SCF Nursing Level 2 Exam 4 Drugs
Hydroxychloroquine DMARD Antimalarial MOA - 2nd line therapy, relieves severe inflammation,
modify the inflammatory response in the body to prevent bone & cartilage destruction, disease-
modifying anti-Rheumeral drugs
Hydroxychloroquine DMARD Antimalarial Contraindications/Interactions - hepatic or renal
disease, avoid ETOH, pregnancy C, Not for children; can interfere response to rabies disease. Increases
digoxin levels, retinopathy, anorexia, GI distress, hair loss, agranulocytosis, blue/black skin discolorations
(unusual skin pigmentation), thrombocytopenia-low platelets, fatigue
Hydroxychloroquine DMARD Antimalarial Dose/Admin - Take as soon as possible (within 1st 2
years of RA Dx, if not first 3 months), Not PRN, every day, but not long term, full effect 6 weeks-6
months, best with food.
Methotrexate DMARD MOA - 1st Line Therapy: Immunosuppressor, ant-inflammatory; (folic acid
antagonist-antimitotic); used in high doses for cancer, disease modifying
Methotrexate Immunosuppressor DMARD Contraindications/Interactions/Adverse Effects -
Hepatic & renal disease, infections, blood dyscrasias, very young, & very old, bone marrow
suppression malaise, fetal defects (Category X male 3 months/Female 1 month), sudden death;
interstitial pneumonitis (SOB/cough/CT scan); fog, Avoid ETOH(1-2/week); decrease to 4 cups of
coffee/week, keep well hydrated
Methotrexate Immunosuppressor DMARD Dose/Admin - Take as soon as possible within 1st 2
years of RA Dx, if not first 3 months, Not PRN, once a week, PO/IM deep/large, may take 2-4 weeks to
work, don't take with folic acid (1 mg only) or PPI, Get vaccines prior (no live), immunosuppression
cautions/blunted symptoms
Methotrexate Immunosuppressor DMARD Labs - AST/ALT bilirubin; CBC for decrease in WBC &
platelets, LFT, Renal functions, BUN/Cr Baselines, Check for TB/Hep B
Adalimumab (Humira/Embrel) Biologic Response Modifiers DMARD MOA - Inhibits tumor necrosis
factor (facilitated inflammation) a cytokine that blocks the normal inflammatory & immune response
, controlled by TNF (tumor necrosis factor). Modify inflammatory response; prevent bone & cartilage
destruction,
Adalimumab (Humira/Enbrel) Biologic Response Modifiers DMARD
Contraindications/Interactions/Adverse Effects - Infections-UTI, URI, pneumonia, fatigue, HTN,
injection site irritation, increased malignancy (lymphoma); anaphylaxis; hematuria; lupus like, active
infection neoplastic disease, CVD, Neuro disease, active or latent TB; Hep B, pregnancy B, No live
vaccines,
Adalimumab (Humira/Enbrel)Biologic Response Modifiers DMARD Dose/Admin - Hold if going into
surgery, taken every other week SQ, Half-life=10-20 days, 1st dose given in hospital/controlled setting,
most ins will not pay unless all options have been exhausted, can take with other DMARS
COX 2 Inhibitors-celecoxib (Celebrex) MOA - NSAID for the stomach, protects the stomach lining,
No inhibition of Cox-1; inhibits prostaglandin-inflammation/pain-synthesis by inhibiting COX-2, Help
manage symptoms, may help with some inflammation
COX 2 Inhibitors-celecoxib (Celebrex) Contraindications/Interactions/Adverse Effects - CV events,
dizziness, sinusitis, edema, nausea, flatulence, diarrhea, rash, Nephrotoxic advanced renal disease,
hepatic failure, anemia, GI bleed, aspirin/sulfa allergies Separate from antacids by 2 hours.
COX 2 Inhibitors-celecoxib (Celebrex) Labs - CBC, LFT, BUN, Creatinine, monitor for fluid retention
in those with HTN, CHF, black tarry stools
Prednisone (systemic corticosteroid) MOA - Suppress histamine & prostaglandins;
immunosuppressant & anti-inflammatory, help manage symptoms more for RA flares, decrease
inflammation & immune response
Prednisone (systemic corticosteroid) Contraindications/Interactions/Adverse Effects - Systemic
infections, cataracts, peptic ulcer disease, osteoporosis, HTN, renal disease, pregnancy C, CHF, avoid
alcohol, suppression of adrenal gland function, hyperglycemia, hypokalemia, mood changes, creates
potential for existing infection to grow rapidly & undetected masks infections, increased water weight
"daily"
