1. Disease ModifyingAnti- Rheumatic Drugs (DMARDs) Kalsoom Saleem CMS # 8107

2. Bones Articular cartilage-joins two 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 3. 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 4. Treatment Goals Relieve pain Reduce inflammation Slow joint damage Improve functioning National Institute of Arthritis and Musculoskeletal and Skin Diseases Information Clearinghouse The Arthritis Foundationwww.arthritis.org 5. 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 6. Classification 7. Synthetic Abatacept Azothioprine Choloroquine & Hydrocholoroquine Methotrexate Sulfasalazine National Arthritis Action Plan: A Public Health Strategy, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion 8. Abatacept 9. Pharmacokin- etics Monotherapy or combination therapy 60-100= 750 mg >60 Kg=500 mg IV 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 10. Adverse Effects Hypersensitivity Lymphomas Bertram G.Katzung, Susan B.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 11. 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 12. Pharmacokin- etics Drugs rapidly metabolized and cleared from 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 13. Adverse effects Bone marrow depression Alopecia GI disturbances 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 14. Chloroquine & hydroxychloro quine- MOA Unclear Depression ofT-lymphocytes Inhibition of 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 15. Pharmacokin- etics Well absorbed 50% protein binding 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 16. Adverse effects Ocular toxicity Abdominal pain 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 17. Biologics- TNF-- blocking agents Adalimumab Eternacept Certolizumab Golimumab 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 18. Adalimumab 19. 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 20. Adverse Effects Opportunistic infections Leukopenia Skin infections 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 21. Eternacept 22. Pharmacokin- etics SC 25 mg twice/week Half-life = 4.5 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 644 23. 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 24. Certolizumab- MOA 25. Pharmacokin- etics Half-life = 14 days 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 26. Adverse effects Opportunistic infections Fungal infections Bacterial infections Tuberculosis 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 646 27. B-cell Blocking agents Rituxan, Rituximab, Genentech USA, 2013. http://www.rituxanforra.com/patient/considering-treatment/anti-tnfs 28. Rituximab 29. Pharmacokin- etics IV Dose = 1000 mg 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 30. Adverse Effects Flu Rituxan, Rituximab, Genentech USA, 2013. http://www.rituxanforra.com/patient/considering-treatment/anti-tnfs