RA meds

Question 1

What is the cellular cause of RA? What type of hypersensitivity is this?

Answer 1

T cell activation

Also, immune factor stage

Question 2

What are the three stages of RA?

Answer 2

Initiation stage
Amplification
Final stage (chronic inflammation)

Question 3

What is the antibody that is elevated in RA? What is this?

Answer 3

Rheumatoid factor

IgM to the Fc of IgG

Question 4

What are the chemokines that are released in RA? What do these cause?

Answer 4

TNF-a
IL1
IL6

Inflammation and fibrosis

Question 5

What is the first line treatment for RA?

Answer 5

NSAIDs (ASA, acetaminophen, indomethacin, IBU etc)

Question 6

What is the role of glucocorticoids in RA?

Answer 6

Reduce the inflammation and cause dramatic improvement in RA

Question 7

What are the disease -modifying anti-rheumatic drugs (DMARDs)? MOA?

Answer 7

Drugs that reduce inflammation, improve symptoms, and slow bone damage

MOA unknown

Question 8

Do NSAIDs affect the course of RA? What about DMARDs?

Answer 8

No for NSAIDs

Yes for DMARDs

Question 9

What is the timeframe of onset for DMARDs?

Answer 9

slow (6 weeks to 6 months)

Question 10

What are the two different DMARDs?

Answer 10

Synthetic and biologic

Question 11

What is the MOA of methotrexate? What is the effect in RA treatment?

Answer 11

Inhibits AICAR transformylase to increase extracellular adenosine and inhibit T cell activation

First line treatment for RA

Question 12

What is the MOA of cyclosporin?

Answer 12

Inhibits IL1 and IL2 receptor production

Question 13

What is the MOA of cyclophosphamide?

Answer 13

Crosslinks DNA to prevent cell replication

Question 14

What is the MOA of azathioprine?

Answer 14

Interferes with nucleic acid metabolism and synthesis, and inhibits cell proliferation

Suppressed B and T cell function

Question 15

What is the MOA of Leflunomide? What is its role in RA treatment?

Answer 15

Inhibits ribonucleotide synthesis and causes cell cycle arrest

First agent for RA

Question 16

What are the antimalarial agents that are used to treat RA? MOA?

Answer 16

Chloroquine and hydroxychloroquine

MOA unknown

Question 17

What are the biological DMARDs?

Answer 17

Organic compounds made by living cells modify biologic responses

Question 18

What are the two drugs that are anti-TNF-a antibodies?

Answer 18

Etanercept

Infliximab

Question 19

What is the MOA of rituximab?

Answer 19

B cell depleting agent

Question 20

What is the MOA of abatacept?

Answer 20

T-cell costimulation inhibitor

Question 21

What is the MOA of Anakinra?

Answer 21

IL-1 cytokine inhibitor

Question 22

What is the MOA of Etanercept?

Answer 22

anti-TNF-a antibodies

Question 23

What is the MOA of Infliximab?

Answer 23

anti-TNF-a antibodies

Question 24

What is the definition of a migraine?

Answer 24

HA from 4-72 hours
Is: unilateral, pulsating, moderate-severe pain
Associated with N/v

Question 25

What are the characteristics of migraine headaches (location, quality, severity, aggravating factors,)?

Answer 25

Unilateral Pulsating quality Aggregated by physical activity

Question 26

Which gender is more commonly affected with migraines?

Answer 26

Women

Question 27

What two parts of the head anatomy are affected with migraine HAs?

Answer 27

Dural vasculature | CN V dysfunction

Question 28

What happens to the blood vessels in migraine headaches?

Answer 28

Vasodilation in the brain, causes stimulation of the mechanoreceptors in the trigeminal nerve, causing ssx.

Question 29

What are the temporal progression of migraine headaches?

Answer 29

1. Premonitory phase 2. Aura 3. HA 4. Resolution 5. Postdrome

Question 30

What are the ssx of the postdrome phase of migraine HAs?

Answer 30

Hangover, fatigue

Question 31

What happens to the cerebral blood flow with the progression of a migraine HA?

Answer 31

Lower in aura phase, then big increase in HA phase

Question 32

What are the three main specific migraine treatments?

Answer 32

Ergotamine Dihydroergotamine Triptans

Question 33

Who are the candidates for preventative therapy for migraines?

Answer 33

Unresponsive to acute attack meds Frequent attacks

Question 34

What are the two beta blockers that are used in migraine headaches?

Answer 34

Propranolol (beta 1 and 2) | Metoprolol (beta 1)

Question 35

What is Amitriptyline?

Answer 35

TCA antidepressant

Question 36

What are the two anticonvulsants used to treat migraine HAs?

Answer 36

Valproic acid | Topiramate

Question 37

What is the MOA of valproic acid?

Answer 37

GABA-A receptor agonist

Question 38

What is the MOA of Topiramate?

Answer 38

GABA-A receptor agonist

Question 39

What is the MOA of Verapamil?

Answer 39

CCB

Question 40

What is the side effect of overuse of NSAIDs for the treatment of migraines?

Answer 40

Can transform migraine into a more severe, chronic disorder

Question 41

What type of drug is meperidine? What drug should this never be used with?

Answer 41

Opiate analgesic

Question 42

What type of drug is butorphanol?

Answer 42

Opiate analgesic

Question 43

What are the antiemetics that are used for migraine HAs?

Answer 43

Metoclopramide Chlorpromazine Prochlorperazine

Question 44

What is the MOA of Metoclopramide?

Answer 44

weak 5HT3 receptor antagonist

Question 45

What is the MOA of Chlorpromazine?

Answer 45

Centrally acting D2 receptor antagonist

Question 46

What is the MOA of Prochlorperazine?

Answer 46

Centrally acting D2 receptor antagonist

Question 47

What are the two ergot derivatives?

Answer 47

Ergotamine | Dihydroergotamine

Question 48

What is the MOA of ergot derivatives? What are these used for?

Answer 48

Vasoconstriction d/t stimulation of alpha adrenergic and 5HT 1D receptors Used for Acute migraines

Question 49

What are the disadvantages of ergot derivatives?

Answer 49

Complex pharmacology and pharmacokinetics Potent and sustained vasoconstrictive effect

Question 50

What is the MOA of sumatriptan (and other Triptans)? What does this cause? What are these used for?

Answer 50

Selective 5HT 1D and 1B receptor agonists used in the treatment of migraine HAs Inhibit nociception of CN V, cause cranial vasoconstriction

Question 51

Why are the triptans better to treat migraine HAs over ergot derivatives?

Answer 51

More selective pharmacology Safer

Question 52

What is the ultimate treatment for migraine headaches?

Answer 52

Sleep

Question 53

What is the major adverse effect of triptans?

Answer 53

Agina MI (Rarely)