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MSK II > Rheumatic diseases pharm > Flashcards

Rheumatic diseases pharm Flashcards

1
Q

nonbio DMARDs

A

hydroxycholoroquine
leflunomide
MTX
sulfasalazine

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2
Q

rarely used nonbio DMARDs

A

azathiprine
cyclosporine
gold salts
minocycline

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3
Q

bio DMARDs TNF-alpha blockers

A 
adalimumab
certolizumab
etanercept
folimumab
inflizimab
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4
Q

other bio DMARDs

A

abatacept
rituximab
tocilizumab

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5
Q

NSAIDs

A

celecoxib
ibuprofen
naproxen

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6
Q

corticosteroids

A

prednisone
methyprednisolone
trimcinolon

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7
Q

acute gout drugs

A

NSAIDs
colchicine
cortiosterids

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8
Q

prevents of gout drugs

A

allopurinol
febuxostat
pegloticase
probenecid

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9
Q

standard drug combo for RA

A

DMARD
NSAID
+/- corticosteroid

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10
Q

recommend initial Tx DMARDs for RA

A

MTX or LEF

if disease is mild can use the safer HCQ or sulfasalazine

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11
Q

MTX MOA

A

at high doses (chemo) inhibits dihydrofolate reductase
low doses used in RA MOA unknown, but does have direct inhibitory effect on proliferation and stimulates apoptosis of immune cells

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12
Q

MTX drug interactions

A

concentration is increased by HCQ

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13
Q

common adverse effects of MTX

A

nausea, upset stomach, diarrhea
stomatitis, alopecia, fever
macular punctate rash, HA, fatigue, inability to concentrate

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14
Q

life threatening adverse effects of MTX

A

hepatotoxic
pulmonary damage
myelosupression
nephrotoxicity (basically never occurs with low doses used for RA)

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15
Q

MTX and hepatic enzymes

A

freqently elevated, but cirrhosis is rare
liver enzymes should be monitored before and after Tx
Pts at risk for hep B and C should be screened before starting MTX
should not drink alcohol

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16
Q

MTX and lungs

A

baseline chest x-ray should be obtained before initiating Tx

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17
Q

MTX CI

A

pregnancy

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18
Q

leflunomide MOA

A

prodrug converted to active A77-1726 in intestines and plasma
inhibiits dihydroorotate dehydrogenase -> T proliferation and B cell production of Abs inhibited

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19
Q

uses of leflunomide

A

as effective as MTX in preventing RA-assocaited bone damage
can be used as initial monotherapy or added when MTX ineffective
best results when LEF and MTX combined, but hepatotoxicity effective may be additive

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20
Q

LEF adverse effects

A

diarrhea very common

elevation of liver enzymes, mild alopecia, weight gain, increased BP, leukopenia, and thrombocytopenia

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21
Q

LEF CI

A

prego

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22
Q

HCQ MOA

A

poorly understood
possibly suppression of T-cell responses to mitogens, decreased leukocyte chemotaxis, stabilization of lysosomal enzymes, inhibition of DNA and RNA synthesis and trapping of free radicals

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23
Q

HCQ uses

A

best known for malaria
RA and lupus
usually used in combo with either MTX or sulfasalazine

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24
Q

adverse effects of HCQ

A 
ocular toxicity (should be screened yearly)
dyspepsia, nausea, vomiting, abdominal pain, rashes, nightmares
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25
Q

sulfasalazine MOA

A

poorly understood
decreased IgA and IgM rheumatoid factor production
suppression of T cell responses and B cell proliferation
inhibition of cytokine release

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26
Q

sulfasalazine metabolites

A

sulfapyridine and 5-ASA

5-ASA is active drug in IBD, but sulfapyridine is active drug in RA

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27
Q

uses of sulfasalazine

A

reduces radiologic disease progression in RA

also used for Tx of UC and JIA

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28
Q

sulfasalazine adverse effects

A

more toxic then HCQ
nausea, vomitins, HA, anorezia, and rash common
reversible infertility in men
probably safe in prego

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29
Q

adverse effects of TNF-alpha blockers

A

injection site rxn common
fever, uticaria, dyspnea, hypotension
cytopenias, CBCs should be monitored regularly

30
Q

serious adverse effects of TNF-alpha blockers

A

serious infections, sepsis, TV,

31
Q

TNF alpha blockers and CA

A

increased risk of lymphomas

32
Q

TNF alpha blockers and heart

A

associated with heart failure and should not be used in pts with class III/IV CHF and EF <50%

33
Q

TNF alpha blockers and prego

A

ok

34
Q

abatacept MOA

A

genetically engineered fusion protein of CTLA-4 R and Fc region of human IgG
binds CD80 and CD86 -> inhibits T cell activation

35
Q

abatacept response tme

A

can have relief with one dose, full benefit in 6 months

36
Q

uses of abatacept

A

RA

JIA

37
Q

adverse effects abatacept

A

infusion rxns -> HTN, HA, dizzy, anaphylacotoid rxn
increase of serious infections
pregnancy- C risk of fetal autoimmune disease

38
Q

Rituximab MOA

A

chimeric MAB that depletes CD20 expressing B cells

39
Q

rituximab PK

A

IV

40
Q

rituximab uses

A

RA, usually in combo with MTX

hematological malignancies

41
Q

rituximab adverse effects

A

mild infusion rxn (rash)
severe infusion rxn (urticarial or anaphylactoid) rare
increased infections

42
Q

tocilizumab MOA

A

humanized MAB bind and inhibits IL-6 R signaling

43
Q

tocilizumab PK

A

IV or sub-Q

44
Q

tocilizumab uses

A

effective in some RA pts refractory to nonbio DMARDs or anti TNFs
JIA

45
Q

adverse effects tocilizumab

A 
infusion rxn 
HTN
neutropenia
elevated transaminases
dyslipidemai
serious: GI perforation, serious infections, anaphylaxis
46
Q

tolmetin

A

not effective for gout

47
Q

aspirin

A

less effective then other NSAIDs for anklosing spondylitis
not sued for gout bc can inhibit uric excretion at low doses and increased excretion at high doses, but increases risk for stones

48
Q

first line Tx for gout

A

NSAIDs

49
Q

oxaprozin

A

should not be given to pts with uric acid stones b/c increased uric acid secretion in urine

50
Q

colchicine

A

primary Tx for many years, but declined d/t toxicity

may be used if NSAIDs CI

51
Q

probenecid

A

only potent uricosuric agent in US

52
Q

pegloticase

A

recombinant uricase available for Tx of severe chronic gout refractory to conventional antihyperuricemic therapy

53
Q

colchicine MOA

A

binds tubulin and prevents polymerization of microtubules -> inhibits leukocyte migration and phagocytosis

54
Q

uses of colchicine

A

second line for acute gout
basically only effective if initiated w/in 12-24hours of onset of attack
used at low doses for prophylaxis

55
Q

allopurinol MOA

A

purine analog that competitively and irreversibly inhibits xanthine oxidase

56
Q

allopurinol uses

A

preferred Tx for gout inbetween episodes

57
Q

adverse effects of allopurinol

A

can precipitate acute gouty arthritis, should be given with NSAIDs or colchicine at first
GI

58
Q

febuxostat MOA

A

non-purine xanthine oxidase inhibitor

59
Q

febuxostat uses

A

Tx of chronic hyperuricemia in gout pts

60
Q

adverse effects of febuxostat

A

can precipitate acute gouty arthritis, should be given with NSAIDs or colchicine at first
generally well tolerated
most frequent: liver fnx abnormalities, diarrhea, HA, nausea

61
Q

febuxostat drug interactions

A

cannot be combined with azathioprine or 6-mercaptopurine

62
Q

pegloticase MOA

A

recombinant uricase converts uric acid to allantoin

63
Q

pegloticase administration

A

IV every 2 wks

64
Q

pegloticase uses

A

chronic gout

65
Q

pegloticase adverse effects

A

can precipitate acute gouty arthritis, should be given with NSAIDs or colchicine at first
infusion rxns common
anaphylaxia
body may initiate an immune attack on drug

66
Q

pegloticase CI

A

glucose-6-phoaphatate dehydrogenase deficiency dt concern for hemolytic anemia

67
Q

probenecid MOA

A

organic acid that acts at anionic transport site of renal tubules ot reduce resorption of uric acid

68
Q

probenecid uses

A

when allopurinol or febuxostat CI or when tophi present

69
Q

probenecid adverse effects

A

increased uric acid secretion -> increased stone, CI in those with stones
generally well tolerated
mild GI and rash

70
Q

probenecid drug interactions

A

aspirin and other salicylates diminish effects

MSK II (19 decks)

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