RA Treatments

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  1. Methotrexate MOA
    dec formation of antibodies to chimeric biologic response modifiers (BRMs)
  2. MTX toxicity in oral vs. inj
    less GI toxicity in inj
  3. MTX onset of action
    1-2 mo
  4. MTX contraindications
    pregnancy/lactation (absolute)

    • relative:
    • acute bacterial infection
    • latent TB
    • chronic liver disease
    • CrCl ( 30
    • pleural/peritoneal effusions
    • immunodeficiency
    • leukopenia
    • thrombocytopenia
  5. MTX ADRs
    • GI: stomatitis, N/V (improved with folic acid)
    • inc liver enzymes
    • rash, alopecia (improved with folic acid
  6. MTX DDs
    potential with PPIs
  7. HCQ efficacy over time
  8. HCQ onset of action
    2-6 mo
  9. HCQ ADRs
    GI (mild), dermatologic, opthalmologic (macular damage)
  10. HCQ monitoring
    eye exam in 1st yr of treatment, then annually
  11. Leflunomide moa
    immune modulator --> reduces production of T cells that attack joints
  12. leflunomide CIs
    like MTX, except ok with pulmonary fibrosis and CrCl <30
  13. leflunomide onset of action
    1-3 mo
  14. leflunomide toxicity
    • hepatotoxicity (5% alone; 60% in combo with MTX)
    • diarrhea
    • alopecia
    • rash
    • headache
  15. use to get leflunomide plasma levels quickly
    cholestyramine - bile acid sequestrant
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RA Treatments
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