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kyleannkelsey
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What is the benefit of combining Methotrexate with a TNF-alpha inhibitor?
- Slower radiographic progression
- Greater efficacy
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What laboratory monitoring is required with Etanercept?
None
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What is a usual dose of Etanercept?
- 50 mg SQ weekly
- OR
- 25 mg SQ 2x weekly
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What are the adverse effects of Etanercept?
- Injections ite rxns
- Pancytopenia
- HF exacerbation
- Demyelinating syndromes
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How is Etanercept administered?
- Injected
- Must be at RT for 15-30 minutes prior to administration
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How is Etanercept stored?
Refrigerated
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What are the dosage forms for Etanercept?
Prefilled syringe, autoinjector, or multi-dose vial
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What disease state might implicate use of Etanercept for RA treatment?
Non-viral hepatitis
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Which RA drugs need to be refrigerated?
- Etanercept
- Golimumab
- Anakinra
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What is a usual dose of Infliximab?
- 3 mg/kg IV
- Inject at 0, 2 and 6 weeks then Q8 weeks
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Infliximab MUST be given with what other drug to treat RA?
Methotrexate
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What are the AE of Infliximab?
- Infusion reactions
- Autoantibodies (increase infusion rxns and decrease efficacy)
- Lupus like syndrome
- Worsening or new HF
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How can you help prevent infusion reactions with Infliximab?
- Slow infusion rate
- Give acetaminophen, diphenhydramine or corticosteroids
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Why do you have to give methotrexate with Infliximab and Golimumab but not Adalimumab?
- Adalimumab has no association with autoantibodies like infliximab does
- IgG antibody that is less antigenic
- No foreign protein
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What is the usual dose of Adalimumab?
40 mg SQ x 14 days
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What is the onset of symptom relief for adalimumab?
3 months
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What dosage forms does Adalimumab come in?
Prefilled syringe and syringe
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Golimumab is used with or without methotrexate?
With
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What dosage forms does Golimumab come in?
Prefilled syringe and syringe
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How is Golimumab injected?
At room temperature
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What is the usual dose of Golimumab?
- 50 mg SQ Monthly
- 2 mg/kg IV over 30 minutes repeat 4 weeks later then Q8 weeks
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Which biologic may be yellow in color?
Golimumab
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What is the usual dose of Certolizumab?
- 400 mg SQ at 0, 2 and 4 weeks
- Then, 200 mg every other week
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What dosage forms are available for Certolizumab?
Prefilled syringe or multiple dose vial
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What drugs should Abatacept not be used with?
TNF inhibitors
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What is the onset of symptom relief for Abatacept?
8-12 weeks
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When is it recommended to give Abatacept?
After at least one TNF – Alpha inhibitor has failed
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What are the AEs of abatacept?
- Infusion related rxns
- Infection
- Antibody formation
- Respiratory events
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What patients will have a higher number of respiratory AEs when using Abatacept?
COPD
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Should Abatacept be combined with TNF alpha inhibitors?
No, only leads to more infections, no greater efficacy
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Combination of Abatacept and what other drug increases remission rates?
Methotrexate
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By what route is Abatacept given?
IV
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What group is Abatacept reserved for?
Patients who failed on or are CI to TNF alpha inhibitors
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Do biologics or conventional RA therapies require more monitoring?
Conventional therapies
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What is a usual dose of Rituximab?
- 4 mg/kg IV Q4 weeks
- May increase to 8 mg/kg
- Max = 800 mg
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What is the onset of symptom relief for Rituximab?
2 weeks
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What are the adverse effects of Rituximab?
- Hepatitis
- Hematologic
- GI perforation
- Hypertension
- Hyperlipidemia
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What lab monitoring is needed for treatment with Rituximab?
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When should Rituximab be avoided?
When LFTs are > 1.5 x the upper limit of normal
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Tocilizumab comes in what dosage forms?
IV and SQ
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