MSK and Skin Drugs

Question 1

NSAID that increases uric acid excretion in urine?

Answer 1

Oxaprozin (don’t give to someone with urate stones obviously)

Question 2

MOA of Colchicine?

Answer 2

Inhibits tubulin polymerization

Question 3

5 drugs that inhibit microtubule construction? (not for this test)

Answer 3

Mebendazole (anti-helminthic), Griseofulvin (antifungal), Colchicine, Vinblastin/vincristin, Paclitaxol– Microtubules get constructed very poorly

Question 4

Toxicity of colchicine? 4

Answer 4

Bloody diarrhea, burning throat pain, hematuria, shock

Question 5

Pt presents with bloody diarrhea after starting a medication for a pain in his big toe– med? MOA?

Answer 5

Colchicine

Blocks polymerization of microtubules

Question 6

2 Xanthine oxidase inhibitors?

Answer 6

Allopurinol and Febuxostat

Question 7

MOA of allopurinol?

Answer 7

Purine analog that acts as a suicide inhibitor of xanthine oxidase

Question 8

MOA of Febuxostat?

Answer 8

Non purine irreversible inhibitor of xanthine oxidase

Question 9

When are xanthine oxidase inhibitors used?

Answer 9

Intercritical period

Question 10

Side effects of allopurinol or febuxostat?

Answer 10

May have acute gouty attacks when first started on medication. Put pt on NSAID or colchicine, as well

Question 11

2 drugs normally metabolized by xanthine oxidase?

Answer 11

6MP and Azothiprine (will lead to increased concentration of these two drugs, as they cannot be metabolized)

Question 12

Pt on gout medication presents with necrosis, sloughing of skin, and high fever. Drug? What is this called?

Answer 12

Allopurinol; Steven Johnson syndrome–toxic epidermal necrolysis

Question 13

2 drugs that increase secretion and decrease reabsorption of uric acid?

Answer 13

Sulfinpyrazone and Probenecid

Question 14

MOA of Probenecid and Sulfinpyrazone?

Answer 14

Act on anion transporter in proximal convoluted tubule to increase secretion and decrease reabsorption of uric acid

Question 15

Drug that inhibits urate transporter?

Answer 15

Aspirin (should not be used with sulfinpyrazone or probenecid)

Question 16

Adverse effects of Sulfinpyrazone and Probenecid?

Answer 16

Rash and GI disturbances (take both drugs with food); increased risk for kidney stones– stay hydrated and keep urine pH above 6

Question 17

What two measures should be taken by people using drugs that act on anion transporters in the proximal convoluted tubule to increase uric acid excretion? What are the two drugs?

Answer 17

Sulfinpyrazone and Probenecid

Keep patients hydrated and make sure urine pH does not fall below 6

Question 18

Pegloticase MOA?

Answer 18

Pegylated uricase that converts uric acid into allantoin via oxidation

Question 19

Uricase that lowers serum uric acid?

Answer 19

Pegloticase– converts uric acid to allantoin

Question 20

Selective COX 2 inhibitor

Answer 20

Meloxicam

Question 21

Nabumetone?

Answer 21

Prodrug, Cox 2 inhibitor

Question 22

NSAIDs on platelets?

Answer 22

Acetylation of Cox1 results in inactivation of the enzyme for the lifetime of the platelet

Question 23

Inhibits Cox irreversibly?

Answer 23

Aspirin

Question 24

What drug should not be given with allopurinol?

Answer 24

Salicylates (all but highest doses suppress uric acid excretion)

Question 25

Side effects of salicylates?

Answer 25

CNS depression, tinnitus, headache, thirst, sweat

Question 26

Side effect of acetaminophen?

Answer 26

Hepatotoxicity due to depletion of glutathione stores

Question 27

Drug for acetaminophen overdose?

Answer 27

N- acetylcysteine

Question 28

Antiinflammatory mechanism of NSAIDs is mediated through?

Answer 28

Inhibition of Cox 2

Question 29

Anti analgesic mechanism of NSAIDs is mediated through?

Answer 29

Inhibition of prostoglandin synthesis

Question 30

Anti pyretic mechanism of NSAIDs is mediated via?

Answer 30

PGE2

Question 31

Inhibition of this leads to GI ulcerations?

Answer 31

Cox 1

Question 32

Inhibition of which cox would lead to prolonged bleeding time?

Answer 32

Cox 1

Question 33

Targets DHFR?

Answer 33

Methotrexate-- supplement with folic acid

Question 34

Inhibits pyrimidine synthesis and therefore cell cycle arrest of lymphocytes?

Answer 34

Leflunomide

Question 35

Leflunomide: MOA?

Answer 35

Inhibits pyrimidine synthesis and therefore cell cycle arrest of lymphocytes

Question 36

Side effect of leflunomide?

Answer 36

TERATOGENIC-- must be stopped within two years of pregnancy

Question 37

Why is sulfasalazine used in RA?

Answer 37

Sulfapyridine is thought to be active in RA

Question 38

IgA and IgM rheumatoid factor decreases with this drug?

Answer 38

Sulfasalazine

Question 39

Anti rheumatic drug that causes peripheral neuropathy?

Answer 39

Hydroxychlorquine

Question 40

When are glucocorticoids indicated for RA?

Answer 40

Flares

Question 41

MOA of etanercept?

Answer 41

Binds TNF alpha with high affinity and neutralizes its effects i.e. a decoy receptor

Question 42

Anakinra: MOA?

Answer 42

blocks cellular effects of IL-1

Question 43

Abatacept: MOA?

Answer 43

CTLA 4 Ig

Question 44

Drugs that may cause reactivation of TB?

Answer 44

TNF alpha blockers

Question 45

Cox 2 inhibitor? Why use Cox 2?

Answer 45

Celecoxib-- spares GI mucosa; although may lead to thrombosis and can't be used if one has sulfa allergy

Question 46

Corticosteroids block production of?

Answer 46

Arachidonic acid (block leukotriene and prostaglandins) by blocking phosphlipase 2

Question 47

NSAIDs and ASA act on?

Answer 47

Prostaglandins (not leukotrienes)

Question 48

Diclofenac?

Answer 48

NSAID

Question 49

Ketorolac?

Answer 49

NSAID

Question 50

3 Cox 2 selective inhibitors?

Answer 50

Meloxicam; nabumetone; celecoxib (only one you need to know for boards)

Question 51

Alendronate?

Answer 51

Bisphosphonate

Question 52

Nitrogen containing bisphosphonates block?

Answer 52

Farnesyl pyrophosphate synthase

Question 53

side effect of bisphosphonates?

Answer 53

Results in soft bone; corrosive esophagitis; osteonecrosis of jaw

Question 54

Patient with pagets presents with severe pain in throat?

Answer 54

Bisphosphonates cause corrosive esophagitis

Question 55

Worsens postmenopausal symptoms?

Answer 55

Calcitonin

Question 56

Monoclonal antibody against RANKL?

Answer 56

Denosumab

Question 57

Denosumab?

Answer 57

Antibody against RANKL (mimics osteoprotegrin-- prevents osteoclast maturation)

Question 58

SERM used for osteoporosis?

Answer 58

Raloxifen-- increases risk for venous thrombosis

Question 59

Osteoporosis drug that increases risk for venous thrombosis?

Answer 59

Raloxifen