Rheumatology Pharm

Question 1

Bind and block promoter sites of proinflammatory genes IL-1 alpha and IL-2 beta. Decreased production of tumor necrosis factor alpha

Answer 1

glucocorticoids

Question 2

How do glucocorticoids make us more susceptible to infection?

Answer 2

decreases adherence of leukocytes to vascular endothelium

Question 3

What cells that are part of the immune system do glucocorticoids increase the production of from the bone marrow?

Answer 3

neutrophils (decreases eosinohils, monocytes, lymphocytes, APCs)

Question 4

What vaccines are contraindicated in a patient receiving chronic glucocorticoid therapy?

Answer 4

live vaccines (MMR, varicella, small pox)

Question 5

What do you periodically need to monitor for in a patient receiving glucocorticoids?

Answer 5

BP, glucose, lipids, eye exam, bone density

Question 6

Do steroids need dose adjustments in patients who have renal impairment?

Answer 6

nope!

Question 7

What severity level of RA would a patient who has < 5 inflamed joints, no extraarticular dz, negative RF and anti-CCP antibody, and no evidence of erosions on xray?

Answer 7

mildly active

Question 8

Initial treatment recommendations for mild RA and negative RF with good prognostic signs

Answer 8

hydroxycholoraquine

Question 9

In terms of general drug classes, what can be used in addition to DMARDs for short term symptom management of RA?

Answer 9

NSAIDs or steroids until DMARDs have taken effect

Question 10

What severity level of RA would a patient who has at least 5 inflamed joints, elevated ESR/CRP, positive RF and ACCP antibody, and radiographic evidence of disease be?

Answer 10

moderate to severly active RA

Question 11

Initial treatment choice for a patient who has moderate to severely active RA

Answer 11

methotrexate

Question 12

Treatment options for a patient who has moderate to severely active RA who is unable to tolerate methotrexate

Answer 12

TNF inhibitors such as Etanercept (Enbrel) or Adalimumab (Humira)

Question 13

How long does it take for maximal results of RA therapy take effect?

Answer 13

3-6 months

Question 14

What is the role of narcotic analgesics in RA?

Answer 14

no role unless end stage disease

Question 15

Antimalarial agent that is used as a single agent with mild RA and no evidence of joint destruction and no inflammatory/autoimmune markers on labs. Usually used as add-on to methotrexate tx.

Answer 15

Hydroxychloroquine (Plaquenil)

Question 16

Toxicity associated with Hydroxychloroquine (Plaquenil)

Answer 16

macular damage. Need eye exam every 6-12 months

Question 17

Drug class that Hydroxychloroquine (Plaquenil) decreases the metabolism of (ie increases half-life making it more potent)

Answer 17

beta blockers (except atenolol and nadolol)

Question 18

Drug that inhibits angiogenesis and decreases inflammatory cytokines and IgM RF production

Answer 18

sulfasalazine (Azulfidine)

Question 19

Needed to break down sulfasalazine into sulfapyridine and 5-aminosalicylic acid

Answer 19

coliform bacteria

Question 20

Toxicity associated with sulfasalazine

Answer 20

myelosuppression. Monitor with CBC every 3 months

Question 21

Most commonly used drug for RA. Reduces neutrophil adhesion. Suppression of cell mediated immunity. Inhibitis IL-1, 6, and 8

Answer 21

methotrexate

Question 22

What is methotrexate a structural analog of and needs to be supplemented when patients are on this drug?

Answer 22

folic acid

Question 23

What are the toxicities associated with methotrexate?

Answer 23

myelosuppression, hepatotoxicity, and pulmonary toxicity

Question 24

Name the TNF inhibitors

Answer 24

etanercept (enbrel), infliximab (remicade), adalimumab (humira)

Question 25

bind to tumor necrosis factor-alpha making it inactive interfering with inflammatory activity by decreasing production of IL-6 and CRP

Answer 25

TNF inhibitors

Question 26

TNF factor associated with infusion reactions

Answer 26

Infliximab (Remicade)

Question 27

Block box warning of TNF inhibitors

Answer 27

latent TB infection activation

Question 28

What is used in conjunction with infliximab (remicade) to decrease the development of infliximab antibodies

Answer 28

methotrexate

Question 29

Very expensive TNF inhibitor

Answer 29

Etanercept (Enbrel)

Question 30

Decreases progression of joint erosions and joint space narrowing. Similar to methotrexate (inhibitor of dihydrofolate reductase) that leads to decreased B and T cell proliferation

Answer 30

Leflunomide (Avara)

Question 31

What can reduce the extensive half-life of Leflunomide (Avara) to 1 day?

Answer 31

activated charcoal and cholestyramine

Question 32

Blocks IL-1 receptor to decrease degree of joint destruction and inflammation. No known pharmacokinetic drug interactions

Answer 32

Anakinra (Kineret)

Question 33

What should you not use in combination with Anakinra (Kineret)?

Answer 33

TNF inhibitors

Question 34

Chelating agent used for treatment of | Wilson’s disease, arsenic poisoning, copper, lead and mercury poisoning. Depresses T cell activity

Answer 34

D-Penicillamine (Depen, Cuprimine)

Question 35

Inhibits enzymatic activity required for DNA synthesis | Decrease production of T and B cells. Carcinogenic

Answer 35

Azithroprine (Imuran)

Question 36

Blocks activation of T cells and IL-2. Many drug interactions that increase it’s concentration. Renal toxicity

Answer 36

Cyclosporine A (Sandimmune, Neoral)

Question 37

Black box warning “Only physicians experienced in immunosuppressive therapy…”

Answer 37

Cyclosporine A (Sandimmune, Neoral)

Question 38

Has similar efficacy but greater toxicity compared to traditional DMARDs. decreases prostaglandin production

Answer 38

gold compounds- Auranofin (Ridaura) | Gold Sodium Thimate (Myochrysine)

Question 39

Meds to avoid with SLE that may cause an exacerbation

Answer 39

sulf containing abx, minocyclie, oral contracepties

Question 40

work for both cutaneous and MSK involvement in SLE. may prevent renal and CNS damage

Answer 40

Hydroxychloroquine (Plaquenil)

Question 41

Used in SLE for significant organ involvement

Answer 41

glucocorticoids

Question 42

What should be include in pharm treatement if a patient with SLE is antiphophlipid antibody positive?

Answer 42

Warfarin. antiphospholipid antibody causes a hypercoaguable state

Question 43

First line treatment for acute gout attack

Answer 43

NSAIDs- naproxen or indomethacin

Question 44

Second line treatment for acute gout attack

Answer 44

colchicine

Question 45

Pharm treatment used to prevent acute gout attacks, but are NOT initiated during an acute attack

Answer 45

allopurinol, febuxostat, or probenecid

Question 46

Medications that cause fluid retention and exacerbate CHF

Answer 46

NSAIDs and glucocorticoids

Question 47

NSAID that at higher doses doesn't inrease CV risks

Answer 47

Naproxen

Question 48

NSAID that cannot be given to patients with sulfa allergies

Answer 48

Celecoxib (Celebrex)

Question 49

What should you give a patient having an acute gout attack who is already on chronic colchicine?

Answer 49

give a loading dose

Question 50

Medications that increase uric acid or inhibit renal excretion of uric acid

Answer 50

thiazide/loop diuretics, niacin, aspirin