pharm MSK + neuro DOC, indications,
PK
RA DOC
Methotrexate
what to reduce with MTX
renal dosing
what to take folic acid with?
Methotrexate
Methotrexate contraindications
pregnancy
CLD
immunocompromised
bleeding issues
MTX AE
hepatic fibrosis
pneumonitis
stomatitis
leukopenia
thrombocytopenia
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
PK
RA DOC
Methotrexate
what to reduce with MTX
renal dosing
what to take folic acid with?
Methotrexate
Methotrexate contraindications
pregnancy
CLD
immunocompromised
bleeding issues
MTX AE
hepatic fibrosis
pneumonitis
stomatitis
leukopenia
thrombocytopenia
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
