RA/Gout Med Chem

Question 1

What RA drug class is minocycline?

Answer 1

nonbiological DMARD

Question 2

What RA drug class is azathioprine?

Answer 2

nonbiological DMARD

Question 3

What RA drug class is gold?

Answer 3

nonbiological DMARD

Question 4

What RA drug class is penicillamine?

Answer 4

nonbiological DMARD

Question 5

What is the nonbiological DMARD methotrexate MOA?

Answer 5

inhibits DNA synthesis

Question 6

What is the target of methotrexate?

Answer 6

dihydrofolate reductase (DHFR)

Question 7

Main AE of methotrexate?

Answer 7

hepatotoxicity

Question 8

What is the drug food interaction between cola and MTX?

Answer 8

increased MTX serum levels

MTX has limited solubility at pH below 7

Question 9

What is the DDI between penicillin and MTX?

Answer 9

decreases elimination of MTX

Question 10

What is the DDI between cyclosporine and MTX?

Answer 10

potentiates MTX’s hematologic effects

Question 11

Do nsaids increase MTX toxicity?

Answer 11

yes

Question 12

How does probenecid affect MTX?

Answer 12

inhibits MTX excretion

Question 13

What are the 2 main contraindications for MTX use?

Answer 13

liver disease

immunodeficiency

Question 14

What is the active form of leflunomide?

Answer 14

teriflunomide

Question 15

What is the target of the nonbiological DMARD leflunomide?

Answer 15

dihydroorotate dehydrogenase (DHODH)

Question 16

Leflunomide inhibits the denovo synthesis of ____.

Answer 16

pyrimidine

cytosine, thymine

Question 17

What is the half life of teriflunomide?

Answer 17

14-18 day

Question 18

2 main AEs of leflunomide?

Answer 18

infection

liver toxicity

Question 19

What is the DDI between leflunomide and warfarin?

Answer 19

increased risk of bleeding

Question 20

Which nonbiological DMARD cause increased levels of repaglinide, rosuvastatin, pioglitazone, and rosiglitazone?

Answer 20

leflunomide

Question 21

2 main contraindications of leflunomide?

Answer 21

pregnancy

hepatic impairment

Question 22

What is recommended a a binding agent for leflunomide toxicity?

Answer 22

cholestyramine

Question 23

Which nonbiological DMARD has the possible target of toll-like receptor 9 (TLR9) family receptors?

Answer 23

hydroxychloroquine

Question 24

Does hydroxychloroquine have rapid or slow GI absorption?

Answer 24

rapid

half life 32-50 days, but fast absorption means Sx of overdose can occur as early as 30mins

Question 25

Hypersensitivity to ___ compound is a CI for hydroxychloroquine

Answer 25

4-aminoquinoline

Question 26

Which nonbiological DMARD can cause increased serum digoxin concentrations?

Answer 26

hydroxychloroquine

Question 27

Which portion of the TNF alpha inhibitor infliximab is from human IgG1?

Answer 27

Fc

Question 28

Which portion of infliximab is murine?

Answer 28

Fab

Question 29

What is the target of rituximab?

Answer 29

CD20 protein on cell anti-CD20 antibody

Question 30

Which med targets CD80/86 on APCs?

Answer 30

abatacept

Question 31

Which cell targets CD20 of B cells?

Answer 31

rituximab

Question 32

Which med targets IL6 signaling?

Answer 32

tociluzumab

Question 33

Which med targets IL1 signaling?

Answer 33

anakinra

Question 34

Which TNF alpha med targets soluble TNF receptors?

Answer 34

etanercept infliximab, adalimumab, certolizumab, golimumab are anti-TNF alpha antibodies

Question 35

2 main DDIs of etanercept?

Answer 35

anakinra live vaccines increased risk of infection

Question 36

2 main AEs of etanercept?

Answer 36

injection site rxn | infections

Question 37

Which TNF Alpha inhibitor is CI in heart failure?

Answer 37

infliximab do not give doses greater than 5mg/kg

Question 38

Which class of meds inhibits the formation of uric acid

Answer 38

xanthine oxidase inhibitors

Question 39

Does colchicine have an effect on serum uric acid level?

Answer 39

no

Question 40

What is the target of colchicine?

Answer 40

tubulin arrests neutrophil motility, decreases inflammation

Question 41

What CYP metabolizes colchicine?

Answer 41

CYP3A4 DDI with 3A4 inhibitors: azoles, macrolides, protease inhibitors

Question 42

Colchicine has DDIs with inhibitors of?

Answer 42

P-gp | 3A4

Question 43

Why shouldn't urate reducing therapy be initiated during an acute gout attack?

Answer 43

may prolong attack by changing equilibrium of body rate

Question 44

Which xanthine oxidase inhibitor can cause hypersensitivity syndrome?

Answer 44

allopurinol allopurinol hypersensitivity syndrome (AHS) exfoliative dermatitis, vasculitis, fever, liver dysfunction, eosinophilia, acute interstitial nephritis,; most likely to occur in pts with renal disease along with diuretic therapy; may be fatal

Question 45

Which XOI is NOT purine like?

Answer 45

febuxostat

Question 46

Which XOI causes increased serum conc. of one metabolite of theophylline?

Answer 46

febuxostat

Question 47

What is the target of probenecid?

Answer 47

urate anion exchange transporter (URAT1)

Question 48

Probenecid is used to reduce hyperuricemia in pts who excrete < ___ mg of uric acid per day

Answer 48

600

Question 49

What is the main CI for probenecid?

Answer 49

do not use during acute, gouty attack

Question 50

What is the target of pegloticase?

Answer 50

uric acid

Question 51

How does pegloticase lower uric acid level?

Answer 51

enhances uric acid degradation

Question 52

What does pegloticase convert uric acid too?

Answer 52

allantoin more excretable metabolite

Question 53

What is major CI of pegloticase?

Answer 53

G6PD deficiency