Therapeutics - RA 4

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  1. What is the benefit of combining Methotrexate with a TNF-alpha inhibitor?
    • Slower radiographic progression
    • Greater efficacy
  2. What laboratory monitoring is required with Etanercept?
  3. What is a usual dose of Etanercept?
    • 50 mg SQ weekly
    • OR
    • 25 mg SQ 2x weekly
  4. What are the adverse effects of Etanercept?
    • Injections ite rxns
    • Pancytopenia
    • HF exacerbation
    • Demyelinating syndromes
  5. How is Etanercept administered?
    • Injected
    • Must be at RT for 15-30 minutes prior to administration
  6. How is Etanercept stored?
  7. What are the dosage forms for Etanercept?
    Prefilled syringe, autoinjector, or multi-dose vial
  8. What disease state might implicate use of Etanercept for RA treatment?
    Non-viral hepatitis
  9. Which RA drugs need to be refrigerated?
    • Etanercept
    • Golimumab
    • Anakinra
  10. What is a usual dose of Infliximab?
    • 3 mg/kg IV
    • Inject at 0, 2 and 6 weeks then Q8 weeks
  11. Infliximab MUST be given with what other drug to treat RA?
  12. What are the AE of Infliximab?
    • Infusion reactions
    • Autoantibodies (increase infusion rxns and decrease efficacy)
    • Lupus like syndrome
    • Worsening or new HF
  13. How can you help prevent infusion reactions with Infliximab?
    • Slow infusion rate
    • Give acetaminophen, diphenhydramine or corticosteroids
  14. 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
  15. What is the usual dose of Adalimumab?
    40 mg SQ x 14 days
  16. What is the onset of symptom relief for adalimumab?
    3 months
  17. What dosage forms does Adalimumab come in?
    Prefilled syringe and syringe
  18. Golimumab is used with or without methotrexate?
  19. What dosage forms does Golimumab come in?
    Prefilled syringe and syringe
  20. How is Golimumab injected?
    At room temperature
  21. 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
  22. Which biologic may be yellow in color?
  23. What is the usual dose of Certolizumab?
    • 400 mg SQ at 0, 2 and 4 weeks
    • Then, 200 mg every other week
  24. What dosage forms are available for Certolizumab?
    Prefilled syringe or multiple dose vial
  25. What drugs should Abatacept not be used with?
    TNF inhibitors
  26. What is the onset of symptom relief for Abatacept?
    8-12 weeks
  27. When is it recommended to give Abatacept?
    After at least one TNF – Alpha inhibitor has failed
  28. What are the AEs of abatacept?
    • Infusion related rxns
    • Infection
    • Antibody formation
    • Respiratory events
  29. What patients will have a higher number of respiratory AEs when using Abatacept?
  30. Should Abatacept be combined with TNF alpha inhibitors?
    No, only leads to more infections, no greater efficacy
  31. Combination of Abatacept and what other drug increases remission rates?
  32. By what route is Abatacept given?
  33. What group is Abatacept reserved for?
    Patients who failed on or are CI to TNF alpha inhibitors
  34. Do biologics or conventional RA therapies require more monitoring?
    Conventional therapies
  35. What is a usual dose of Rituximab?
    • 4 mg/kg IV Q4 weeks
    • May increase to 8 mg/kg
    • Max = 800 mg
  36. What is the onset of symptom relief for Rituximab?
    2 weeks
  37. What are the adverse effects of Rituximab?
    • Hepatitis
    • Hematologic
    • GI perforation
    • Hypertension
    • Hyperlipidemia
  38. What lab monitoring is needed for treatment with Rituximab?
    • CBC
    • LFTs
    • Lipid panel
  39. When should Rituximab be avoided?
    When LFTs are > 1.5 x the upper limit of normal
  40. Tocilizumab comes in what dosage forms?
    IV and SQ
Card Set
Therapeutics - RA 4
Therapeutics - RA 4
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