Leflumonide PK
3d loading dose to achieve steady state
if AE lower to 10mg/d
Leflumonide contraindications
pregnancy
CLD
,second line for RA
TNF
what to use for RA + pregnancy
hydroxychloroquine
AE of hydroxychloroquine
GI
vison issues
can you combine DMARDS
no
biologic DMARDs
need to monitor?
TB skin test
screen hep B
avoid live vaccines
TNF risks
do NOT use w heart disease
risk of infection, malignancies, demyelinating disorders (MS)
what drug do you premedicate with antihistamine
infliximab
contraindications infliximab
active ifections
CHF
indication for abatacept
, moderate to severe RA
who fail DMARDS
polymalgia rheumatica drug
IL-6 inhibitor
monitor for IL-6 inhibitor
hep B, AST, ALT
ANC + lipids 4-8w + q3months
contraindication IL-6 inhibitor
ALT or AST >1.5 ULN
active infection
what to combine w anti-CD20
methylprednisone
acetaminophen
antihistamine
decreases immune reactions
indications anti-CD20
mod-severe RA only in combo w MTX
Bcell non-hodgkins
CLL/ SLL
pemphigus vulgaris
myasthenia gravis
when is breastfeeding contraindicated
hydroxychloroquine
sulfasalazine
anti-CD20
when is Cr Cl <30 contraindicated
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