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Rheumatology and Immunology Flashcards

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1
Q

What medications are used for gout?

A

Allopurinol (Zyloprim)

Febuxostat (Uloric)

Colchicine (Colcrys, Gloperba, Mitigare)

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2
Q

How does allopurinol work?

A

Xanthine oxidase inhibitor: decreases uric acid production

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3
Q

What side effects are associated with allopurinol?

A

Diarrhea, liver enzymes abnormalities, rash, acute gouty arthritis, SJS/TENs, aplastic anemia, renal failure

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4
Q

When cant you use allopurinol?

A

Hypersensitivity, HLA-B 5801 (+)

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5
Q

What are the counseling points for allopurinol?

A
  • Take after meals to alleviate GI symptoms
  • Drink plenty of water to prevent kidney stones
  • Avoid alcohol and caffeine
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6
Q

How does febuxostat work?

A

Xanthine oxidase inhibitor: inhibits uric acid production

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7
Q

What are the side effects of febuxostat?

A

Diarrhea, nausea, acute gouty arthritis, ECG abnormalities, stroke, mood changes, rash

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8
Q

When cant you use febuxostat?

A

Concurrent azathioprine (AZA) or mercaptopurine (6-MP)

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9
Q

What is the BBW associated with febuxostat?

A

Increased risk of death (cardiac, all- cause)

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10
Q

What are the counseling points for febuxostat?

A
  • Take with food
  • Seek medical attention for severe mood swings, rashes, or abnormal heartbeat
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11
Q

How does Colchine work?

A

Unknown, may interferes with crystal deposition in joint tissues and may inhibit locomotion and chemotaxis of neutrophils

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12
Q

What are the side effects associated with colchine?

A

Diarrhea, nausea, Agranulocytosis, rhabdomyolysis (esp. w lipid lowering agent)

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13
Q

When cant you use colchine?

A

Use with strong CYP3A4/5 inhibitors in patients with renal or hepatic failure

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14
Q

What are the counseling points for colchine?

A
  • Take as instructed, dosing for acute and chronic gout are different.
  • Dose dosing to symptom relief or onset Dose dosing to symptom relief or onset
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15
Q

What medications are used for rheumatoid arthritis?

A

Methotrexate (Trexall)

Azathioprine (Imuran, Azamun)

Hydroxychloroquine (Plaquenil)

Etanercept (Enbrel Mini, Enbrel SureClick, Erelzi)

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16
Q

How does methotrexate work?

A

Reversibly inhibits dihydrofolate reductase (DHFR)
and blocks DNA synthesis, repair, and cell
replication

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17
Q

What are the side effects associated with methotrexate?

A

Nausea, vomiting, hair loss, stomatitis,
photosensitivity, myelosuppression, Opportunistic infections, maligancies

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18
Q

When cant you use methotrexate?

A

Pregnancy/breastfeeding, alcohol use disorders,
chronic liver disease, preexisting blood dyscrasias

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19
Q

What is the BBW associated with methotrexate?

A

Pregnancy, BMS, GI/liver/lung/skin toxicity

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20
Q

What are the counseling points for methotrexate?

A
  • To be taken ONCE WEEKLY for rheumatic conditions, on the same day each week
  • Take daily folic acid (FA) to lessen risk of common ADRs
  • Avoid live vaccine
  • Must use effective contraception during and after treatment
  • Avoid direct sun exposure
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21
Q

How does azathioprine work?

A

Halts DNA synthesis through incorporation into
replicating DNA, also blocks purine synthesis

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22
Q

What are the side effects of azathioprine?

A

Nausea, leukopenia, infection, Pancreatitis, neoplasia

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23
Q

When cant you use azathioprine?

A

Pregnancy, prior alkylating therapy

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24
Q

What are the BBW associated with azathioprine?

25
What are the counseling points for azathioprine?
- Take with food - Can increase your risk of infections - Report any new mass, fatigue, easy bruising symptoms - May decrease vaccine efficacy
26
How does hydroxychloroquine work?
Unknown, may inhibit locomotion of neutrophils and chemotaxis of eosinophils; impairs immune reactions
27
What are the side effects of hydroxychloroquine?
Nausea, vomiting, diarrhea, Retinopathy, QT prolongation/arrhythmias
28
When cant you use hydroxychloroquine?
Retinal or visual field changes from prior hydroxychloroquine, long term use in children
29
What are the counseling points for hydroxychloroquine?
Take with food or milk
30
What side effects are associated with etanercept?
Injection site reaction (ISR), headache (HA), skin rash, reactivation of latent infection, malignancies, heart failure
30
How does etanercept work?
Recombinant DNA-derived protein, binds to soluble human TNF and blocks its interaction with its receptor
31
When cant you use etanercept?
Sepsis
32
What are the BBW associated with etanercept?
Serious infections, malignancies
33
What are the counseling points associated with etanercept?
- Do not administer dose if s/sx of active infection - Store in the refrigerator, but do not freeze and do not use if frozen even if it has thawed - Keep in carton to protect from light. - Do not shake - Discard syringe in sharps container. - Rotate injection site - Contact HCP if shortness of breath, infections, signs of cancer.
34
What are the glucocorticoids?
Prednisone (Deltasone) Methylprednisolone (Medrol) Dexamethasone (Decadron) Prednisolone (Orapred, Prelone)
35
How do glucocorticoids work
suppress pro-inflammatory genes (like IL-1, TNF-α) and promote anti-inflammatory proteins (like IL-10)
36
What are the side effects associated with glucocorticoids?
ADR mnemonic: “CORTICOSTEROIDS” **C**ushing's Syndrome **O**steoporosis **R**etardation of growth **T**hinning of skin **I**mmunosuppression **C**ataract + glaucoma **O**edema **S**uppression of HPA **T**eratogenicity **E**motional disturbances **R**aised blood pressure **O**besity **I**ncreased body hair growth **D**iabetes **S**triae/Stomach ulcers
37
What are the counseling points associated with glucorticoids?
* Take with food or milk to prevent GI upset * Take in the morning to help prevent insomnia * For high-dose or longer-term treatment, monitor for signs of hyperglycemia, osteoporosis, adrenocortical insufficiency, and infection * Avoid abrupt discontinuation treatment duration > 3 weeks and dose > 20 mg prednisone equivalent
38
What are the antineoplastic(anti-tumor) meds?
* Anastrazole (Arimidex) * Tamoxifen (Soltamox) * Tacrolimus (Prograf, Astagraf XL, Envarsus XR)
39
How does anastrazole work?
Blocks conversion of androgens into estrogen required for tumor growth
40
What side effects can anastrazole cause?
nausea, vomiting, edema, hypertension, hot flashes, arthralgia, arthritis, osteoporosis, depression, GI tract disorder, Myocardial infarction, endometrial cancer, cerebrovascular accident (CVA)
41
When cant anastrazole be used?
Pregnancy, breastfeeding
42
What are the counseling points for anastrazole?
- May lead to bone loss and increased risk of fracture - Seek medical attention if shortness of breath, swelling, chest pain, vaginal bleeding, blistering rash, rapid weight gain
43
How does Tamoxifen work?
Competitively binds to estrogen receptors on tumors, inhibiting tumor growth
44
What are the side effects of Tamoxifen?
Flushing, hot flashes, vaginal discharge, edema, hypertension, Thrombosis, endometrial hyperplasia, uterine cancer, retinopathy
45
When cant you use Tamoxifen?
Pregnancy, breastfeeding, concurrent warfarin therapy or history of deep vein thrombosis or pulmonary embolism
46
What are the BBW associated with Tamoxifen?
Stroke, pulmonary embolism, uterine malignancies
47
What are the counseling points for Tamoxifen?
- Seek immediate care if s/sx of thrombotic event (shortness of breath, leg pain) - Avoid black cohosh as supplement
48
How does tacrolimus work?
Inhibits immune response and limits inflammation for transplants
49
What side effects does Tacrolimus cause?
Diarrhea, nausea, Nephrotoxicity, Tremor, headache, Insomnia
50
When cant you use Tacrolimus?
Concurrent ziprasidone use
51
What are the BBW associated with Tacrolimus?
Malignancies, serious infections, (Astagraf XL) mortality in liver transplantation
52
What are the hemapoetic medications?
Epoetin (Epogen, Procrit, Retacrit) Darbepoetin (Aranesp)
53
How does Epoetin and Darbeopetin work?
Binds to the erythropoietin receptor on erythroid progenitor cells, stimulating production/differentiation of mature red blood cells.
54
What are the side effects associated with Epoetin and Darbeopetin
Injection site thrombosis, Diarrhea, edema, hypertension, fatigue, myalgia, dyspnea and cough (darbepoetin), skin rash and pruritis (Epoetin)
55
When cant you use Epoetin and Darbeopetin?
Uncontrolled HTN, concurrent albumin use (Epoetin), pure red cell aplasia (Darbepoetin)
56
What are the BBW associated with Epoetin and Darbeopetin
Increased CV, stroke, mortality risk, cancer recurrence, DVT (Epoetin)
57
What are the counseling points for Epoetin and Darbeopetin
* Do not shake, dilute, or expose to light. * Store in box in refrigerator, do not freeze. * Single use vial/syringe, do not combine remainders from different vials/syringes * It may take several weeks to see the maximum effects of this medication

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