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Unit 4 Flashcards

1
Q

what is first line treatment for OA

A

Tylenol

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2
Q

Osteophyte formation is seen in what disorder

A

OA

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3
Q

What systems should be monitored when using NSAIDs in the elderly

A

GI, renal, cardiac

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4
Q

Why is chronic NSAID use not advised over the age of 75

A

increased risk for GI bleed

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5
Q

Celocoxib - what is the class and MOA

A

COX2 specific NSAID, blocks prostaglandin synthesis

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6
Q

Why is Celocoxib a better option than Ibuprofen for pain

A

COX2 specific, pain relief with less GI side effects

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7
Q

What is the downside to using a COX 2 inhibitor over a traditional NSIAD

A

increased risk of cardiovascular toxicity

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8
Q

What patients may not have Celocoxib prescribed as a first line medication for inflammatory pain

A

those with a history of myocardial infarction, significant congestive heart failure, stroke, or chest pain related to heart disease

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9
Q

true or false: topical NSAIDs are just as effective as oral NSAIDs for OA pain

A

true

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10
Q

What cartilage matrix components may be considered as alternative therapy to help with treating OA

A

Chondroitin sulfate and hyaluronic acid

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11
Q

What adverese effects does MTX have on the liver and kidney

A

Can cause cirrhosis. Can cause acute kidney injury, azotemia, cystitis, proteinuria and hematuria

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12
Q

Why might liver enzymes be elevated on initiation of MTX

A

May cause transient increase in LFTs which usually resolves on its own

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13
Q

What BW should be ordered on MTX therapy

A

CBC with diff and platelettes, Cr and LFTs

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14
Q

Why might MTX be prescribed

A

RA, atopic dermatitis, chrons disease, SLE, oncology

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15
Q

Why should biologics and NSAIDs not be used together

A

increased risk of bone marrow supression and GI toxicity

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16
Q

Why is folic acid given with MTX

A

reduce risk of oral ulcers, leukopenia, anemia, and thrombocytopenia

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17
Q

What is Lesch-Nyhan sydrome and what can it cause

A

complete abscene of the enzyme HGPRT - leads to gout

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18
Q

what medications may cause gout and why

A

diueretic and ASA - causes decreased excretion of urate

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19
Q

what is pseudogout

A

same symptoms as gout but caused by calcium pyrophosphate dihydrate (CPPD) crystals instead of hyperurecemia

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20
Q

What is the MOA of Probenicid

A

inhibits tubular reabsorption of urate, increasing urinary excretion of urate

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21
Q

True or false: Probenicid is a good option for acute gout attacks

A

False

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22
Q

What is Probenicid used for

A

Gout management/prevention

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23
Q

What is the MOA of allopurinol

A

inhibit xanthine oxidase which is the enzyme that converts xanthine to uric acid

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24
Q

How long after a gout attack has started is colchicine no longer a preferred treatment

A

36 hours

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25
what are the initial therapies for mild to moderate gout
NSAIDs, systemic corticosteroids, colchicine
26
what are the suggested combination therapies for gout if monotherapy is not effective
colchicine and NSAIDs colchicine and oral corticosteroids intra-articular steroid and (NSAID or colchicine or oral corticosteroid)
27
Why are NSAIDs and corticosteroids not combined for treatment of gout?
overlap in toxicities
28
When would you see synovial cell hyperplasia and endothelial cell activation
early stages of RA
29
how do cytokines cause catabolism of chondrocytes in RA
Cytokines drive the generation of reactive oxygen and nitrogen species
30
what characterizes juvenile RA
Onset of RA before age 16
31
In early RA, the synovium becomes more or less vascularized
more
32
what is pannus tissue and when is it seen
layer of roughened granulation tissue, seen in RA
33
what can cause Boutoniere and Swan Neck deformities
RA
34
true or false: risk of death related to cardiovascular disease is increased in patients with RA
True
35
what are DMARDS
disease modifying anti-rheumatic drugs
36
What medications may be prescibed with DMRADS to bridge until the DMRADS reach therapeutic levels
NSAIDs or low dose steroids
37
what is the most commonly prescribed DMRAD
MTX
38
what is the MOA of MTX
folic acid antagonist and antimitotic which supresses inflammatory leukocyte activity
39
What class if sulfalazine and why might is be prescribed
DMRAD - for RA
40
What class is hydroxychloroquine
DMRAD
41
What class if Leflumanide
DMRAD
42
What class is Etanercept
biologic
42
What class is infliximab
biologic
43
what class is adlimumab
biologic
44
how do biologics work
target specific cytokine or cellular targets that are part of the inflammatory process
45
True or false: MTX is often combined with biologic therapy
true
46
what is the most important differential diagnosis for gout
septic arthritis
47
What is most commonly prescribed for acute gout attacks
Indomethacin
48
What class is indomethacin
NSAID
49
What is second and third line for acute gout
2nd colchicine 3rd oral corticosteroids
50
Osteoporosis is an imbalance of ____
bone remodelling
51
what condition causes bone mineral loss
osteoporosis
52
what are the three main cells involved in bone remodelling
osteocytes, osteoblasts, osteocasts
53
what cytokine stimulates osteoclast destruction
OPG
54
What is the receptor for RANKL
RANK
55
what is osteoprogenin (OPG)
a "decoy" protein that binds to RANKL preventing it from stimulating RANK
56
what cell makes RANKL and OPG
osteoblasts
57
when RANKL predominated _____ are activated
osteoclasts
58
when OPG predominates ______ activity are decreased
osteoclast
59
True or false, when RANKL is higher than OPG, there will be bone building
false, there will be bone loss
60
Calcitonin (increases or decreases) osteoclast activity and PTH (increases or decreases) osteoclasts activity
decreases increases
61
decreased vitamin ____ can cause decreased calcium
vitamin D
62
as estrogen levels decline, bone minerals are (increased or decreased) and why
decreased decreased estrogen levels sensitize bones to PTH causing increased osteoclast activity
63
what are the 4 treatment options for osteoporosis
calcium supplements, bisphosphonates, selective estrogen receptor modulators, hormone modifiers
64
What is the treatment for acute exacerbations of osteoarthritis that does not respond to Tylenol or NSAIDs
glucocorticoid injection
65
What supplements may be helpful in osteoarthritis
glucosamine and chondroitin

N517 Tests (7 decks)

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