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What is the brand name for Leflunimide?
Arava
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What is the brand name for Hydroxychloroquine?
Plaquenil
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What is the brand name for Sulfasalazine?
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What is a DMARD?
disease modifying antirheumatic drug
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All pharmacologic therapy for RA should contain one _________.
Oral DMARD
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DMARDs include what drug classes?
Conventional agents for RA and Biologics
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What are the benefits of DMARDs?
- Control signs and symptoms
- Improve functional status
- Slow erosions
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What is the frequency of methotrexate administration?
Weekly
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What is the usual dose of Methotrexate?
7.5-15 mg PO, IM or SQ
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What is the OOA for Methotrexate?
2-3 weeks
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When is the maximum benefit of Methotrexate observed?
6 months
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How often should you titrate methotrexate?
Q6months
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What is the First line therapy for RA?
Methotrexate
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How is Methotrexate excreted?
80% renal
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Is Methotrexate protein bound?
Yes, 35-65%
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What is the oral bioavailability of Methotrexate?
- 70%
- Decreases with increasing doses ( give IM or SQ w/ high doses)
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What is the MOA of Methotrexate?
Anti-inflammatory properties due to its inhibition of cytokine production, purine biosynthesis, and stimulation of adenosine
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What are the AEs of Methotrexate?
- GI
- Bone marrow suppression
- Pulmonary
- Hepatitis
- Photosensitivity
- Folic acid deficiency
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GI adverse effects of Methotrexate generally resolve in what time period after DC?
2-3 weeks
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Concomitant folic acid replacement reduces what AEs of Methotrexate use?
- GI
- Hepatic
- Hematologic (BMS)
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All patients on Methotrexate should receive what other concomitant therapy?
Folic acid
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Does Folic acid supplementation effect efficacy of Methotrexate?
No
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What Laboratory monitoring should be done for a patient on methotrexate for RA?
- Baseline: AST, ALT, alk phos, albumin, total bilirubin, HBV, HCV, CBC, SCr
- Routine (every 1-2 months): CBC, ALT, AST, albumin
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What are the Contraindications for Methotrexate in the treatment of RA?
- CrCl < 30 mL/min
- Teratogenic
- Liver impairment
- Pleural effusions
- Leukopenia/thrombocytopenia
- NSAIDs w/ high dose
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Why should NSAIDs be avoided with high dose Methotrexate?
May increase methotrexate serum concentration
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What is the black box warning for Methotrexate?
- Avoid NSAIDs
- They may increase Methotrexate conc.
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How does the efficacy of Leflunomie and Methotrexate compare?
Approx. Equal
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What is the usual dose of Leflunomide?
- Loading: 100 mg PO QD x 3 days
- Maintenance: 20 mg PO QD
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When should you expect symptom relief for RA with Leflunomide?
1 month after loading dose
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What are the AE of Leflunomide?
- GI distress
- Hepatitis
- Bone marrow suppression
- Alopecia and dyspepsia (omit loading dose to reduce risk)
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Does Leflunomide have a long or short half-life and why?
- Long
- Enterohepatic circulation
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What is the elimination half-life of leflunamide?
14-16 days
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What lab monitoring needs to be done when a patient is treated with Leflunomide for RA?
- Baseline: AST, ALT, CBC
- Routine: AST, ALT, CBC monthly x 6 months, then every 6-8 weeks
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What are the CIs of Leflunomide in the treatment of RA?
- Liver impairment
- Pregnant/Nursing (teratogen)
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Do you need to adjust the dose of Leflunomide for Renal dysfunction?
No
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What situation is Hydroxychloroquine used to treat RA?
Mild RA as a monotherapy
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Does Hydroxychloroquine slow radiographic progression?
No
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Symptom relief should occur in ________ with Hydroxychloroquine.
6 weeks
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