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Indomethacin
NSAID; reduce swelling, inflammation, pain; Inhibition of COX → (-) of PG synthesis. Also inhib. of PMN adhesion, aggregation, & activation (ramifications uncertain).
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Celecoxib
NSAID; selective COX-2 inhibitor
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Prednisolone
Glucocorticoid; regulate the transcription of genes with glucocorticoid response elements; immunosuppressant, anti-inflammatory; SE-infections/ulcers/hyperglycemia/osteoperosis/hypernatremia/hypokalemia
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Prednisone
Glucocorticoid; regulate the transcription of genes with glucocorticoid response elements; immunosuppressant, anti-inflammatory, given with antihistamines; SE-infections/ulcers/hyperglycemia/osteoperosis/hypernatremia/hypokalemia
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Triamcinolone
Glucocorticoid; synthetic corticosteroid
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Methylprednisolone
Glucocorticoid; anti-inflammatory
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Azathioprine
DMARD/non-biologic; for refractory RA or systemic involvement; rarely used; purine synthesis inhibitor; SE-myelosuppression/GI toxicity/carcinogenic; allopurinol can cause toxicities
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Cyclosporine
DMARD/non-biologic; limited use; rarely used; immunosuppressant; binds calcineurin phosphatatse and decree IL-2; SE-neprotoxicity/neurotoxicity/hyperuricemia; Erythromyocin and grapefruit can slow clearance
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Methotrexate
DMARD/non-biologic; inhib dihydrofolate reductase; depletion THF required for purine sin; early RA therapy; fastest acting DMARD; SE-bone marrow suppression/stomatitis/pulmonary/teratogenic; leucovorin reduce toxicity; avoid alcohol
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Hydroxychloroquine
DMARD/non-biologic; antimalarial; traps free radicas/stabilizes lysosomal mem; mild RA; combo with NSAIDS/methotrexate/sulfasalazine; prolonged response 3-6mo
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Sulfasalazine
DMARD/non-biologic; antimalarial; anti-inflammatory, immunomodulator; mild RA; combo with methotrexate; 2-3mo response; more toxicity than hydroxychloroquine
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Etanercept
DMARD/biological; TNF-a Inhibitors; fusion protein; binds TNF-a, prevents activation of receptors; monotherapy or combo with methotrexate; SE-skin rxn/infection/malignancy/autoimmune/CHF; contraindications-SLE/MS/infections/
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Adalimunab
DMARD/biological; TNF-a Inhibitors; humanized ant-TNF-a monoclonal Ab; monotherapy or combo with methotrexate; SE-skin rxn/infection/malignancy/autoimmune/CHF; contraindications-SLE/MS/infections/
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Infliximab
DMARD/biological; TNF-a Inhibitors; chimeric anti-TNF-a monoclonal Ab; combo with methotrexate for pts who don't respond to methotrexate alone; SE-skin rxn/infection/malignancy/autoimmune/CHF; contraindications-SLE/MS/infections/
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Anakinra
IL-1 inhibitor; receptor antagonist; inhibits pro-inflam effects; monotherapy and combo with methotrexate; not given with TNF inhibitor; least effective;
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Abatacept
Selective Costimulation Modulator; fusion protien homologue of CD28 TCR for B7; binds to B7 with higher affinity than CD28; inhibits TNF-a/interferion-y/IL-2; not given with another DMARD; SE-HTN/headache/anaphylaxis/infections
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Rituximab
CD20 Ab; chimeric monoclonal Ab agains CD20; Bcell specific; combo with methotrexate or DMARD not recommended; black box warning-fatal infusion rxns; SE-infection/reactivation of HepB
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