injury.</p> Signup and view all the answers

    Which of these methods is important before starting treatment with TNF-α inhibitors?

    <p>Review immunization status and history of malignancy.</p> Signup and view all the answers

    What is the primary goal in the early treatment of rheumatoid arthritis using synthetic DMARDs?

    <p>Quick eradication of inflammation</p> Signup and view all the answers

    What is the initial dosing regimen for Sulfasalazine in mild disease?

    <p>500mg daily increasing up to 1.5g bd</p> Signup and view all the answers

    Which condition should be excluded before starting Hydroxychloroquine?

    <p>G6PD deficiency</p> Signup and view all the answers

    What is the typical onset time for Sulfasalazine to show effects?

    <p>4-12 weeks</p> Signup and view all the answers

    What side effect risk is specifically associated with Hydroxychloroquine?

    <p>Ocular retinopathy</p> Signup and view all the answers

    Which biological DMARD has the longest onset time before effects may be seen?

    <p>Rituximab</p> Signup and view all the answers

    What is the primary route of administration for Tofacitinib?

    <p>Oral medication</p> Signup and view all the answers

    Which of the following options requires monitoring of lipid levels as part of its management?

    <p>Tocilizumab</p> Signup and view all the answers

    Which adverse effect is common across most biological DMARDs?

    <p>Infections</p> Signup and view all the answers

    Which drug is used for severe rheumatoid arthritis that does not respond to TNF-α inhibitors?

    <p>Rituximab</p> Signup and view all the answers

    What type of adverse effects are associated with Anakinra?

    <p>Injection site reactions and neutropenia</p> Signup and view all the answers

    Which of the following drugs has a contraindication for patients with tuberculosis?

    <p>Tofacitinib</p> Signup and view all the answers

    What is the onset time for Abatacept to show effects?

    <p>14 days</p> Signup and view all the answers

    Study Notes

    Learning Outcomes

    • Identify signs, symptoms, and diagnostic lab tests for rheumatoid arthritis (RA).
    • Understand the treatment goals for RA management.
    • Recognize the management strategies for RA.
    • Be aware of monitoring for disease progression and treatment-related adverse effects.

    Diagnosis and Clinical Findings

    • RA symptoms are gradual and include malaise, fatigue, and musculoskeletal pain.
    • Joint symptoms typically exhibit a symmetrical pattern: pain, stiffness, swelling, and redness, especially in MCP, PIP, and MTP joints.
    • Morning stiffness, weight loss, fever, and depression may also occur as extra-articular symptoms.

    Biological DMARDs

    • Reserved for patients unresponsive to synthetic DMARDs.
    • Commonly combined with methotrexate - using more than one biological DMARD increases infection risk.
    • Key biological DMARDs include TNF-α inhibitors, Rituximab, Abatacept, Anakinra, Tocilizumab, and Tofacitinib.
    • Vaccination against pneumonia, influenza, hepatitis A and B, and HPV is recommended.

    TNF-α Inhibitors

    • First-line biological agents: Adalimumab, Certolizumab, Etanercept, Golimumab, Infliximab.
    • Rapid onset but contraindicated in patients with TB or hepatitis infections.
    • Potential adverse effects: injection site reactions, upper respiratory infections, thrombocytopenia, and malignancies.
    • Regular monitoring of FBP, CrCl, and LFT is essential.

    Rituximab

    • Recommended for severe RA not responding to TNF-α inhibitors.
    • Onset of effect takes about 4 months; administered through IV infusion.
    • Common side effects include infusion reactions and muscle pain, necessitating monitoring of FBP, LFT, and CrCl.

    Abatacept

    • For RA unresponsive to TNF-α inhibitors, onset in approximately 14 days; IV administration.
    • Notable side effects: hypertension and increased liver enzymes, requiring same monitoring protocols as Rituximab.

    Anakinra

    • Slower onset (2 weeks) and less effective than TNF-α inhibitors, delivered via SC injection.
    • Risks include injection site reactions and neutropenia; monitor FBP and lipid profile.

    Tocilizumab

    • Onset of action between 2-4 weeks; administered via IV infusion.
    • Possible adverse reactions include infections and GI ulcers; monitoring includes FBP, LFT, and lipid levels.

    Tofacitinib

    • For moderate to severe RA not responding to methotrexate or TNF antagonists.
    • Can be used alone or in combination (excluding cyclosporine, azathioprine).
    • Watch for adverse effects such as elevated LFT and risk of infections; regular monitoring of FBC, Hb, lipid levels, and LFT required.

    Laboratory Findings

    • Elevated ESR and C-reactive protein levels; presence of rheumatoid factor, HLA typing, and antibodies such as ANA and CCP.
    • Anemia typical, presenting as normocytic/microcytic alongside low serum iron levels.

    Prognosis

    • Disability is common, significantly impacting quality of life.
    • Mortality rates are 2-3 times higher with extra-articular manifestations like infections or cardiovascular diseases.

    Treatment Goals

    • Primary objective is achieving remission: reduce symptoms, normalize inflammatory markers, and eliminate joint swelling.
    • Enhance joint and muscle function, minimize treatment side effects, restore quality of life, and prevent co-morbidities.

    Non-Drug Interventions

    • Recommendations include physical therapy, exercise, dietary changes, occupational therapy for assistive devices, smoking cessation, and immunisation.
    • Omega-3 fatty acids and gamma-linolenic acid supplements may be beneficial.

    Synthetic DMARDs

    • Introduce early for optimal effectiveness; aims for rapid inflammation control to reduce joint damage.
    • Sulfasalazine is first-line for mild disease, with dosage adjustments required based on tolerance and monitoring for blood dyscrasias.

    Hydroxychloroquine

    • Also first-line for mild disease but primarily used in combination therapy due to its lower efficacy.
    • Monitoring for retinopathy and psoriasis worsening is essential; standard dosing is 200 to 400 mg daily.

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    Related Documents

    RA Therapy.pdf

    Description

    This quiz covers the pharmacotherapeutic management of rheumatoid arthritis within the context of Integrated Pharmacology and Therapeutics Module 1.1.2. It assesses your understanding of the therapeutic approaches and medication strategies used in treating this inflammatory condition.

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