Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Clinical Medicine > Pharm 3 > Flashcards

Pharm 3 Flashcards

(94 cards)

Start Studying
1
Q

What’s the first line of treatment in RA?

A

methotrexate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How does methotrexate work?

A

inhibits dihydrofolate reductase leading to decreased folic acid supplies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Methotrexate MOA

A

decreases cell proliferation; increases apoptosis of T cells; increases adenosine release; alters expression of CAM; inhibits pro-inflammatory cytokies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

SE of methotrexate

A

mucosal ulcers, stomatitis, nausea, diarrhea, alopecia, anemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

When is methotrexate contraindicated?

A

pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Dose for leflunomide?

A

10-20 mg qd after LD of 100 mg for 3 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

LD or leflunomide is associated with?

A

severe diarrhea and may be skipped

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Leflunomide mechanism

A

inhibits mitochondrial dihydroorotate dehydrogenase (DHODH) ultimately resulting in decreased DNA and RNA in rapidly dividing cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Leflunomide is approved for?

A

RA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

SE of Leflunomide?

A

diarrhea, alopecia, elevated liver enzymes, weight gain, increased BP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Sulfasalazine dose

A

maintenance dose 1 gram bid-tid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

SE of Sulfasalazine

A

N/V, HA, rash, rarely anemia and methemoglobinemia and neutropenia; reversible infertility in men but not women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Is Sulfasalazine ok in pregnancy?

A

yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Hydroxychloroquine dosing

A

200 mg bid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What type of drug is Hydroxychloroquine

A

anti-malarial

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How long is it to see an effect on Hydroxychloroquine

A

3-6 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Does Hydroxychloroquine impact bone changes in RA?

A

no

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

SE of Hydroxychloroquine

A

retinal damage if doses exceed 6 mg/kg/day, GI issues, rash, nightmares

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Is Hydroxychloroquine safe in pregnancy?

A

Yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Hydroxychloroquine and diabetes?

A

may improve glucose profiles in diabetic patients and lower A1c

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Hydroxychloroquine and cardiac risk?

A

LDL, HDL, TG improvement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Ultimately how does Hydroxychloroquine help RA?

A

helps symptomatically, but not with bone changes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Tofacitinib dose

A

5 mg bid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What type of drug is Tofacitinib

A

Janus Kinase Inhibitor–suppresses immune response

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
When is Tofacitinib used?
in combo with MTX or alone in moderate to severe disease where MTX failed or cannot be used
26
When does Tofacitinib dose need to be decreased to 5 mg qd?
if patient is on a CYP3A4 or CYP2C9 inhibitors or has moderate to severe renal or liver impairment
27
Does Tofacitinib decrease joint damage?
no
28
Avoid Tofacitinib in conjunction with?
immunosuppressants and live vaccines
29
Tofacitinib SE?
HA, diarrhea, URI, rarely GI perforation
30
Examples of anti-TNF agents
etanercept, infliximab, adalimumab, certolizumab, golimumab
31
Examples of non-TNF agents
abatacept, rituximab, tocilizumab
32
SE of TNF-alpha inhibitors
injection site reaction, infection, new onset psoriasis, increased risk of leukemia and lymphoma
33
Contraindications for TNF-alpha inhibitors
presence of serious or recurrent infections
34
TNF-alpha inhibitors should be avoided in?
patients with class III or higher HF and EF less than 50% as well as patients with demyelinating diseases
35
What happens if a patient needs TNF-alpha inhibitor therapy?
meds must be held for duration of treatment
36
What should patients be tested for prior to starting a TNF-alpha inhibitor?
TB
37
Types of non-TNF agents
B cell depleters, t cell co-stimulation inhibitors, IL-6 inhibitors
38
SE of B cell depleters
infusion reactions, rash (30%) with first infusion then decreases with subsequent infusions
39
Contraindications of B cell depleaters
presence of serious or recurrent infection, type 1 allergic reactions to murine proteins
40
T cell co-stimulation inhibitors SE
infusion, reactions, increased risk of lymphoma
41
Contraindications of T cell co-stimulation inhibitors
presence of serious or recurrent infection
42
IL-6 inhibitors SE
infusion reactions, infection, increased lipids, URI, HA, HTN, elevated liver enzymes, decreased neutrophils, decreased platelets, GI perforation (esp in diverticulitis and on corticosteroids)
43
What should patients be screened for before staring an IL-6 inhibitors?
TB
44
Which two drugs may decrease risk of diabetes?
hydroxychloroquine and TNF inhibitors
45
Pregnancy is a contraindication for which two drugs?
MTX and leflunomide
46
When are biologics recommended?
only after nonbiologic failure in patient with poor prognosis or failure of two nonbiologic regimens in patients without poor prognosis; given with MTX
47
What are our four drugs for acute gout treatment?
fast-acting NSAIDs, Cox-2 inhibitors, corticosteroids, colchicine
48
First line therapy for acute gout?
Fast-acting NSAIDs
49
Fast-acting NSAID examples
indomethacin, naproxen, sulindac
50
When do you begin fast-acting NSAIDs during an acute gout attack?
first 24 hours
51
Dosing for fast-acting NSAID for gout
High dose for 2-3 days then step down over 2 weeks and continue for 2 days after resolution
52
Issue with cox-2 inhibitors?
increased CV risk
53
How are corticosteroids administered in acute gout?
Intra-articular injection is highly effective in large joints and when limited to one or two locations; could do oral for small joints
54
Issue with indomethacin?
can cause CNS issues in the elderly
55
Colchicine MOA
binds intracellular tubulin ultimately leading to inhibition of leukocyte migration and phagocytosis -> anti-inflammatory effects
56
Common colchicine dose?
0.6 mg qd-bid
57
What are our two xanthine oxidase inhibitors?
allopurinol, febuxostat
58
What is the standard of care for chronic gout?
allopurinol
59
allopurinol dose
100 mg qd then increase 100 mg qd every 1-4 weeks until goal serum level is reached (lower dose for renal disease)
60
When do you start allopurinol for gout?
Give with NSAID or colchicine initially until uric acid levels are less than 6 mg/dl then slowly D/C (over months)
61
SE of allopurinol?
GI disturbance, HA, rash, rarely cataracts, aplastic anemia, peripheral neuritis
62
Does allopurinol work in an acute attack?
NO
63
Febuxostat dosage
40-80 mg qd; in clinical trials, 80-120 mg was more effective at lowering uric acid than 300 mg allopurinol regardless of overproduction or underexcretion
64
What should you use febuxostat with?
NSAID or colchicine
65
SE of febuxostat
elevated LFTs, diarrhea, HA, nausea
66
What's the concern with febuxostat
cardiovascular events in higher doses
67
Metabolism of febuxostat
liver, so no need for renal adjustment
68
urate oxidase enzyme example
pegloticase
69
What is pegloticase?
recombinant mammalian uricase attached to PEG
70
MOA of pegloticase
Catalyzes oxidation of uric acid to allantoin (inert and soluble)
71
Dosing of pegloticase
Given as IV infusion every 2 weeks; optimal length of treatment not established
72
what should be given with pegloticase?
NSAID or colchicine prophylaxis needed for first 6 months of treatment
73
SE of pegloticase
infusion reactions (premed with antihistamine and corticosteroid), gout flares, nausea, bruising
74
You should not use pegloticase in who?
Do not use in G6PD deficiency; screening of patients of African and Mediterranean decent recommended
75
What happens with the immune system and pegloticase?
Patients will develop immune response to pegloticase (92%) – increased risk of infusion reactions seen as well as decreased efficacy
76
Drugs that cause gout
thiazides, niacin, levodopa, cyclosporine, aspirin
77
Lupus drugs
hydroxychloroquine, NSAIDs, immunosuppressants and corticosteroids, biologics
78
Hydroxychloroquine does what for lupus
decreases flare ups
79
Efficacy of hydroxychloroquine decreases with
smoking
80
When are immunosuppressants and corticosteroids used for in lupus?
serious or life threatening lupus
81
Examples of lupus biologics
belimumab, rituximab
82
Which biologic is useful in decreasing symptoms in mild lupus
belimumab
83
which biologic is useful in resistant lupus
rituximab
84
What % of lupus is drug induced lupus
10%
85
Does drug-induced lupus resolve?
Typically resolves after drug d/c but may take weeks to months
86
Common drug induced lupus agents
hydralazine, procainamide, isoniazid, methyldopa, quinidine, minocycline, chlorpromazine
87
Age differences in SLE vs DILE
SLE age 20-40; DILE 50
88
sex differences in SLE vs DILE
SLE: women DILE: both
89
onset differences in SLE vs DILE
SLE: gradual; DILE: sudden
90
severity differences in SLE vs DILE
SLE: can be severe; DILE: remains mild
91
Hepatomegaly differences in SLE vs DILE
SLE: hepatomegaly less common; DILE: hepatomegaly common
92
anti-double strand DNA antibody differences in SLE vs DILE
SLE: 50-70%; DILE: rare
93
anti-smith differences in SLE vs DILE
SLE: 20-30%; DILE: rare
94
hypocomplimentemia differences in SLE vs DILE
SLE: 50-60%; DILE: rare

Clinical Medicine (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions