Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Anatomy > Pharm Exam 2 > Flashcards

Pharm Exam 2 Flashcards

1
Q

How long can bone remodeling take?

A

3-4 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What reabsorbs (removes) bone?

A

osteoclasts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What forms (synthesizes) bone?

A

osteoblasts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What do osteoblasts secrete?

A

alkaline phosphatase (ALP)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

When is secretion of alkaline phosphatase increased?

A

In bone growth (children & adolescents)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What causes the loss of bone mass after 30?

A

Reabsorption > Formation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Name of vitamin D2?

A

Ergocalciferol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Name of Vitamin D3?

A

Cholecalciferol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

“Vitamin D”

A

D2 & D3 (both act similarly)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Where is vitamin D converted into 25-hydroxyvitamin D?

A

Liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Where is 25-hydroxyvitamin D converted to 1-25 dihydroxyvit D (calitriol;D3)

A

Kidneys

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the result of:
Low serum Ca 2+ and
Increases in PTH

A

Increased bone resorption AND Increased Ca2+ resorption from the gut

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the precursor condition of osteoporosis?

A

osteopenia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the bone density of osteopenia?

A

1 to <2.5 SD below average bone mass

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the bone density of osteoporosis?

A

> or = to 2.5 SD below average bone mass

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the 3 categories of osteoporosis?

A

Post menopausal
Age-related
Secondary: medications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What causes postmenopausal osteoporosis?

A 
Decreased estrogen (E2),
Increased bone resorption WITHOUT increased formation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the 2 cytokines that are stimulated and released by decreases in estrogen?

A

IL-1

TNF-alpha

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What does IL-1 do?

A

potent inducer of resorption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What does TNF-alpha do?

A

induces osteoclast maturation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

When does peak bone density occur?

A

2nd- 4th decades

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Why are females more likely to have fractures compared to men with age related osteoporosis?

A

females have smaller mass and therefore a smaller loss results in fracture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the causes of age related osteoporosis? (6)

A
  1. Decreased osteoblast function
  2. Decreased Ca2+ and Vitamin D intake and absorption
  3. Decreased sex hormone levels
  4. Increased mechanical bone stress
  5. Decreased physical activity
  6. Decreased sun exposure (Decreased formation of DHVitD)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is secondary osteoporosis associated with in men?

A

risk factors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are the drug-induced medications of secondary osteoporosis?

A

Steroids, heparin, thyroid hormone replacement & anticonvulsants are most common
Prednisone >7.5mg/d (decreased bone formation; increased bone resorption)
Heparin greater than 15K-30K units/day for > 3-6 months :MOA unknown
T3 & T4 increase osteoclast activity
anticonvulsants increase vitamin D metabolism (osteomalacia & OP)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Osteoporosis Risk Factors (5)

A 
Lifestyle
Diet
Chronic Illness
Medications
Fall-related conditions ( meds: anxiolytics &amp; benzodiazepines)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Dietary changes for Osteoporosis therapy? (3)

A

Increase Ca2+ to 1200-1500mg/d
Increase Vet D to 200-600 units/daily
Dairy products; oily fishies; fortified milk; 15-20 mins sun 2-3x/week

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are the nonpharmacologic therapies for osteoporosis? (3)

A

Dietary changes
social habit changes
exercise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Why should calcium supplements be taken with meals?

A

best absorbed in acid pH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What type of calcium is pH independent?

A

calcium citrate (24% Ca, $$$)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Why is calcium citrate beneficial in elderly?

A

elderly may have decreased gastric acid output

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is a common SE of calcium supplements for osteoporosis?

A

constipation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Calcium cannot be taken within 1-2 hours of : (5)

A 
iron
tetracycline
quinolones
bisphosphonates
phenytoin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is first line therapy for osteoporosis in men and women?

A

Bisphosphonates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

How do bisphosphonates work?

A

they are absorbed to the bone later becoming permanent

inhibit action of osteoclasts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

How are bisphosohonates taken?

A

take with water and don’t lie down for half an hour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What are a SE of oral bisphosphonates?

A

esophagitis may occur

Osteonecrosis of bone!!! (esp jaw)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What are bisphosphonate medications? (6)

A 
alendronate (fosamax)
Etidronate (Didronel)
Ibanronate (Boniva)
Pamidronate (Aredia)
Risedronate (actonel)
zoledronic acid (Reclast)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

How is alendronate (fosamax) taken for OP prevention and treatment?

A

prevention: 5mg daily/ 35mg weekly

TreatmentL 10mg daily/ 70 mg weekly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What is etidronate (didronel) used for?

A

Paget’s disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What is the indication for pamdronate (aredia)?

A

hypercalcemia of malignancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What is a monoclonal antibodies (MAb) for osteoporosis?

A

denosumab (prolia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What is the method of action of denosumab (prolia)?

A

inhibition of osteoclast formation, function & survival

NOT FIRST LINE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What is denosumab (prolia) different compared to bisphosphonates?

A

unlike bisphosphonates, effects of osteoclasts are reversible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What medication is a recombinant human parathyroid hormone PTH for osteoporosis?

A

Teriparatide (forteto)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Why is teriparatide (forteo) only reserved for pts with very high risk of fracture?

A

$$$$$

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What is a common SE of teriparatide (forteo)?

A

orthostatic hypotension may occur early in therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What is the blackbox warning associated with teriparatide (forteo)?

A

induces osteosarcoma in animals (no cases reported in humans)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What is the line of therapy for osteoporosis AFTER bisphosphonates, denosumab or terparatide?

A

selective estrogen receptor modulators (SERMs)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What is the MOA of SERMs?

A

estrogen- like activity on bone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What are the types of selective estrogen receptors modulators (SERMS)? (2)

A

Raloxifene (Evista)

Bazedoxifene (Duavee)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What SERM is used in combination with conjugated estrogen and only for shoe term use?

A

Bazedoxifene (Duavee)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What medication for OP opposes action fo PTH?

A

calcitonin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What medication decreases osteoclast activity and resorption but is not as effective as other OP meds?

A

calcitonin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

What medication is reserved for acute fractures or chronic osteoporosis pain?

A

calcitonin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

What medications should be given with calcitonin?

A

concurrent Ca 2+ and Vit D should be given

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Pharmacologic doses decrease bone resorption and are less effective than bisphosphonates?

A

calcitonin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

What is the more potent type of calcitonin compared to mammalian?

A

salmon calcitonin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

What form is calcitonin given?

A

nasal spray

60
Q

Osteonecrosis or aseptic necrosis is associated with what?

A

steroid therapy

61
Q

When will you see the greatest bone loss with steroid therapy?

A

1st 6-12 months of therapy

62
Q

What does of prednisone is usually required for steroid induced osteoporosis (SIO)?

A

> 7.5mg/ daily

therefore important to use lower dose for shortest duration

63
Q

What are the 3 main types of arthritic conditions?

A
  1. osteoarthritis: “wear and tear”; obesity
  2. Rheumatoid Arthritis: autoimmune
  3. Gouty Arthritis: elevated uric acid
64
Q

What is the most common of the joint diseases that affects nearly 50% of adults over 65 years of age?

A

Osteoarthritis

65
Q

What joint disease affects mainly all the weight bearing joints and hands?

A

osteoarthritis

66
Q

What type of joint disease is often unilateral and early in the disease the pain decreases with rest; however morning stiffness usually lasts less than 30 mins

A

osteoarthritis

67
Q

How many people in the US are affected by OA?

A

15.8 million

68
Q

What are the risk factors of OA?

A

obesity

repetitive use injury

69
Q

What are the categories of OA?

A

Primary (idiopathic): no known cause
Secondary: known abnormalities or trauma
Erosive: reflects changes to underlying bone

70
Q

What are the treatment options for OA?

A

diet
physical & occupational therapy
surgery

71
Q

What are the diet treatments for OA?

A

weight reduction
glucosamine supplements
chondrotin sulfate
Neither are PDA approved!

72
Q

What are the physical and occupational therapy treatments for OA?

A

heat treatments, exercise- reduce pain, decrease stiffness

caution against heat >30 mins (burns)

73
Q

What is OA drug therapy target at?

A

pain relief

74
Q

What is the oral analgesic of choice for OA?

A

acetaminophen

75
Q

What is the second choice oral agents for OA?

A

NSAIDs

76
Q

What medicine for OA is better for significant inflammation?

A

NSAIDs

77
Q

What other two medications besides NSAIDs and Acetaminophen may help with OA?

A 
topical analgesics (Cepsaicin)
COX-2 inhibitors
78
Q

What medication is a COX-2 Inhibitor?

A

Celecoxin (Celebrex) 100-200mg BID or 200mg QD

79
Q

What is chronic inflammation of synovial lining with proliferation = pannus

A

Rheaumatoid arthritis

80
Q

What does pannus do to the joint?

A

erodes cartilage and bone surface

81
Q

RA causes erosions that ultimately destroy the joint resulting in what?

A

immobility

82
Q

What joints are usually affected with RA?

A

small joints of hands
wrists
feet

83
Q

How long does morning stiffness usually last with RA?

A

> 30 minutes or ALL DAY

84
Q

What are the non-pharmacologic therapies for RA? (5)

A 
rest
occupational therapy
physical therapy
use of assistive devices
weight reduction
85
Q

What are the recent changes in approach to therapy for RA? (4)

A
  1. early diagnosis and treatment
  2. combination of DMARDs
  3. agents that target cytokines (anti tif alpha & interleukin-1 receptor antagonists)
  4. recognizing coexisting illnesses (infection, OP, cardiovascular dz)
86
Q

What are the 2 classifications for ‘length of disease’ for RA?

A

early : less than 6 months

established: greater than 6 months

87
Q

What is the ‘extent of disease activity’ for RA?

A

low
moderate
high

88
Q

what is the ‘presence of poor prognostic factors’ for RA?

A

functional limitation
extra-articular disease (nodes, RA vasculitis)
Positive Rheumatoid factor
bony erosions by X-ray

89
Q

What are the pharmacologic agents for RA?

A

NSAIDs
Corticosteroids
DEMARDS

90
Q

When are NSAIDs especially helpful with RA?

A

early disease to provide pain relief pending diagnosis. they DO NOT slow progression of the disease

91
Q

What are potent suppressors of inflammatory response that decrease the progression of RA on X-ray?

A

corticosteroids (CS)

92
Q

Over 1/2 patients will receive what LOW dose of CS therapy?

A

less than or equal to 10mg prednisone daily

93
Q

What high dose CS therapy is used for RA?

A

greater than 10mg- 60mg daily of prednisone

used less than 3 months followed by a taper over 7-10 days

94
Q

What is a predictable side effects of corticosteroids for RA?

A

adrenal cortex suppression

95
Q

What are common csDMARDS(Conventional synthetic Disease modifying anti rheumatic drugs) medications?

A

methotrexate (MTX)
Leflunomide (LEF)
Hydroxychloroquine (HCQ)
Sulfasalazine(SSZ)

96
Q

What is the csMARD of choice for RA that is most often selected for initial therapy?

A

methotrexate (MTX)

97
Q

What is the RA low dose for methotrexate?

A

less than 30mg weekly; start at 7.5mg weekly and increase by 5mg a week

98
Q

What is the standard of care for RA patients without contraindications?

A

methotrexate

99
Q

Methotrexate oral absorption is variable therefore if poor PO response what do you do?

A

try IV / Sub Q

100
Q

What mediation can be taken with methotrexate on skip days to minimize toxicity?

A

folic acid 1-3mg/daily

101
Q

What pregnancy category is methotrexate?

A

Category X

102
Q

What mediation used with methotrexate is potentially complimentary (additive toxicity)?

A

leflunomide (LEF)

103
Q

What csMARD has a long half life of 15-18 days and can take 2 years for complete elimination?

A

leflunomide (LEF)

104
Q

Since leflunomide is a category X what is important in females?

A

females need reliable birth control during use and verify non detectable blood level prior to pregnancy

105
Q

What is a rare complication of leflunomide?

A

hepatic necrosis (0.02-0.04%)

106
Q

What is the least potent but best tolerated csDMARD and commonly combined with methotrexate?

A

hydroxychloroquine (HCG)

107
Q

What was the first DMARD that was developed specifically for RA and is most commonly used in combination therapy?

A

sulfasalazine (SSZ)

108
Q

What are the dual therapy combinations of csDMARDS for RA? (4)

A

MTX + SSZ
MTX + HCQ
SSZ + HCG
combos with LEF

109
Q

What is the triple therapy csDMARD combination for RA?

A

MTX + SSZ + HCQ

110
Q

What is the anti- TNFbiologic for RA?

A

Infliximab (Remicade)

111
Q

What is the non TNF RA biologic?

A

Tofacitinib (Xeljanz)

112
Q

What was the first biologic agent available for RA?

A

Infliximab (Remicade)

113
Q

What medication is chimeric (human/mouse) monoclonal antibody?

A

Infliximab (Remicade)

114
Q

What mediations may reactivate latent TB and other infections.

A

Infliximab (Remicade) & Tofacitinib (Xeljanz)

115
Q

What testing should be done prior to starting Infliximab (Remicade) & Tofacitinib (Xeljanz)?

A

TB skin test & CXR

116
Q

What medications may minimize anaphylactoid reactions of Infliximab (Remicade)?

A

antihistamines
APAP
steroids

117
Q

In feb 2016 the FDA approved the first BIOSIMILAR product in the US, which is a “generic” of what medication for RA?

A

Infliximab (Remicade)

118
Q

What is the only FDA approved oral non DMARD for RA?

A

Tofacitinib (Xeljanz)

119
Q

What medications for RA has a MOA to inhibit janus kinase (JAK)

A

Tofacitinib (Xeljanz)

120
Q

What is gout characterized by? (3)

A

Hyperuricemia (greater than 7mg/dL)
Recurrent attacks of gouty arthritis
Caused by precipitated monosodium rate crystals in joints (decreased pH)

121
Q

Gout is the result of what 2 things?

A

uric acid overproduction (increase PRPP synthetase and decreased HGPRT enzyme)
uric acid under excretion (100% filtered, 90% reabsorbed)

122
Q

What are the risk factors for gout?

A 
obesity
male (10x)
increased age
alcohol intake 
protein/purine rich diet
htn
123
Q

IN gout what suggests increased synthesis?

A

greater than 1 g uric acid/ 24 hour urine

124
Q

What are chronic uric acid deposits?

A

tophi

125
Q

What are the gout treatments? (5)

A 
patient education (diet)
analgesics for gout: NSAIDs
Mediations for acute attacks: colchicine high dose
Corticosteroids
Prevention of future attacks
126
Q

What medication is given in gout for prevention of future attacks? (4)

A

colchicine (low dose)
Xanthine oxidase inhibitor (first line)
Uricoseuric agents (add on)
recombinant urate oxidase

127
Q

When should NSAIDs be taken for Gout?

A

Around the clock-NOT PRN

128
Q

What is a common analgesic agent for gout?

A

celecoxib (Celebrex)

129
Q

What mediation is used for acute attacks (flares), max is 3 tabs in an hour, 75-95% of patients respond

A

colchicine

130
Q

What percentage of people taking colchicine experience GI side effects(diarrhea) before relief of gout?

A

50-80%

131
Q

How is colchicine prescribed prophylactic ?

A

0.6 mg QD or BID

stop when symptom free for 1 year

132
Q

When are corticosteroids used for gout?

A

reserved for patients with contraindications to NSAIDs or colchicine

133
Q

How are the corticosteroids given for gout?

A

oral
IM
intraarticular injection

134
Q

What is the adult doing for allopurinol with mild gout?

A

200-300mg po daily

135
Q

What is the adult dose for moderate- severe gout for allopurinol?

A

400-600mg po daily

136
Q

When do you increase the dose of allopurinol

A

increase over 3-4 weeks

137
Q

When do you decrease dose of allopurinol?

A

with increased age or decreased renal function

138
Q

What is an adverse effect of allopurinol?

A

agranulocytosis <1%

139
Q

Why is allopurinol given with colchicine prophylaxis?

A

may predicate gout

140
Q

what mediation has no advantage over allopurinol but is more expensive. May predicate gout with initial use

A

Febuxostat (Uloric)

141
Q

what agents promote urinary UA elimination inhibiting UA resorption?

A

uricosuric agents for gout

142
Q

What are the uricosuric agents? (2)

A

probenecid

sulfinpyrazone

143
Q

what is the first in new class-urate oxidase (uricase) enzymes?

A

pegloticase (krystexxa)

144
Q

What medication is a pegylated recombinant (procine) enzyme?

A

pegloticase (krystexxa)

145
Q

What medication may produce anaphylaxis (<7%) and is suggesting to premeditate with antihistamine AND steroids?

A

pegloticase (krystexxa)

146
Q

What medication is used ONLY for severe gout refractory to or intolerant of approximately dosed oral ULT?

A

pegloticase (krystexxa)

Anatomy (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions