Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Pharm Exam 5 > Unit XIV Bone & Joint (Chapters 59 & 61) > Flashcards

Unit XIV Bone & Joint (Chapters 59 & 61) Flashcards

1
Q

Treatment goals for Rheumatoid Arthritis (4)?

A

Relieving symptoms (Pain, inflammation, stiffness)
Maintaining joint function and ROM
Minimize systemic involvement
Delay disease progression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Non-drug therapies for Rheumatoid Arthritis?

A 
Physical therapy (massage, warm baths, and applying heat to affected areas)
Proper rest and exercise to decrease joint stiffness and improve function (NOT TO EXCESS)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Drug Classes for treatment of Rheumatoid Arthritis (3)?

A

NSAIDS
Glucocorticoids
Disease-modifying antirheumatic drugs (DMARDS)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Role of NSAIDS in the treatment of RA?

A

Quick relief of joint pain/inflammation

Used until DMARDS on board (then withdrawn)
DON’T delay disease progression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Role of Glucocorticoids in treatment of RA?

A

Quick relief of joint pain/inflammation, particularly used for flares & with DMARDS until they take effect

CAN delay disease progression
Can not be used long term because of toxicity/adverse effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Role of Disease-modifying antirheumatic drugs (DMARDS) in treatment of RA?

A

Reduce joint destruction and slow progression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

MOA of DMARDS?

A

Interfere with immune and inflammatory responses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

3 types of DMARDS?

A

Conventional (traditional)
Biologic
Targeted

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

MOA of Conventional (traditional) DMARDS?

A

Extensive effects on the immune system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

MOA of Biologic DMARDS?

A

Work on cytokines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

MOA of Targeted DMARDS?

A

Block specific pathways inside cells of the immune system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Do all NSAIDS work the same in every patient?

A

All have antirheumatic effects but some may respond differently to others

Try multiple to see which is best for the patient

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Black Box warning for NSAIDS (3)?

A

Thrombotic events
GI Ulceration
Bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Which NSAID should be used when there is a high risk for GI Ulceration and low risk from thrombosis?

A

Celebrex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the NSAID dose range when employed for RA (higher or lower than ‘regular’ use)?

A

Higher

ASA can be 5.2 g/day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Delivery systems for glucocorticoids for treatment of RA (2) and when each is used?

A

1) Oral formulations with generalized symptoms (low-grade fever and other systemic effects)
2) Intra-articular injections when limited to specific joints to give relief with limited systemic adverse effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Can NSAIDS and Glucocorticoids be used together?

A

No–discontinue NSAIDS when using glucocorticoids r/t increased GI bleeding.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Which type of DMARDs is the least expensive?

A

Conventional

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

List examples of Conventional DMARDs (2)

A

Methotrexate

Hydroxychloroquine (Plaquenil)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the first-line Conventional DMARD for use of RA treatment?

A

Methotrexate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Which DMARD works faster than other DMARDs?

A

Methotrexate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How long does it take for the effects of Methotrexate to take effect?

A

3-6 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What must always be prescribed with Methotrexate?

A

Folic Acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Adverse Effects of Methotrexate (4)?

A

Hepatic fibrosis
Bone Marrow Suppression
GI Ulceration
Pneumonitis (general inflammation of lung tissue)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Monitoring parameters with Methotrexate?
LFTs | CBC
26
What dose of Folic Acid must be given in conjunction with Methotrexate?
5mg/week
27
What is the role of Folic Acid when given in conjunction with Methotrexate?
Reduces GI & Hepatic Toxicity
28
Contraindications of Methotrexate (5)?
``` Pregnancy Breastfeeding Blood Dyscrasias Immunodeficiency Liver Disease ```
29
Drug interactions with Methotrexate (3)?
Alcohol LIVE VACCINES Inactivated vaccines require revaccination 3 months after therapy is stopped)
30
What vaccines should be given prior to starting treatment with Methotrexate (5)?
``` Pneumonia Flu Hep B HPV Herpes Zoster ```
31
Black Box warning with Methotrexate (4)?
Toxicity of bone marrow, liver, lung, and kidney Skin reactions Hemorrhagic Enteritis GI perforation
32
What drug is typically combined with Hydroxychloroquine (Plaquenil) in the treatment of RA?
Methotrexate
33
How long does it take for Hydroxychloroquine to take effect after the start of treatment for RA?
3-6 months
34
What is the most significant adverse effect risk with Hydroxychloroquine?
``` Retinal Damage (producing irreversible blindness) Loss of vision is directly related to dosage, low doses only for long term use) ```
35
Adverse effects of Hydroxychloroquine (7)?
Retinal damage/vision loss Cardiomyopathy Varying degrees of AV heart block BBB Can prolong QT interval (increases risk for ventricular dysrhythmias) Hypoglycemia GI distress (taking with food or milk helps)
36
Monitoring parameters with Hydroxychloriquine | (1)?
Ophthalmologic exam before beginning therapy and at least every 6 months
37
Examples of Biologic DMARDs?
Etanercept (Enbrel) | Adalimumab (Humira)
38
Drug class of Biologic DMARDs?
Tumor Necrosis Factor Inhibitors
39
Monitoring parameters for Methotrexate?
LFTs (due to potential liver damage) CBC and platelets (due to immunosuppressant effects)
40
Long or short half-life with Hydroxychloriquie?
Extremely long 1/2 life of 40 days
41
MOA of Biologic DMARDs?
Specific immunosuppressant meds that target different parameters on the inflammatory cascade.
42
What is the delivery system of most biologic DMARDs?
Injection or Infusion
43
Black Box Warning with Etanercept (Enbrel)
Increased risk for serious systemic infections (TB and HBV) and sepsis
44
Drug Interactions with Etanercept (Enbrel)
Other immunosuppressant drugs
45
Adverse Effects Etanercept (Enbrel)
Significant immune suppression
46
Monitoring Parameters with Etanercept (Enbrel)
CBC Platelets *to monitor for significant infection
47
Patient education related to Etanercept (Enbrel)
TB tests Stay away from sick people (constantly immunosuppressed) NO LIVE VACCINES (inactivated only)
48
Can Adalimumab (Humira) be used in combination with methotrexate and/or other DMARDs?
YES, often is
49
Adverse Effects of Adalimumab (Humira)?
Significant immune suppression
50
Monitoring Perameters with Adalimumab (Humira)
CBC | Platelets
51
Patient Eduation related to Adalimumab (Humira)
TB tests, stay away from sick people (constantly immunosuppressed) NO LIVE VACCINES (inactivated only)
52
Example of Targeted DMARDs
Xeljanz
53
What class of drugs are Targeted DMARDs?
Janus kinase Inhibitors (JAK)
54
What is the delivery system of Targeted DMARDs?
Oral
55
Indications for use for Xeljanz?
Those who cannot take methotrexate or who did not respond well to Methotrexate
56
Adverse Effects of Xeljanz (4)?
Bone Marrow Supression Bradycardia (with prolonged PR intervals) Hyperlipidemia Increased occurrence of malignancies
57
Patient education regarding Xeljanz?
TB Tests Stay away from sick people (constantly immunosuppressed) NO LIVE vaccines (only inactivated)
58
Black Box warning for Xeljanz?
Development of potentially fatal infections (TB in particular)
59
Drug Interactions with Xeljanz (3)?
CYP inhibitors Other biologic DMARDs (DO NOT combine) Other immunosuppressant agents (DO NOT combine)
60
What do osteoCLASTS do?
Reabsorb (break down) old bone
61
What do osetoBLASTS do?
Deposit new bone and increase bone mass
62
Where does absorption of Ca take place?
Small intestine
63
How is Ca excreted?
Kidneys
64
What vitamin increases Ca reabsorbtion?
Vitamin D
65
What are common sources of Vitamin D?
Sun Diet Supplements
66
What happens to Vitiam D requirements with age?
They increase
67
What mineral is essential to maintain solid bone structure?
Calcium
68
What is the function of Vitamin D in the role of Ca?
Vitamin D is necessary in order for Ca to absorb well.
69
What are non-drug measures for preventing osteopenia/osteoperosis (3)?
Weight-bearing exercises Adequate Dietary Ca Supplemental Vit D/Ca when necessary
70
What are first-line drugs for Osteoporosis?
Calcium Salts
71
Examples of Ca Salts
Calcium Carbonate--Tums, Rolaids Calcium Citrate--Citracal
72
Adverse effects of Ca Salts?
Constipation | Diarrhea at high doses only
73
Calcium Salt Drug Interactions (4)?
Glucocorticoids (decrease absorbtion of Ca) Can decrease the effectiveness of some antibiotics (tetracyclines & quinolones) Can decrease the effectiveness of Thyroid medications Can decrease the effectiveness of some anti-seizure meds (Dilantin) Bisphosphonates (reduced absorption) ``` Thiazides (HYPERcalcemia) Loop Diuretics (HYPOcalcemia) ```
74
Can Calcium Salts be taken in conjunction with other medicines?
Ca salts should not be taken within 1 hour of other medicines (2 hours is better)
75
Ca Salt food interactions?
Oxalic acid (spinach, rhubarb, swiss chard, beets). These decrease the absorption of Ca.
76
Should Ca salts be taken with food or on an empty stomach?
Empty stomach
77
Types of Ca Supplements/Ca Salts (2)?
Calcium Carbonate | Calcium Citrate
78
Which is more widely used...Calcium Carbonate or Calcium Citrate?
Calcium Carbonate
79
Which is generally easier to tolerate...Calcium Carbonate or Calcium Citrate?
Calcium Citrate
80
Which is better absorbed...Calcium Carbonate or Calcium Citrate?
Calcium Citrate
81
Which is better for people with tendencies toward GI upset or other medication problems...Calcium Carbonate or Calcium Citrate?
Calcium Citrate
82
What class of drugs is the primary cornerstone treatment for osteoporosis in the US?
Bisphosphonates
83
MOA of Bisphosphonates?
Help improve bone density by decreasing the effectiveness of osteoCLASTS.
84
Examples of Bisphosphonates (4)
Fosamax Boniva Reclast Actonel
85
What drug class are Fosamax, Boniva, Reclast, Actonel?
Bisphosphonates
86
What is the most widely used/FIRST LINE Bisphosphonate for the treatment of osteoporosis?
Alendronate (Fosamax)
87
Alendronate (Fosamax) Indications for use (3)?
Osteoporosis in post menopausal women Osteoporosis in men Glucocorticoid induced osteoporosis
88
Alendronate (Fosamax) Indications for use (3)?
Osteoporosis in postmenopausal women Osteoporosis in men Glucocorticoid induced osteoporosis
89
How to decrease risk of esophagitis caused by Alendronate (Fosamax(?
``` Take with full glass of water Remain upright (seated or standing) for at least 30 min after taking it ```
90
How to decrease the risk of esophagitis caused by Alendronate (Fosamax and Actonel)?
``` Take with a full glass of water Remain upright (seated or standing) for at least 30 min after taking it ```
91
Alendronate (Fosamax) food interactions (3)?
DO NOT TAKE with: Food Coffee Orange Juice *Take on an empty stomach with water
92
MOA of Alendronate (Fosamax)?
Inhibits bone reabsorption by decreasing the activity of osteoCLASTS
93
MOA of Risedronate (Actonel)
Incorporates itself into the bone for you to 5 years to help strengthen bones
94
Risedronate (Actonel) Indications for use?
Osteoporosis in postmenopausal women Osteoporosis in men Glucocorticoid induced osteoporosis
95
Risedronate (Actonel) Adverse effects(3)?
Flu-like symptoms GI ESOPHAGITIS
96
Ibandronate (Boniva) indications for use?
Prevention and treatment of post-menopausal osteoporosis
97
Ibandronate (Boniva) formulations for administration (and frequency)?
PO-once a month IV-once every 3 months Depends on preference/tolerance
98
Ibandronate (Boniva) Adverse Reactions?
PO-Mostly GI | IV-can cause renal insufficiency
99
Should Ibandronate (Boniva) be taken on empty stomach or with food?
Empty stomach with water
100
How long should patients remain upright after taking Ibandronate (Boniva)?
SIXTY minutes | vs. 30 minutes for Fosamax and Actonel
101
Zoledronic Acid (Reclast) Indications for use?
Osteoporosis in postmenopausal women Osteoporosis in men Glucocorticoid induced osteoporosis
102
How is Zoledronic Acid (Reclast) administered?
IV ONLY | Once a year or once every 2 years
103
Zoledronic Acid (Reclast) Adverse effects
``` Transient fever and flu-like symptoms Kidney Damage (dose dependent) ```
104
Use Zoledronic Acid (Reclast) with caution in what patients?
Renal Insufficiency
105
Estrogen therapy for prevention of osteoporosis (discouraged by research)requires what two factors?
Intact Uterus | Progestin Administration
106
Indication for use of Evista?
Prevention and treatment postmenopausal osteoporosis AND | REDUCE RISK for breast cancer
107
Selective Estrogen Receptor Modulators (SERMS) are CONTRAINDICATED when...(3)?
Patients with estrogen dependent cancer Pregnancy Women of childbearing age
108
Example of Selective Estrogen Receptor Modulators (SERMS)?
Raloxifene (Evista) | Tamoxifien
109
What drug class is Teriparatide (Forteo)?
Man-made form of Parathyroid Hormone
110
Teriparatide (Forteo) Indication for use?
Osteoporosis in postmenopausal women Osteoporosis in men Glucocorticoid induced osteoporosis
111
MOA of Teriparatide (Forteo)?
Interferes with osteoCLASTS | Increases bone deposition by building more osetoBLASTS
112
How is Teriparatide (Forteo) adminisered?
Auto inject pen
113
Teriparatide (Forteo) Adverse Effects?
GI Effects | Transient bone pain/arthralgia
114
What bone mineralization drugs can be used in infants/children?
Calcium and Vitamin D ONLY
115
What bone mineralization drugs can be used in Pregnancy and breastfeeding?
Calcium and Vitamin D ONLY
116
Administration of bone mineralization drugs in older adults (3)?
Estrogen (BEERS criteria) Bisphosphonates (Increased risk of esophagitis) Do not continue therapies beyond 5 years

Pharm Exam 5 (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions