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jcu1
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Methotrexate MOA
dec formation of antibodies to chimeric biologic response modifiers (BRMs)
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MTX toxicity in oral vs. inj
less GI toxicity in inj
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MTX onset of action
1-2 mo
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MTX contraindications
pregnancy/lactation (absolute)
- relative:
- acute bacterial infection
- latent TB
- chronic liver disease
- CrCl ( 30
- pleural/peritoneal effusions
- immunodeficiency
- leukopenia
- thrombocytopenia
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MTX ADRs
- GI: stomatitis, N/V (improved with folic acid)
- inc liver enzymes
- rash, alopecia (improved with folic acid
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MTX DDs
potential with PPIs
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HCQ efficacy over time
decreases
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HCQ onset of action
2-6 mo
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HCQ ADRs
GI (mild), dermatologic, opthalmologic (macular damage)
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HCQ monitoring
eye exam in 1st yr of treatment, then annually
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Leflunomide moa
immune modulator --> reduces production of T cells that attack joints
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leflunomide CIs
like MTX, except ok with pulmonary fibrosis and CrCl <30
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leflunomide onset of action
1-3 mo
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leflunomide toxicity
- hepatotoxicity (5% alone; 60% in combo with MTX)
- diarrhea
- alopecia
- rash
- headache
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use to get leflunomide plasma levels quickly
cholestyramine - bile acid sequestrant
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