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Chapter 49: Rheumatoid Arthritis

PT is a 38-year-old patient with a past medical history of rheumatoid arthritis. His physician is switching him to an alternative agent today. He experienced a sulfa allergic reaction 2 years ago. Which of the following DMARDs is contraindicated in a patient with a history of a sulfa allergy should be avoided for PT?

a. Neoral

b. Arava

c. Rheumatrex

d. Azulfidine

e. Cytoxan

Answer d is correct. Azulfidine (sulfasalazine) is contraindicated in patients with history of hypersensitivity to medications containing sulfa.

Answer a is incorrect. Neoral (cyclosporine) is not contraindicated in patients with a sulfa allergy.

Answer b is incorrect. Arava (leflunomide) is not contraindicated in patients with a sulfa allergy.

Answer c is incorrect. Rheumatrex (methotrexate) is not contraindicated in patients with a sulfa allergy.

Answer e is incorrect. Cytoxan (cyclophosphamide) is not contraindicated in patients with a sulfa allergy.

Which of the following is the correct mechanism of action for etanercept (Enbrel)?

a. Monoclonal antibody that targets the CD20 antigen on B lymphocytes

b. TNF-α inhibitor

c. Immunoglobulin protein which inhibits T lymphocytes

d. Dihydrofolate reductase inhibitor

Answer b is correct. Enbrel (etanercept) is a TNF-α inhibitor.

Answer a is incorrect. Rituximab is a monoclonal antibody that targets CD20 antigen on B lymphocytes.

Answer c is incorrect. Abatacept is a T-cell inhibitor.

Answer d is incorrect. Methotrexate is a dihydrofolate reductase inhibitor.

Which of the following is a reason that DMARDs are preferred over non-DMARD for RA management?

a. DMARD agents have fewer adverse reactions than non-DMARDs.

b. Non-DMARD agents are less cost-effective than DMARDs.

c. DMARD agents may reduce or prevent joint damage and preserve joint function.

d. Non-DMARD agents require close laboratory monitoring.

Answer c is correct. Unlike non-DMARD agents such as NSAIDs, aspirin, and COX-2 inhibitors, DMARDs reduce or prevent joint damage and preserve joint function and integrity.

Answer a is incorrect. Both DMARD and non-DMARD drug agents have associated adverse reactions and neither drug class is less likely to cause them than the other.

Answer b is incorrect. Though ...

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