MSK Drugs (Not including anti-inflammatories)

Question 1

Name the bisphosphonates

Answer 1

alendronate, other “-dronates”

Question 2

Mechanism of bisphosphonates

Answer 2

pyrophosphate analogs

bind hydroxyapatite in bone, inhibiting osteoclast activity

Question 3

Use of bisphosphonates

Answer 3

osteoporosis
hypercalcemia
Paget disease of bone

Question 4

Toxicity of bisphosphonates

Answer 4

corrosive esophagitis (pts advised to take with water and remain upright for 30 minutes)
osteonecrosis of jaw

Question 5

Mechanism of teriparatide

Answer 5

recombinant PTH analog given subcutaneously daily –> increased osteoblastic activity

Question 6

Use of teriparatide

Answer 6

osteoporosis

causes increased bone growth compared to antiresportive therapies (bisphosphonates)

Question 7

Toxicity of teriparatide

Answer 7

transient hypercalcemia

may increase risk of osteosarcoma

Question 8

Name the acute gout drugs

Answer 8

NSAIDs (naproxen, indomethacin)
Glucocorticoids (oral and intra-articular)
Colchicine

Question 9

Mechanism of colchicine

Answer 9

binds and stabilizes tubulin to inhibit MT polymerization, impairing neutrophil chemotaxis and degranulation

Question 10

Use of colchicine

Answer 10

acute and prophylactic value for gout

Question 11

Toxicity of colchicine

Answer 11

GI side effects

Question 12

Why not give salicylates in gout?

Answer 12

all doses but the HIGHEST dose depress uric acid clearance

even highest doses have only minor uricosuric activity

Question 13

Name the chronic gout drugs (preventative

Answer 13

allopurinol, febuxostat, pegloticase, probenecid

Question 14

Mechanism of allopurinol

Answer 14

inhibits xanthine oxidase after being converted to alloxanthine
decreases conversion of xanthine to uric acid

Question 15

Use of allopurinol

Answer 15

gout prevention/chronic tx

Question 16

Use of allopurinol in leukemia and lymphoma

Answer 16

to prevent tumor lysis-associated urate nephropathy

Question 17

Mechanism of febuxostat

Answer 17

inhibits xanthine oxidase

Question 18

Name the two antimetabolite drugs that need to be careful of dosing when using allopurinol/febuxostat

Answer 18

azathioprine and 6-mercaptopurine (6-MP)

because normally metabolized by xanthine oxidase

Question 19

Mechanism of pegloticase

Answer 19

recombinant uricase that catalyzes metabolism of uric acid to allantoin (more water soluble product)

Question 20

Mechanism of probenecid

Answer 20

inhibits reabsorption of uric acid in proximal convoluted tubule (also inhibits secretion of penicillin)
can precipitate uric acid calculi
NEED TO HAVE PRISTINE KIDNEYS TO USE

Question 21

What do need to check before starting TNF-alpha inhibitor?

Answer 21

TB status because using TNF-alpha inhibitors could predispose to infection by reactivating latent TB

TNF-alpha is important in granuloma formation and stabilization

Question 22

Mechanism of etanercept

Answer 22

fusion protein (receptor for TNF-alpha and IgG1 Fc receptor), produced by recombinant DNA

Question 23

Use of etanercept

Answer 23

RA
psoriasis
ankylosing spondylitis

Question 24

Mechanism of infliximab/adalimumab

Answer 24

anti-TNF-alpha monoclonal antibodies

Question 25

Use of infliximab/adalimumab

Answer 25

IBD
RA
ankylosing spondylitis
psoriasis