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MSK Pharmacology Flashcards

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1
Q

Inhibitor of dihydrofolate reductase

A

Methotrexate

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2
Q

Methotrexate inhibits this

A

Dihydrofolate reductase

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3
Q

This drug is slow in onset of benefit (>6 weeks) but can be very effective for a long time

A

Methotrexate

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4
Q

Most commonly used DMARD, alone or in combination with biologics

A

Methotrexate

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5
Q

Methotrexate has bone marrow toxicity when coadministered with these

A

NSAIDs

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6
Q

Methotrexate is contraindicated in these 2 circumstances

A

Pregnancy and Renal failure

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7
Q

Methotrexate has drug interactions with these

A

Protein binding drugs

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8
Q

This DMARD has interactions with protein binding drugs

A

Methotrexate

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9
Q

This DMARD has bone marrow toxicity when coadministered with NSAIDs

A

Methotrexate

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10
Q

Drug that blocks pyrimidine synthesis by inhibiting dihydroorotate dehydrogenase

A

Leflunomide

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11
Q

Leflunomide blocks this by inhibiting dihydroorotate dehydrogenase

A

Pyrimidine synthesis

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12
Q

Leflunomide blocks pyrimidine synthesis by inhibiting this

A

Dihydroorotate dehydrogenase

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13
Q

Leflunomide has this black box warning

A

Hepatotoxicity

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14
Q

Leflunomide is contraindicated in this

A

Prengnancy (teratogenicity)

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15
Q

These two DMARDs together are super additive in benefit and toxicity (especially hepatotoxicity)

A

Methotrexate and Leflunomide

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16
Q

This may bind DNA and disrupt rheumatoid factor synthesis

A

Hydroxychloroquine

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17
Q

2 non-biologic DMARDs that can cause hemolysis in patients with deficiency in glucose-6-phosphate dehydrogenase

A

Hydroxychloroquine and Sulfasalazine

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18
Q

Hydroxychloroquine may bind DNA and disrupt synthesis of this

A

Rheumatoid factor

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19
Q

DMARD with unclear mechanism in Rheumatoid Arthritis, and hemolysis in patients with G6PD deficiency

A

Sulfasalazine

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20
Q

3 TNF inhibitors

A

Etanercept
Infliximab
Adalimumab

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21
Q

Recombinant human TNF receptor 2/IgG1 fusion protein (non-functional receptor fragment), acts as decoy receptor, captures TNF to block inflammation and decrease cytokine release

A

Etanercept

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22
Q

Biologic DMARD that acts as decoy receptor, captures TNF to block inflammation and decrease cytokine release

A

Etanercept

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23
Q

What is Etanercept?

A

Recombinant human TNF receptor 2/IgG1 fusion protein
Acts as a decoy receptor to capture TNF

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24
Q

Etanercept has increased risk of these 2 things

A

Malignancy and infections

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25
DMARD that targets TNF alpha, suppresses cytokine synthesis and release
Infliximab
26
Drug with increased risk of infections and TB reactivation Increased risk of lymphoma in children/adolescents
Infliximab
27
Infliximab has increased risk of infections, specifically reactivation of this
TB
28
Infliximab has increased risk of this in children/adolescents
Lymphoma
29
Recombinant human monoclonal antibody for TNF alpha, blocks interaction with receptor
Adalimumab
30
Oral Janus Kinase inhibitor (competitive) Blocks intracellular Janus Kinase (JAK1 & JAK3) signal to disrupt activation of immune system
Tofacitinib
31
What does Tofacitinib do?
Blocks intracellular JAK signal to disrupt activation of immune system (competitive oral janus kinase inhibitor)
32
Rheumatoid arthritis treatment usually begins with this monotherapy
Methotrexate
33
First line treatment for osteoarthritis
Acetaminophen
34
Treatment for moderate to severe osteoarthritis
NSAIDs, approved topical diclofenac gel available
35
These injections provide short-term (4-8 weeks) releif for osteoarthritis
Intra-articular glucocorticoid
36
Procedure that may be done to treat osteoarthritis
Autologous chondrocyte implantation
37
Autologous chondrocyte implantation can be therapy for this condition
Osteoarthritis
38
This is the end product of purine degradation in humans
Urate
39
Urate is the end product of this process in humans
Purine degradation
40
Tumor lysis syndrome/chemo-induced cell death can cause gout through this
Overproduction of uric acid
41
Is Colchicine used for acute or long-term gouty arthritis?
Acute
42
Are non-steroidal anti-inflammatory drugs used for acute or long-term gouty arthritis?
Acute
43
Are glucocorticoids used for acute or long-term gouty arthritis?
Acute
44
How is acute gouty arthritis treated?
Termination of inflammatory process (colchicine, NSAID, glucocorticoids)
45
Is allopurinol and febuxostat used for acute or long-term gouty arthritis?
Long-term Inhibit uric acid synthesis
46
Is probenecid and sulfinpyrazone used for acute or long-term gouty arthritis?
Long-term Increase excretion
47
How is long-term gouty arthritis treated?
By decreasing uric acid production or increasing excretion
48
2 xanthine oxidase inhibitors
Allopurinol and Febuxostat
49
2 uricosuric agents
Probenecid and Lesinurad
50
Serum uric acid reduction may mobilize urate from tissue deposits, causing this
ULT-induced gouty flare (urate lowering therapy)
51
Drug that binds tubulin, disrupts leukocyte recruitment to affected joints and inhibits leukotriene synthesis/release
Colchicine
52
Colchicine binds this, as it is an antimitotic
Tubulin
53
Colchicine disrupts recruitment of this to affected joints
Leukocytes
54
Colchicine inhibits synthesis/release of this
Leukotriene
55
Risk of bone marrow toxicity often limits therapy of acute attack with this drug to 7 days or less
Colchicine
56
Treatment for gout that may cause severe diarrhea and bone marrow toxicity
Colchicine
57
Allopurinol and Febuxostat inhibit this
Xanthine oxidase
58
Drugs that are indicated for multiple acute gout attacks per year, and tophi or chronic arthritis on exam
Allopurinol and Febuxostat
59
Allele that is strongly associated with Allopurinol hypersensitivity
HLA-B*5801
60
HLA-B*5801 allele is strongly associated with hypersensitivity to this
Allopurinol
61
Allopurinol should not be used with either of these 2 drugs, which are metabolized by xanthine oxidase
Mercaptopurine or azathioprine
62
Mercaptopurine and azathioprine should not be used with this drug
Allopurinol
63
Why should mercaptopurine and azathioprine not be used with allopurinol?
Both are metabolized by xanthine oxidase, which allopurinol inhibits Dose should be reduced to 1/4 normal dose when combined with allopurinol
64
Drug that should not be given with allopurinol, because allopurinol inhibits CYP1A2
Theophylline
65
Theophylline is metabolized by this, which allopurinol inhibits
CYP1A2
66
Allopurinol inhibits CYP1A2, blocking metabolism of this
Theophylline
67
Probenecid and Sulfinpyrazone block this
Urate reabsorption
68
Two drugs that block urate reabsorption
Probenecid and Sulfinpyrazone
69
Drug that blocks urate reabsorption and impacts PK of some drugs
Probenecid
70
Common adverse effects of this drug include gouty arthritis and stone formation
Probenecid
71
An adverse effect of Probenecid is formation of this
Stone
72
An adverse effect of Probenecid is that it can induce this
Gouty arthritis
73
Severe adverse effects of this drug include bone marrow depression and hypersensitivity
Probenecid
74
Probenecid is contraindicated in cases of this
Renal impairment/calculi
75
Probenecid interacts with this type of drug
Anti-uricosuric drugs (salicylates, diclofenac, pyrazinamide)
76
Probenecid increases serum levels of this drug
Methotrexate
77
Drug that increases serum methotrexate
Probenecid
78
Drug that interacts with anti-uricosuric drugs (salicylates, diclofenac, pyrazinamide, et al)
Probenecid
79
Drug for gout that has a high risk of anaphylaxis (clinical setting - given only after premedication with antihistamines and corticosteroids)
Pegloticase
80
Black box warning of Pegloticase
High risk of anaphylaxis
81
Colchicine is used to treat this condition
Gout

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