NSAIDS, DMARDS, Non-opioid Analgesics Flashcards
Which of the following is not used to treat inter-critical gouty arthritis?
A. Uricase
B. Probenecid
C. Allopurinol
D. Colchicine
E. Sulfinpyrazone
D. Colchicine is used as first-line drug for ACUTE gouty attack
For inter0critical gouty arthritis, we provide Urate lowering therapy via:
- Xanthine Oxidase inhibitors (Purine analogues such as allopurinol, oxypurinol, and tisopurine. Others include febuxostat, topiroxostat, and inositols (phytic acid and myo-inositol)
- Uricosurics (Probenecid, Sulfinpyrazone and Lesinurad)
- Uricase (Pegloticase and Rasburicase)
The only non-acid NSAID current in use
Nabumetone
- ketone prodrug
- Nabumetone itself is non-acidic and, following absorption, it undergoes extensive first-pass metabolism to form the main circulating active metabolite (6-MNA) which is a much more potent inhibitor of preferentially cyclo-oxygenase (COX)-2.
Which of the following is not true of NSAIDs?
A. They are well absorbed, and food does not substantially change their bioavailability
B. They are highly metabolized
C. Their metabolism proceeds, in large part, by way of the CYP3A or CYP1A families of P450 enzymes in the liver
D. Renal excretion is the most important route of final elimination
E. Most are highly protein-bound (~98%), usually to albumin
C. CYP3A and CYP2C
Which products of the LOX and COX pathway result to the alteration of vascular permeability, bronchial constriction, and increased secretion?
Leukotrienes (LOX: LTC4, LTD4, LTE4)
Prostaglandin and Thromboxane (COX)
- hence, causing bronchospasm, congestion, mucous plugging
Which anti-gout agent is used to treat inflammation induced by phagocyte attraction and activation by LTB4?
Colchicine
Which group of NSAIDs do not inhibit platelet aggregation?
Cox-2 selective inhibitors and Non-acetylated salicylates
COX-2-selective inhibitors have increased incidence of the following, EXCEPT:
A. Edema
B. GI ulcers
C. Hypertension
D. MI
B. low effect on GI
DOC NSAIDs for patients with renal insufficiency
Non-acetylated salicylates
Which of the following is NOT an adverse effect of NSAIDs?
A. Aseptic meningitis
B. Dyspepsia
C. Neutropenia
D. Pruritus
E. Hypokalemia
E should be Hyperkalemia due to renal insufficiency
This is responsible for the anti-inflammatory action of aspirin
Salicylic acid
Which of the following is the effect of aspirin at lower dose (80mg)?
A. Anti-pyretic
B. Anti-platelet
C. Anti-inflammatory
D. Analgesic
B. Anti-platelet at 80mg, Anti-inflammatory at 325mg (higher dose)
Which of the following is NOT true of aspirin?
A. Rapidly hydrolyzed (serum half-life 15 minutes) to acetic acid and salicylate
B. Irreversibly inhibits platelet COX so that aspirin’s antiplatelet effect lasts 8–10 days
C. Long-term use is associated with higher incidence of colon cancer
D. May be valuable in treating preeclampsia-eclampsia
C.
long-term use of aspirin at low dosage is associated with a lower incidence of colon cancer
Which of the following is NOT true of aspirin?
A. Rapidly hydrolyzed (serum half-life 15 minutes) to acetic acid and salicylate
B. Irreversibly inhibits platelet COX so that aspirin’s antiplatelet effect lasts 8–10 days
C. Long-term use is associated with higher incidence of colon cancer
D. May be valuable in treating preeclampsia-eclampsia
C.
long-term use of aspirin at low dosage is associated with a lower incidence of colon cancer
Which of the following is NOT true of aspirin?
A. Rapidly hydrolyzed (serum half-life 15 minutes) to acetic acid and salicylate
B. Irreversibly inhibits platelet COX so that aspirin’s antiplatelet effect lasts 8–10 days
C. Long-term use is associated with higher incidence of colon cancer
D. May be valuable in treating preeclampsia-eclampsia
C.
long-term use of aspirin at low dosage is associated with a lower incidence of colon cancer
What are the main adverse effects of aspirin at anti-thrombotic doses?
Gastric upset (intolerance) and Gastric bleeding
Which of the following is not true of Non-acetylated Salicylates?
A. All nonacetylated salicylates are effective anti-inflammatory drugs
B. They inhibit platelet aggregation
C. They may be preferable when COX inhibition is undesirable such as in patients with asthma and/or renal insufficiencies
D. They are administered in doses up to 3–4 g per day
B. DO NOT inhibit platelet aggregation (may be used in patients with bleeding tendencies)
Aspirin should not be used in children and adolescents for viral infections (with or without fever) because of an increased risk of ___________, a rare and potentially fatal pediatric illness defined as acute noninflammatory encephalopathy with fatty liver failure.
Reye’s syndrome
Which arachidonic acid isozyme is inducible by cytokines and Growth factors for the pathologic prostaglandin production?
COX-2
Which of the following is FALSE of COX-2 isozyme?
A. Has profound impact on platelet aggregation
B. Its selective inhibitors inhibit prostacyclin synthesis in the vascular endothelium
C. Inhibitors of it do not offer cardioprotective effect
D. Causes inflammation, pain, and fever
A. NO impact on platelets
Which Selective COX-2 inhibitor can cause rashes brought by its sulfonamide ring?
Celecoxib
Celecoxib interacts occasionally with which anticoagulant?
Warfarin since they are metabolized via CYP2C9
Which of the following is NOT true of Meloxicam?
A. Given to patients with SEVERE pain
B. Inhibit synthesis of TXA2 at supratherapeutic doses
C. It is an enol carboxamide related to piroxicam
D. Only preferentially selective
E. Associated with fewer GI sx compared to piroxicam
A. Mild to moderate pain only
Which Selective COX-2 inhibitors are associated with increased cardiovascular thrombotic events?
Valdecoxib and Rofecoxib
This Selective COX-2 inhibitor is used to relieve moderate post-surgical dental pain, but should only be used for a maximum of 8 days for treatment of inflammatory and painful symptoms
Etoricoxib (Arcoxia)
This is the first parenteral COX-2 selective inhibitor to be developed for the management of pain, is a prodrug that is rapidly hydrolyzed in vivo to its active form, valdecoxib, which is approximately 28,000-fold more potent against COX-2 than COX-1.
Parecoxib
Which of the following is not a Non-selective NSAID?
A. Diclofenac
B. Nimesulide
C. Diflunisal
D. Etodolac
E. Flurbiprofen
A. Nimesulide is a relatively selective COX-2 inhibitor
Which of the following is FALSE of Diclofenac?
A. Results to less GI ulceration
B. A phenylacetic acid derivative that is relatively
nonselective as a COX inhibitor
C. Combination with Misoprostol may result in Constipation
D. Elevation of serum aminotransferases
occurs more commonly with this drug than with
other NSAIDs
E. Used for prevention of postoperative ophthalmic inflammation, and solar keratosis
C. should be diarrhea
if with Omeprazole = Renal adverse effect
Which of the following is FALSE of Diflunisal?
A. Derived from Salicylic Acid but not metabolized to salicylic acid or salicylate
B. It has anti-pyretic effect
C. It is subject to capacity-limited metabolism
D. It undergoes an enterohepatic cycle with reabsorption of its glucuronide metabolite followed by cleavage of the glucuronide to again release the active moiety.
E. Does not cross the BBB
B. Largely devoid of antipyretic effects
Non-selective NSAIS that is a racemic acetic acid derivative with an intermediate half-life of 6.5 hours
Etodolac
What is the recommended dose of Etodolac in OA and RA?
300 mg twice or three times a day up to 500 mg twice a day initially followed by a maintenance of 600 mg/d
Which of the following is not a propionic acid derivative NSAID?
A. Flurbiprofen
B. Ibuprofen
C. Ketoprofen
D. Naproxen
E. Ketorolac
E. Ketorolac is a synthetic pyrrolizine carboxylic acid derivative with anti-inflammatory, analgesic, and antipyretic activities.
NSAID available in a topical ophthalmic formulation for inhibition of intraoperative miosis
Flurbiprofen
NSAID available intravenously, effective for perioperative analgesia in minor ear, neck, and nose surgery, and in lozenge form for sore throat.
Flurbiprofen
Which of the following is not true of Flurbiprofen?
A. Has been shown in rat tissue to also affect tumor necrosis factor α (TNF-α) and nitric oxide synthesis.
B. Rarely causes cogwheel rigidity, ataxia, tremor, and myoclonus
C. Hepatic metabolism is extensive
D. Its (R)(+) and (S)(–) enantiomers are metabolized differently, and it does not undergo chiral conversion
E. NOTA
E. NOTA
Which of the following is not true of Ibuprofen?
A. Oral doses of <1600 is given for anti-inflammation
B. In doses of about 2400 mg daily, ibuprofen is equivalent to 4 g of aspirin in anti-inflammatory effect
C. Ibuprofen oral and IV is effective in closing patent ductus arteriosus in preterm infants
D. In comparison with indomethacin, ibuprofen decreases urine output less and also causes less fluid retention
E. Antagonizes irreversible platelet inhibition induced by aspirin
A. Oral ibuprofen is often prescribed in lower doses (<1600 mg/d), at which it is analgesic but not anti inflammatory. It is available over the counter in low-dose forms.
Ibuprofen is relatively contraindicated in individuals with the following except:
A. Nasal polyps
B. Angioedema
C. Bronchospastic reactivity to aspirin
D. Dysmenorrhea
D. an indication
Ibuprofen in combination with __ may be an alternative to codeine-based analog
paracetamol
T/F: Common rare hematologic effects of ibuprofen include agranulocytosis and aplastic anemia.
T
A potent non-selective COX-2 inhibitor that can be given for gout and ankylosing spondylitis
Indomethacin
Epidural injections of Indomethacin produce a degree of pain relief similar to that achieved with ___________ in post-laminectomy syndrome.
methyl prednisolone
The GI adverse effect related to Indomethacin
Pancreatitis
This propionic acid derivative that inhibits both COX
(nonselectively) and lipoxygenase
Ketoprofen
T/F: Ketoprofen is superior to other NSAIDs in efficacy
F
This medication for arthritis prolongs the half-life of Indomethacin and Ketoprofen
Probenecid
The major adverse effects of Ketoprofen are on the:
GI tract and the central nervous system
This NS-NSAID decreases opioid requirement by 25-50%
*NS: Non-selective
Ketorolac
For seasonal allergic conjunctivitis
Ketorolac
Ketorolac is an effective analgesic and has been used successfully to replace ___________ in some situations involving mild to moderate postsurgical pain
morphine
Which patient below may take Dolfenal for pain relief?
A. Post-CABG patient
B. 5-year-old with Colles fracture
C. Breastfeeding mother
D. Patient under dialysis
E. 37-week pregnant patient
C. Mefenamic acid does not pass in the breast milk
Which NS-NSAID can only be given to patients aged 14 year old and above?
Mefenamic acid = MeFourteenamic acid
Renal impairment results in a doubling of this NSAID half-life and a 30% increase in the area under the curve.
Nabumetone
Pseudo porphyria and Photosensitivity as adverse effects
Nabumetone
Indicated for tumor fever
Naproxen
___ is a naphthylpropionic acid derivative. It is the only
NSAID presently marketed as a single enantiomer, its free fraction is significantly higher in women than in men, but half-life is similar in both sexes
Naproxen
Its adverse effects include rare cases of allergic pneumonitis, leukocytoclastic vasculitis, and pseudoporphyria
Naproxen
Drug combined with naproxen to reduce gastric acid production and protect the mucosal lining of the stomach
Esomeprazole
A propionic acid derivative NSAID that has a very long half-life (50–60 hours) but DOES NOT undergo enterohepatic circulation.
Oxaprozin
Non-selective NSAID with mild uricosuric effect
Oxaprozin
Which of the following does not describe peroxicam
A. It’s a nonselective COX inhibitor
B. At high concentrations, it inhibits polymorphonuclear leukocyte migration
C. Can decreases oxygen radical production, and inhibit lymphocyte function
D. Has long-half life
E. Do not cause peptic ulcer and bleeding even with high dose
E. When piroxicam is used in dosages higher than 20 mg/d, an increased incidence of peptic ulcer and bleeding (relative risk up to 9.5) is encountered
Which of the following is not an indication for Sulindac?
A. Rheumatic disease
B. Nephrotic syndrome
C. Familial intestinal Polyposis
D. Breast and prostate cancer prevention
B. Its an adverse effect
Which NS-NSAID is known to cause Stevens Johnson Epidermal Necrolysis Syndrome?
Sulindac
Which of the following is the side effect of Phenacetin?
A. Aplastic anemia
B. Agranulocytosis
C. Nephrotoxicity
D. Cardiovascular disease
C.
Phenacetin - nephrotoxic: papillary necrosis and acute tubular necrosis
Phenylbutazone - aplastic anemia and agranulocytosis
Rofecoxib and Valdecoxib - cardiovascular thrombotic
events
Which NSAID are ineffective for gout?
Aspirin, Salicylates, and Tolmetin
NSAIDs associated with the greatest toxicity
Indomethacin and Tolmetin
Least toxic NSAIDs
Ibuprofen, Salsalate, and Aspirin
Drugs associated with more liver function test abnormalities than other NSAIDs
Diclofenac and Sulindac
The safest NSAID for patients with high risk for GI bleeding
Celecoxib
T/F: Acetaminophen has significant anti-inflammatory effect
F
Although said to be equivalent to aspirin as an
analgesic and antipyretic agent, acetaminophen lacks antiinflammatory properties.
The highly reactive metabolite of acetaminophen (in large doses) that is toxic to both liver and kidney
N-acetyl-p-benzoquinone
T/F: Acetaminophen alone is adequate therapy for inflammatory conditions such as RA.
F: no significant anti-inflammatory effect
T/F: Unlike aspirin, acetaminophen does not antagonize the effects of uricosuric agents; hence, may be used concomitantly with PROBENECID
T
The preferred drug in patients allergic to aspirin, when salicylates are poorly tolerated. It is preferable to aspirin in patients with hemophilia, in those with a history of peptic ulcer, and in those in whom bronchospasm is precipitated by aspirin.
Acetaminophen
Hemolytic anemia and methemoglobinemia are very rare adverse events of these drugs
Acetaminophen
and
Sulfasalazine
Toxic dose of Acetaminophen
15 g
Death due to severe hepatotoxicity with centrilobular necrosis
Antidote for acetaminophen overdose
N-acetylcysteine (due to sulfhydryl groups)
Paracetamol + ___________ = Alaxan
Ibuprofen
Paracetamol + ___________ = analgesia, analgesic and anti-inflammatory
Tramadol
Paracetamol + ___________ = Neozep
Phenylephrine HCl + Chlorphenamine malate
Paracetamol + ___________ = Buscopan
Hyoscine butyl bromide
Paracetamol + ___________ = Dolo-Neurobion
Vit B complex
Paracetamol + ___________ = Norgesic Forte
Orphenadrine citrate
Legacy product biological DMARD
biological original or boDMARD
A targeted synthetic DMARD (tsDMARD) marketed as biologic
Tofacitinib
T-cell–modulating biologic DMARD for RA
Abatacept
B-cell cytotoxic agent bDMARD for RA
Rituximab
The anti–IL-6 receptor antibody bDMARD for RA
Tocilizumab (To-Six-lizumab)
Which of the following is not an IL-1–inhibiting bDMARD?
A. Anakinra
B. Canakinumab
C. Abatacept
D. Rilonacept
C. Abatacept is T-cell modulating bDMARD via its CTLA-4 ligand that binds to CD80/86 to block binding of CD28 of T-cells for their activation
T/F: Based on the MOI of Abatacept, it can cause URTI, UTI infusion0related anaphylaxis and increased incidence of lymphoma
TRUE: T-cell modulation
T/F: Live vaccines may be given 3 months after treatment with Abatacept
F
- stop abatacept administration for 3 months prior to administration of live vaccines
T/F: Abatacept was found to be better than placebo in preventing progression to defined RA in patients with undifferentiated inflammatory arthritis.
T
The rheumatic disease in which abatacept was found to have the most beneficial effects
Psoriatic Arthritis
All patients should be screened for latent tuberculosis and viral hepatitis before starting this bDMARD.
Abatacept
The major metabolite of Azathioprine
6-thioguanine
Which of the following is not a function of the major metabolite of Azathioprine?
A. suppresses inosinic acid synthesis
B. inhibit B-cell and T-cell function
C. decrease immunoglobulin production, and IL-2 secretion
D. suppress T-lymphocyte responses to mitogens
D. is specific for Chloroquine and Hydrochloroquine
csDMARD used in scleroderma
Azathioprine
Which of the following is not true of Azathioprine?
A. Maintenance of remission in Behcet’s disease
B. Used in scleroderma
C. May cause bone marrow suppression
D. May cause kidney transplant rejection
E. Shows efficacy for polymyositis and reactive arthritis
D. It’s indicated in prevention of kidney transplant rejection in combination with other immunosuppressants
csDMARDs that are deaminated in the liver and may cause ocular toxicity
Chloroquine and Hydrochloroquine
Which of the following is False of Chloroquine and Hydrochloroquine?
A. Safe in pregnancy
B. Very effective DMARDs
C. Used in Sjogren’s syndrome
D. Stabilize lysosomal enzymes
D. Trap free radicals
B. NOT
This csDMARD cross-links with DNA to prevent cell replication to suppress T- and B-cells
Cyclophosphamide
This csDMARD increase the effect of allopurinol
Cyclophosphamide
csDMARD that inhibits calcineurin
Cyclosporine
Which of the following is not true of cyclosporine?
A. Grapefruit juice decreases its bioavailability
B. Inhibits IL-1 an IL-2 receptor production
C. Affects T-cell dependent B-cell function
D. Cardiotoxic and may cause sterility and bladder CA
B. increases
csDMARD that retards the appearance of new bony erosions
Cyclosporine
Which of the following is not true of Leflunomide?
A. Undergoes rapid conversion, both in the intestine and in the plasma
B. Its metabolite inhibits dihydroorotate dehydrogenase
C. Arrests stimulated cells in the G2 phase of cell growth
D. Affect IL-10 & IL-8 receptors and NF-kB activation
E. Contraindicated in pregnancy
C. G1
csDMARD approved for use in RA and retards the appearance of new bony erosions
Cyclosporine
The first line synthetic nonbiologic antimetabolite (csDMARD) for treating RA
Methotrexate
Which of the following is not true of methotrexate?
A. Allows the accumulation of AMP that is converted to adenosine which inhibits inflammation
B. Recommended dose of treatment is 15-25mg weekly
C. Excreted primarily in urine followed by the bile (30%)
D. Both the parent compound and the metabolite are polyglutamated within cells where they stay for prolonged periods
B. 7.5 mg/wk for start, followed by 15-25 mg per week, and toxic at 30-35mg weekly
csDMARD that can reduce the clearance or increase the tubular reabsorption of methotrexate.
Hydroxychloroquine
Most common toxicities of methotrexate
Mucosal ulcers and nausea
Semi-synthetic DMARD that interferes with leukocyte adhesion to endothelial cells through inhibition of E selectin, P-selectin, and intercellular adhesion molecule 1
Mycophenolate mofetil
Effective DMARD for treatment of renal diseased due to SLE
Mycophenolate mofetil since it interferes with leukocyte adhesion
The active product of MMF that inhibits inosine monophosphate dehydrogenase, leading to suppression of T- and B-lymphocyte proliferation.
Mycophenolic acid
T/F: MMF is rarely associated with malignancy
T
A chimeric monoclonal antibody biologic agent that targets CD20 B lymphocytes. Depletion of these cells takes place through cell- mediated and complement-dependent cytotoxicity and stimulation of cell apoptosis.
Rituximab
Pretreatment protocol for the bDMARD that depletes B-lymphocytes
Acetaminophen, antihistamine and IV glucocorticoids (100mg methyl prednisolone) 30 minutes prior to infusion of Rituximab
Treatment combination approved for the treatment of adult patients with granulomatosis with polyangiitis (previously known as Wegener’s granulomatosis) and microscopic polyangiitis
Rituximab + glucocorticoids
Most common SE of Rituximab during the first 1000-mg treatment
rashes
Rituximab treatment require monitoring for ______ before and several months after the initiation of the treatment
reactivation of HBV infection
The active moiety of Sulfasalazine in the treatment of RA
Sulphapyridine (the other metabolite is 5-aminosalicylic acid)
csDMARD effective in RA and reduces radiologic disease progression
Sulfasalazine
csDMARD for spondyloarthropathy-associated uveitis.
Sulfasalazine
bDMARD Indicated for adult patients with moderately to severely active RA who have had an inadequate response to one or more DMARDs.
Tocilizumab
Screening for ____________ should be done prior to beginning tocilizumab
tuberculosis
Demyelinating disorders including multiple sclerosis are rarely associated with the use of which bDMARD?
Tocilizumab
Indicated bDMARD for patients older than 2 years with active SJIA or active PJIA
Tocilizumab
The fully human IgG1 anti-TNF monoclonal antibody that complexes with soluble TNF-α and prevents its interaction with p55 and p75 cell surface receptors.
Adalimumab
T/F: The clearance of adalimumab is decreased by more
than 40% in the presence of methotrexate
T
The recombinant, humanized antibody Fab fragment conjugated to a polyethylene glycol (PEG) with specificity for human TNF-α.
Certolizumab
TNF-α blocking agent that neutralizes membrane-bound and soluble TNF-α in a dose-dependent manner.
Certolizumab
This is a recombinant fusion protein consisting of two soluble TNF p75 receptor moieties linked to the Fc portion of human IgG1; it binds TNF-α molecules and also inhibits lymphotoxin α.
Etanercept
This is a human monoclonal antibody with a high affinity for soluble and membrane-bound TNF-α. It effectively neutralizes the inflammatory effects produced by TNF-α seen in diseases such as RA
Golimumab
The chimeric (25% mouse, 75% human) IgG1 monoclonal antibody that binds with high affinity to soluble and possibly membrane bound TNF-α.
Infliximab
First created to prevent allograft rejection, this tsDMARD selectively inhibits all members of the Janus kinase family to varying degrees.
Tofacitinib
T/F: Upper respiratory tract infection and urinary tract infection represent the most common infections with Tofacitinib use
T
Oldest drug in the IL-1 inhibitors
Anakinra
The human IgG1/κ monoclonal antibody against IL-1β that forms a complex with IL-1β, preventing its binding to IL-1 receptors.
Canakinumab
T/F: Canakinumab is indicated for active SJIA in children
less than 2 years
False: 2 years and older
- it is also used to treat CAPS, particularly the familial cold autoinflammatory syndrome and Muckle-Wells syndrome subtypes for adults and children 4 years or older. -
- Canakinumab is also used to treat gout
The age limit for the use of Rilonacept
12 years old
____________ is the ligand-binding domain of the IL-1 receptor. It binds mainly to IL-1β and binds with lower affinity to IL-1α and IL-1RA. Rilonacept neutralize IL-1β and prevents its attachment to IL-1 receptors.
Rilonacept
The IL-1 antibody that specifically inhibits B-lymphocyte stimulator (BLyS).
Belimumab
Belimumab is approved only for the treatment of adult patients with _____________ who are receiving standard treatment.
active, seropositive SLE
T/F: Cases of depression and suicide have been reported in patients receiving belimumab
T
Dosage of prednisone should not exceed ____ mg daily
7.5mg
The centrally acting analgesic related to opioids that has no significant anti-inflammatory effects
Tramadol
T/F: Tramadol may be given for 1 month
F: Cannot be given for more than 1 week
The alkaloid used for gouty attacks
Colchicine
T/F: Combination therapy for patients not responding adequately to monotherapy is now the rule in the treatment of RA.
T
T/F: Colchicine inhibits formation of LTB4 and IL-1β
T
Anti-gout medication that prevents attacks of acute Mediterranean fever
Colchicine
Which of the following is not an adverse effect of colchicine?
A. DIC
B. Hepatic cirrhosis
C. Seizures
D. Hair loss
E. Peripheral neuritis
B. mild beneficial effect with this and sarcoid arthritis
T/F: NSAIDs inhibit urate crystal phagocytosis
T
NSAID commonly used in initial Tx of gout as replacement for colchicine
Indomethacin
Agents used to reduce the body pool of urate in patients with tophaceous gout
Uricosuric agents
Urine pH should be _____ when using sulfinpyrazone
above 6.0 or alkali in uricosuric agents
T/F: Probenecid is complete excreted by the kidney
F: Probenecid is completely reabsorbed by the renal tubules and Sulfinpyrazone is excreted by the kidney
Drug used between attacks (the “intercritical period”) for prolonged prophylaxis
Colchicine
T/F: The preferred and standard-of-care therapy for gout during the period between acute episodes is allopurinol, which reduces total uric acid body burden by inhibiting xanthine oxidase.
T
This is often the first-line agent for the treatment of chronic gout in the period between attacks and it tends to prolong the intercritical period.
Allopurinol
The metabolite of allopurinol that retains the capacity to inhibit xanthine oxidase
Alloxanthine
T/F: Dietary purines are not an important source of uric acid.
T
When initiating allopurinol, colchicine or NSAID should be used until steady-state serum uric acid is normalized or decreased to __________ mg/dL and they should be continued for 6 months or longer.
less than 6mg/dL
The non-purine xanthine oxidase inhibitor that reduces the formation of xanthine and uric acid without affecting other enzymes in the purine or pyrimidine metabolic pathway
Febuxostat
T/F: Febuxostat at daily dosing of 80 mg or 120 mg was more effective in lowering serum urate levels than was allopurinol at a standard 300-mg daily dose
T:
The urate-lowering effect was comparable regardless of the pathogenic cause of hyperuricemia—overproduction or underexcretion.
This is a recombinant mammalian uricase that is covalently attached to methoxy polyethylene glycol (mPEG) to prolong the circulating half-life and diminish immunogenic response.
Pegloticase
T/F: Pegloticase may be used in asymptomatic hyperuricemia
False
T/F: Gout flare can occur during treatment with pegloticase, especially during the first 3–6 months of treatment
T
There is some concern for hemolytic anemia in patients with ___________ because of the formation of hydrogen peroxide by uricase; therefore, pegloticase should be avoided in these patients.
glucose-6-phosphate dehydrogenase deficiency
Most commonly used oral corticosteroids
Prednisone
Intra-articular injection of 10 mg (small joints), 30 mg (wrist, ankle, elbow), and 40 mg (knee) of ________________ can be given if the patient is unable to take oral corticosteroid medications.
triamcinolone acetonide
