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7262 MS Block 1 > Drugs > Flashcards

Drugs Flashcards

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1
Q

nsaids should not be used as monotherapy for RA.

a. true
b. false

A

a. true

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2
Q

How are corticosteroids used for RA?

A

NOT used as monotherapy, but used as bridge therapy

can be given intra-articularly

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3
Q

How often is MTX given for RA?

A

once WEEKLY

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4
Q

What is the DMARD of choice for initial RA therapy?

A

MTX

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5
Q

What should MTX be premedicated with?

A

folic acid

5mg/week

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6
Q

The synthetic DMARD for FA leflunomide is NOT recommended if ALT is > ___ ULN.

A

2

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7
Q

What is used for elimination of leflunomide?

A

cholestyramine

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8
Q

What is the half life of teriflunomide?

A

14-18 days

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9
Q

Is vaccination with live vaccines recommended with leflunomide?

A

no

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10
Q

How long is contraception needed after d/c of leflunomide?

A

3 months

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11
Q

When can the synthetic RA DMARD hydroxychloroquine be used as monotherapy?

A

mild RA where MTX is contraindicated

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12
Q

Does hydroxychloroquine need hepatic/renal dose adjustment?

A

no

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13
Q

What synthetic RA DMARD can cause retinal/visual changes?

A

hydroxychloroquine

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14
Q

What time period of use/dose of hydroxychloroquine can cause disorder for the cornea?

A

use > 5 years or daily dose > 5mg/kg/day ABW or 400mg

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15
Q

What kind of drug is sulfasalazine?

A

synthetic DMARD

prodrug

used for RA

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16
Q

The synthetic DMARD sulfasalazine should not be used in pts with what allergies?

A

sulfa

salicylate

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17
Q

What should sulfasalazine be premedicated with/

A

antihistamine or steroids

to prevent serum sickness

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18
Q

What two things can decrease absorption of sulfasalazine?

A

antibiotics

iron

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19
Q

What synthetic DMARD can cause yellow to orange urine/skin discoloration?

A

sulfasalazine

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20
Q

What is drug class of tofacitinib, barcitinib, upadacitinib?

A

JAK inhibitors

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21
Q

The RA JAK inhibitor tofacitinib dose should be reduced to __mg daily (IR) in moderate to severe renal impairment and moderate hepatic impairment.

A

5

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22
Q

The RA JAK inhibitor tofacitinib should be avoided in pts with counts less than?

lymphocyte < __?
ANC < __?
Hgb < __?

A

lymphocyte: 500
ANC: 1000
Hgb: 9

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23
Q

How should the RA JAK inhibitor barcitinib be dose adjusted in pts with GFR 30-60?

A

1mg once daily

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24
Q

The RA JAKL inhibitor barcitinib should not be used in pts with eGFR < __

A

30

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25
The RA JAK inhibitors barcitinib and upadacitinib should not be used if lymphocytes < __? ANC < __? Hgb < __?
500, 1000, 8 tofacitinib is same except Hgb < 9 instead of 8
26
Which two RA JAK inhibitors should not be used with biologic DMARDS or strong immunosuppressants?
barcitinib | upacitinib
27
What is dose for RA JAK inhibitor upadacitinib?
15mg PO once daily
28
Which RA JAK inhibitor can be given as monotherapy or in combo with MTX or other non-biologic DMARDS?
upadacitinib
29
What drug class is adalimumab?
TNF alpha inhibitor
30
What drug class is etanercept (Enbrel)?
TNF alpha inhibitor
31
What drug class is infliximab (Remicade)?
TNF alpha inhibitor
32
What drug class is golimumab (Simponi)?
TNF alpha inhibitor
33
Doses of infliximab > ___ mg should not be give n in CHF or to pts with hypersensitivity to murine proteins.
5
34
Which two TNF alpha inhibitors for RA must be taken in combo with MTX?
infliximab | golimumab
35
What might infliximab be premedicated with?
diphenhydramine acetaminophen to prevent infusion rxn
36
What is abatacept (for RA) MOA?
CD80/CD86
37
How is the RA drug abatacept given?
IV infusion based on pt weight
38
What drug class is certolizumab?
TNF alpha inhibitor
39
What drug class should the RA drug abatacept NOT be given with?
TNF alpha inhibitors
40
What screening is done at baseline for the RA drug abatacept?
TB | Hep B
41
What is the RA drug rituximab MOA?
chimeric antibody to CD20
42
What is the RA drug rituximab given in combo with?
MTX premedicate with diphenhydramine, glucocorticoid, acetaminophen to prevent infusion rxns
43
What screening is done for the RA drug rituximab?
TB | Hep B
44
What is the MOA of the RA drug tocilizumab?
humanized antibody that inhibits IL-6
45
Which RA drug is a CYP3A4 inducer, and should NOT be given in combo with biologic DMARDS?
tocilizumab NABs can develop
46
Does tociluzmab have hepatic dose adjustments?
yes
47
Do not give the RA drug tociluzumab if ANC < __? platelets < __? ALT/AST > __ x ULN?
2000, 100,000, 1.5
48
The RA drug tociluzimab can cause elevated ___
lipids transaminitis
49
What screening is done for RA drug tociluzumab?
TB
50
NSAIDS should be given within at least ___ hours for acute gout attack?
24
51
What nsaid should not be given if allergy to sulfa?
celecoxib
52
nsaids should be use with caution with ___ impairment and the ___ trimester of pregnancy
renal, third
53
What is colchicine MOA?
prevents migration of neutrophils
54
What is max dose of colchicine for acute gout?
1.8mg daily
55
What is max dose of colchicine for gout prophylaxis?
1.2mg daily
56
Which gout med is contraindicated with concomitant use of P-gp or 3A4 inhibitors in the presence of hepatic/renal impairment?
colchicine
57
What is main AE of colchicine?
diarrhea
58
Can corticosteroids for acute gout be given with live or live attenuated vaccines?
no
59
What is MOA of gout drug allopurinol?
xanthine oxidase inhibitor
60
What is the max dose of allopurinol for chronic gout management?s
800mg/day
61
What is starting dose of allopurinol for pts with stage 4 or 5 CKD?
50mg daily
62
Which chronic gout management drug is contraindicated with HLAB*5801 allele?
allopurinol severe cutaneous rxn
63
Which xanthine oxidase inhibitor can cause maculopapular eruption, DRESS, SJS, and TENS?
allopurinol
64
What is allopurinol dose for pts with stage 3 or higher CKD?
100mg per day
65
What is the MOA of febuxostat (Uloric)?
xanthine oxidase inhibitor
66
What is the dose of the chronic gout drug febuxostat if CrCl < 30?
40mg daily
67
Should xanthine oxidase inhibitors (allopurinol, febuxostat) be d/c during gout attack?
no
68
Which chronic gout med has FDA warning of increased death in pts with cardiovascular disease?
febuxostat xanthine oxidase inhibitor
69
Febuxostat should only be prescribed if pts have contraindications, treatment failure, or intolerance to allopurinol. a. true b. false
a. true
70
What is main AE of febuxostat?
transaminitis
71
What is the MOA of the chronic gout drug lesinurat?
Inhibits renal apical transporters (URAT1 and OAT4)
72
The chronic gout drug lesinurad (URAT1/OAT4 inhibitor) should be taken in combo with what?
a xanthine oxidase inhibitor
73
Lesinurad is not recommended imp ts taking allopurinol doses < ___mg daily or < __ mg daily if CrCl is less than 60.
300, 200
74
If treatment with xanthine oxidase inhibitor is interrupted lesinurad should be continued. a. true b. false
b. false should also be witheld
75
2 main AEs of lesinurad?
nephrolithiasis | renal failure
76
What is pegloticase MOA?
pegylated recombinant uricase chronic gout management
77
When is pegloticase (Krystexxa) contraindicated?
G6PD deficiency risk of hemolysis
78
What is the MOA of probenecid?
uricosuric agent
79
What is the max dose of probenecid?
2000mg/day
80
Should probenecid be initiated during an acute gout attack?
no
81
Probenecid is contraindicated with concomitant use of what drug class?
salicylates
82
What is main AE of probenecid?
urolithiasis
83
2 main AEs of the chronic gout drug pegloticase?
antibody development | infusion reaction
84
Which gout drug is used refractory to XOI or uricosuric agents?
pegloticase
85
2 IL-1 inhibitors for gout?
anakinra canakinumab can be considered in refractory cases
86
which antihypertensive is the drug of choice for gout?
losartan

7262 MS Block 1 (11 decks)

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