Chapter 50. Rheumatoid Arthritis
PT is a 38-year-old patient with a past medical history of rheumatoid arthritis. He is changing therapy at today’s visit to an alternative agent. He had a sulfa allergic reaction 2 years ago. Which of the following DMARDs is contraindicated in a patient with a history of a sulfa allergy?
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 which targets the CD20 antigen on B-lymphocytes
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 cause 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 formulary restrictions may limit the availability of ...