Please enable JavaScript.

Coggle requires JavaScript to display documents.

Rheumatoid Arthritis - Coggle Diagram

- - - - MOA: Immunosupression by inhibition of dihydrofolate & leukotrine synthesis
      - ADR: dose related ( increased events w/ NSAIDS & loop diuretics)
        
        Decreased WBC
        
        Stomatitis
        
        Neurotoxicty, renal toxicty, hepaotoxicity,pulmonary toxicity
        
        RASH -> SJS
      - Regimen:
        
        LOT: 1st line
        
        Route: Parenteral > Oral
        
        Dose/Freqency: 5 - 20 mg/week
      - Monitoring:
        
        CBC ( anemia,WBC,platelets)
        
        LFTs
        
        SCr q4-8 weeks
      - Duration:
        
        Long term term Maintenance therapy for RA
      - Warnings/precautions/contraindications
        
        Teratogenic
        
        D/C if acute infections
      - Interactions: alcohol
      - Special Populations: do not take if/becoming pregnant
      - Education/counseling
        
        Take w/ 1 mg QD folic acid to avoid toxicty
        
        Annual TB test
      - Determinants of health
        
        access, education
  - - - Monitoring:
        
        baseline: CBC with differential, TB screening; during: s/sx of infection, lupus-like syndrome, malignancy
      - Duration:
        
        Result seen In 2 weeks- 3 months. Long term therapy for RA
      - Regimen:
        
        40 mg SQ every other week; may increase to 40mg every week or 80mg every other week
      - Warning/Precautions/Contraindications
        
        Increased risk of infection
        
        Tuberculosis
        
        Lymphoma and other malignancies
        
        Formation of neutralizing anti-drug antibodies
        
        Hepatitis B
      - MOA
        
        binds to TNF-alpha to interfere with binding to TNFa receptors and subsequent cytokine-driven inflammatory processes
      - Interactions:
        
        Other immunosuppressants
        
        Anti-TNF agents
        
        DMARDs
      - Special Populations:
        
        Not recommended for women who are pregnant/planning to get pregnant or breastfeeding
      - Education/Counseling
        
        Administration
        
        Given as a shot into the fatty part of the skin on top of the thigh or the belly area; wash hands before and after
        
        Missed dose
        
        Take as soon as you remember, do not take 2 doses at same time/extra doses
        
        Storage and Disposal
        
        Store in a refrigerator and do not freeze. Store in the original container to protect from light. Check with your pharmacist about disposal for drug take-back programs.
      - Determinants of health
        
        access (high cost)
      - ADRs
        
        skin rash
        
        infection
        
        local injection site reaction
        
        headache
- - - - 1 large joint = 0
      - 2-10 large joints = 1
      - 1-3 small joints = 2
      - 4-10 small joints = 3
      - 10 joints = 5
    - - Negative RF AND negative ACPA = 0
      - Low RF or low ACPA = 2
      - High RF or high ACPA = 3
    - - < 6 week = 0
      - 6 weeks or more = 1
    - - Normal CRP and ESR = 0
      - Abnormal CRP or abnormal ESR = 1