Patient Care I- Exam 2 Study Guide Graded A+

Tazarotene - ANSWER Tazorac Vitamin D3 - ANSWER Calcitriol Calcipotriene - ANSWER - Calcipotriol - Taclonex Hydrocortisone - ANSWER Cortaid Desonide - ANSWER Desonate Triamcinolone Acetonide - ANSWER - K ...

Tazarotene - ANSWER Tazorac Vitamin D3 - ANSWER Calcitriol Calcipotriene - ANSWER - Calcipotriol - Taclonex Hydrocortisone - ANSWER Cortaid Desonide - ANSWER Desonate Triamcinolone Acetonide - ANSWER - Kenalog - Nasacort Betamethasone - ANSWER Diprolene Desoximetasone - ANSWER Topicort Pimecrolimus - ANSWER Elidel Tacrolimus - ANSWER Protopic Anthralin - ANSWER Micanol Keratolytics - ANSWER Adjunct Methotrexate - ANSWER - Rhuematrex OR Trexall - weekly dosed - CATEGORY X - inhibits dihyrofolate - s/e: hepatotoxicity, bone marrow suppression, stomatitis (mouth ulcers), pulmonary fibrosis - DMARDs - folic acid 1mg with admin - DOC for RA and CD RA: - MTX given w/ DMARDs or corticosteroids - onset: 4-6wks or up to 4-6months - given PO for maintenance 7.5mg-30mg weekly - "normal dosing" is 7.5mg-15mg weekly then a 2.5mg increase for 2-4 weeks - also have IM or SC: autoinjectable - drug interactions outside of NSAIDs (w/ OATP1/3): diuretics, ACE, Penicillin If a patient is pregnant and has RA but is allergic to MTX, what is the next drug of choice? - ANSWER Plaquenil True or false: MTX can be given to a patient that has a creative clearance less than 30. - ANSWER False, due to kidney excretion. Brand name for Hydrochloroquine - ANSWER Plaquenil - anti-malarial drug used in RA - onset is 6-12 weeks - s/e: blurred vision (retinopathy), nausea and epigastric pain - safe in pregnant woman - not as effective than MTX and Sulfasalazine True or false. Patients taking Hydroxychloroquine do not have to take an eye exam once a year. - ANSWER False, due to crystallization in the eye, patient must have an ophthalmologic exam. If a patient has rheumatoid nodules but cannot take methotrexate, what would the next drug of choice be? - ANSWER Biologics. Due to nodules being a key indicator for MTX use. If a pt. has tried first two drug of choices in the non-Biologics, what would the next drug of choice be? Patient is fearful of needles. - ANSWER Biologics True or false. All Biologics are category B. - ANSWER True Provide the key side effect of Plaquenil - ANSWER Retinopathy = blurred vision True or false: onset of Plaquenil is longer than Rheumatrex. - ANSWER True Which drug used for RA and isn't an immunosuppressant? - ANSWER Plaquenil Brand name for Leflunomide - ANSWER Arava - inhibits pyrimidine - maintenance dose: 20mg/day - diarrhea occurs frequently - CATEGORY X If a patient was taking Arava and wants to start fertility options, what would there options be? - ANSWER 1. Discontinue drug 2. Take Cholestyramine 8g/TID for 11 days Why would Arava not be drug of choice in RA? - ANSWER - requires loading dose (100mg/BD for 3 days) and FREQUENT DIARRHEA Brand name for Cyclophosphamide - ANSWER Cytoxan Brand name for penicillamine - ANSWER Cuprimine Which NSAIDs interact with MTX specially? - ANSWER those going through OATP1/3 (not contraindicated but requires monitoring) Side effects of Methotrexate - ANSWER - bone marrow suppression - renal failure - hepatotoxicity (elevated LFTs) - pulmonary embolism - stomatitis Monitoring parameters of Methotrexate - ANSWER - CBC w/ differentials and platelets - serum creatinine - LFT tested every (2-4 weeks— first 3 months) then (4-8weeks— 3-6 months) then (every 12 weeks after 6 months) - RFT - PFT (if lung disease is induced) Aprelimast - ANSWER Otezla - phosphodiesterase-4 inhibitor - less toxic than DMARDS but less effective than biologics - s/e: depression, HA, nausea, diarrhea - given PO Acitretin - ANSWER Soriatane - vitamin A. retinoid used for erythrodermic and puscular psoriasis - KEY: category X (black box warning), do not take alcohol 2 months after the discontinuance - dose: takes 3-6 months, 25-50mg BD - s/e: dry scalp and lips, chapped lips blurred vision, photosensitivity jaundice and hepatitis Cyclosporine - ANSWER Neoral, Sandimmune - FULMINANT IBD (used as a pre-op medication) - 2nd choice after topical corticosteroids - COULD CAUSE NEPHROTOXICITY AND NEUROTOXICITY (seizures may occur) - not used denial failure - NOT used in pts. with HTN - - INTERACTS WITH 3A4 inhibitor (Verapamil) Azathioprine - ANSWER Imuran - SOLE immunosuppressant that causes PANCREATITIS and looks like elevated lipase levels - takes up to 12 months for "real" effects - taken with a corticosteroids - mod-severe IBD/UC - monitor CBC w/ differentials and platelets, LFT, RFT Monitoring parameters of TNF-Inhibitors - ANSWER - LFT - RFT