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DMARDs
This document discusses disease-modifying anti-rheumatic drugs (DMARDs) used to treat rheumatoid arthritis. It describes the goals of treatment as relieving pain, reducing inflammation, slowing joint damage, and improving functioning. The main drug classes used are synthetic DMARDs like methotrexate, sulfasalazine, hydroxychloroquine, azathioprine, and biologic DMARDs that target cytokines like TNF-α. Specific drugs discussed in more detail include abatacept, adalimumab, etanercept, certolizumab, and rituximab. For each drug, information is provided on their mechanism of action, pharmacokinetics, dosing, and
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DMARDs
- 1. Disease ModifyingAnti- Rheumatic Drugs (DMARDs) KalsoomSaleem CMS # 8107
- 2. Bones Articular cartilage-joinstwo bones Acting as shock absorber Continuously subjected to wear and tear caused by stress on bones National Institute of Arthritis and Musculoskeletal and Skin Diseases Information Clearinghouse The Arthritis Foundationwww.arthritis.org
- 4. Rheumatoid Arthritis Autoimmune disease Causes systemic effects, shortens life and reduces mobility Etiology: Unknown Genetics Environmental factors Infection Autoimmunity Signs and Symptoms: Joint inflammation Pain and stiffness Fatigue, fever National Institute of Arthritis and Musculoskeletal and Skin Diseases Information Clearinghouse The Arthritis Foundationwww.arthritis.org
- 6. Treatment Goals Relieve pain Reduce inflammation Slowjoint damage Improve functioning National Institute of Arthritis and Musculoskeletal and Skin Diseases Information Clearinghouse The Arthritis Foundationwww.arthritis.org
- 7. Drug Treatment • COX-selective • COX-non- selective NSAIDs •Biologics • Synthetic DMARDs • Cortisone • Hydrocortisone Corticosteroids • Paracetamol Another analgesic National Institute of Arthritis and Musculoskeletal and Skin Diseases Information Clearinghouse The Arthritis Foundationwww.arthritis.org
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- 9. Synthetic Abatacept Azothioprine Choloroquine & Hydrocholoroquine Methotrexate Sulfasalazine National ArthritisAction Plan: A Public Health Strategy, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion
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- 11. Pharmacokin- etics Monotherapy or combination therapy 60-100= 750 mg >60 Kg=500 mgIV 3 doses-IV (1 day, 2 week, 4 week) Bertram G.Katzung, Susan B.Masters, Anthony J.Trevor, McGrawHill Publications, Basic and clinical Pharmacology, Ch. 36, NSAIDs, Antirheumatic Drugs, Nonopioid Anelgesics And Drugs Used toTreat Gout, 12th Ed., 2012, pg 642
- 12. Adverse Effects Hypersensitivity Lymphomas Bertram G.Katzung, SusanB.Masters, Anthony J.Trevor, McGrawHill Publications, Basic and clinical PharmacologyCh. 36, NSAIDs, Antirheumatic Drugs, Nonopioid Anelgesics And Drugs Used toTreat Gout, 12th Ed., 2012, pg 642
- 13. Azithioprine MOA TPMT-Liver 6-thioguanine Disturbs function of IL- 1,2,B &T-cells Bertram G.Katzung, Susan B.Masters, Anthony J.Trevor, McGrawHill Publications, Basic and clinical Pharmacology, Ch. 36, NSAIDs, Antirheumatic Drugs, Nonopioid Anelgesics And Drugs Used toTreat Gout, 12th Ed., 2012, pg
- 14. Pharmacokin- etics Drugs rapidly metabolized and clearedfrom blood Patient deficient inTMPT-suffer myelosuppression Bertram G.Katzung, Susan B.Masters, Anthony J.Trevor, McGrawHill Publications, Basic and clinical Pharmacology, Ch. 36, NSAIDs, Antirheumatic Drugs, Nonopioid Anelgesics And Drugs Used toTreat Gout, 12th Ed., 2012, pg 642
- 15. Adverse effects Bone marrow depression Alopecia GI disturbances Bertram G.Katzung, SusanB.Masters, Anthony J.Trevor, McGrawHill Publications, Basic and clinical Pharmacology, Ch. 36, NSAIDs, Antirheumatic Drugs, Nonopioid Anelgesics And Drugs Used toTreat Gout, 12th Ed., 2012, pg 642
- 16. Chloroquine & hydroxychloro quine- MOA Unclear Depression ofT-lymphocytes Inhibitionof DNA/RNA synthesis Trapping of free radicalsBertram G.Katzung, Susan B.Masters, Anthony J.Trevor, McGrawHill Publications, Basic and clinical Pharmacology, Ch. 36, NSAIDs,Antirheumatic Drugs, Nonopioid AnelgesicsAnd th
- 17. Pharmacokin- etics Well absorbed 50% proteinbinding Half-life = 45 days Bertram G.Katzung, Susan B.Masters, Anthony J.Trevor, McGrawHill Publications, Basic and clinical Pharmacology, Ch. 36, NSAIDs, Antirheumatic Drugs, Nonopioid Anelgesics And Drugs Used toTreat Gout, 12th Ed., 2012, pg 642
- 18. Adverse effects Ocular toxicity Abdominal pain Bertram G.Katzung, SusanB.Masters, Anthony J.Trevor, McGrawHill Publications, Basic and clinical Pharmacology,Ch. 36, NSAIDs, Antirheumatic Drugs, Nonopioid Anelgesics And Drugs Used toTreat Gout, 12th Ed., 2012, pg 643
- 19. Biologics- TNF-- blocking agents Adalimumab Eternacept CertolizumabGolimumab Infliximab Bertram G.Katzung, Susan B.Masters, Anthony J.Trevor, McGrawHill Publications, Basic and clinical Pharmacology, Ch. 36, NSAIDs, Antirheumatic Drugs, Nonopioid Anelgesics And Drugs Used toTreat Gout, 12th Ed., 2012, pg 643
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- 21. Pharmacokin- etics Used SC Half-life=10-20 days Dose= 40-60 mg Bertram G.Katzung, Susan B.Masters, Anthony J.Trevor, McGrawHill Publications, Basic and clinical Pharmacology, Ch. 36, NSAIDs, Antirheumatic Drugs, Nonopioid Anelgesics And Drugs Used toTreat Gout, 12th Ed., 2012, pg 643
- 22. Adverse Effects Opportunistic infections Leukopenia Skin infections Bertram G.Katzung, SusanB.Masters, Anthony J.Trevor, McGrawHill Publications, Basic and clinical Pharmacology, Ch. 36, NSAIDs, Antirheumatic Drugs, Nonopioid Anelgesics And Drugs Used toTreat Gout, 12th Ed., 2012, pg 643
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- 24. Pharmacokin- etics SC 25 mg twice/week Half-life = 4.5days Bertram G.Katzung, Susan B.Masters, Anthony J.Trevor, McGrawHill Publications, Basic and clinical Pharmacology, Ch. 36, NSAIDs, Antirheumatic Drugs, Nonopioid Anelgesics And Drugs Used toTreat Gout, 12th Ed., 2012, pg 644
- 25. Adverse Effects Adverse Effects Juvenile Arthritis Psoriasis Systemic Lupus Erthymatosus Bertram G.Katzung,Susan B.Masters, Anthony J.Trevor, McGrawHill Publications, Basic and clinical Pharmacology, Ch. 36, NSAIDs, Antirheumatic Drugs, Nonopioid Anelgesics And Drugs Used toTreat Gout, 12th Ed., 2012, pg 644
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- 27. Pharmacokin- etics Half-life = 14days Clearance decreases with decrease in body weight Dose = 400 mg initially followed by 200 mg every 2nd week. Bertram G.Katzung, Susan B.Masters, Anthony J.Trevor, McGrawHill Publications, Basic and clinical Pharmacology, Ch. 36, NSAIDs, Antirheumatic Drugs, Nonopioid Anelgesics And Drugs Used toTreat Gout, 12th Ed., 2012, pg 645
- 28. Adverse effects Opportunistic infections Fungal infections Bacterial infections Tuberculosis BertramG.Katzung, Susan B.Masters, Anthony J.Trevor, McGrawHill Publications, Basic and clinical Pharmacology, Ch. 36, NSAIDs, Antirheumatic Drugs, Nonopioid Anelgesics And Drugs Used toTreat Gout, 12th Ed., 2012, pg 646
- 29. B-cell Blocking agents Rituxan, Rituximab,Genentech USA, 2013. http://www.rituxanforra.com/patient/considering-treatment/anti-tnfs
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- 31. Pharmacokin- etics IV Dose = 1000mg Duration = 2 weeks for 6-9 months Bertram G.Katzung, Susan B.Masters,Anthony J.Trevor, McGrawHill Publications, Basic and clinical Pharmacology, Ch. 36, NSAIDs,Antirheumatic Drugs, NonopioidAnelgesicsAnd Drugs Used toTreat Gout, 12th Ed., 2012, pg 646
- 32. Adverse Effects Flu Rituxan, Rituximab, GenentechUSA, 2013. http://www.rituxanforra.com/patient/considering-treatment/anti-tnfs