Week 6

Question 1

OA pain lasts how long in the morning?

Answer 1

Less than an hour

Question 2

First line therapy for OA:

Answer 2

Tylenol

Question 3

Tylenol is hard on what organ?

Answer 3

Liver

Question 4

Second line therapy in OA:

Answer 4

NSAIDS

Question 5

NSAIDS are hard on what organ?

Answer 5

Kidneys

Question 6

NSAIDS MOA:

Answer 6

Inhibits the conversion of arachidonic acid to prostaglandin, prostacyclin, and thromboxanes- all of which are mediators of pain and inflammation

Question 7

Which NSAID is Cox2 selective?

Answer 7

Celebrex

Question 8

Contraindications for NSAIDS:

Answer 8

Allergy to Asa, alcohol dependence, pregnancy

Question 9

Do not use Celebrex with:

Answer 9

Sulfa allergy and CV disease

Question 10

NSAIDs have a black box warning for:

Answer 10

An increase in CV adverse events and is contraindicated for perioperative pain treatment in patients undergoing CABG

Question 11

Adverse events of NSAIDs:

Answer 11

Visual changes, weight gain, ha, dizziness, nervousness, photosensitivity, fluid retention

Question 12

First line therapy for rheumatoid arthritis?

Answer 12

NSAIDs and start DMARDS ASAP

Question 13

Most common DMARD:

Answer 13

Methotrexate

Question 14

Methotrexate MOA:

Answer 14

A folic acid antagonist, thought to affect leukocyte suppression, decreasing the inflammation that results from immunologic by products

Question 15

Starting dose of methotrexate?

Answer 15

7.5 mg PO weekly up to a max of 25-30 mg weekly

Question 16

Methotrexate contraindicated in:

Answer 16

Pregnancy (cat x), lactation, leukopenia (wbc less than 3000), AIDS, renal impairment, or liver disease

Question 17

Adverse events of methotrexate:

Answer 17

Nausea and abdominal pain- most common
Oral ulcers, leukopenia, anemia
*take 1mg folic acid daily to minimize

Question 18

Baseline labs with methotrexate:

Answer 18

CBC, LFTs, BUN, serum creatinine

Question 19

Monitoring with methotrexate:

Answer 19

CBC every 4 weeks

BUN, creatinine, and liver function every 3 months

Question 20

DMARDS other than methotrexate:

Answer 20

Sulfasalazine (azulfidine)
Hydroxychloroquine (plaquenil)
Leflunimide (Arava)

Question 21

How long to see improvement with methotrexate?

Answer 21

3-8 weeks

Question 22

What should be taken with methotrexate?

Answer 22

1 mg of folic acid daily

Question 23

Sulfasalazine indicated in:

Answer 23

Patients with significant synovitis but no poor prognostic factors.

Question 24

Sulfasalazine dosage:

Answer 24

1000mg/d initial and increase to 2000 mg over 2 weeks. Max is 3000 mg

Question 25

Time to see effect with sulfasalazine?

Answer 25

May notice changes in 1 month with full results in 4 months

Question 26

Sulfasalazine is contraindicated in:

Answer 26

Sulfa allergy, G6PD, GI/GU tract obstruction, porphyria

Question 27

Adverse events of sulfasalazine:

Answer 27

N/D, dizziness, oral ulcers, Orange-yellow pigment of the skin, HA, depression

Question 28

Anti malarial agent that cannot limit the progression of RA- indicated for patients as adjunct to methotrexate or as a single agent therapy in early/mild RA without bone erosion.

Answer 28

Hydroxychloroquine (plaquenil)

Question 29

Dosage of plaquenil:

Answer 29

200 mg BID or 400mg daily

Question 30

When to see an effect with plaquenil:

Answer 30

2-6 months

Question 31

Plaquenil is contraindicated in:

Answer 31

Retinal field changes due to ocular effects of long-term therapy

Question 32

Adverse events of plaquenil:

Answer 32

N/V/D, skin pigmentation changes, rash

Question 33

Exerts anti inflammatory and anti proliferative actions, retarding erosions and joint space narrowing.

Answer 33

Leflunomide (arava)

Question 34

Arava is:

Answer 34

Usually mono therapy and a last resort

Question 35

Arava is contraindicated in:

Answer 35

Pregnancy, lactation, alcoholism, and liver disease

Question 36

First targeted synthetic DMARD available

Answer 36

Togacitinib (xelinjax)

Question 37

TNF alpha inhibitors:

Answer 37

Humira, Enbrel, Remicade

Question 38

These agents bind to the circulating TNF alpha and render it inactive. This results in reduced infiltration of inflammatory cells into joints

Answer 38

TNF alpha inhibitors

Question 39

How quickly do TNF alpha inhibitors work?

Answer 39

May take days to weeks to see results (2-4 weeks)

Question 40

Contraindications of TNF alpha inhibitors:

Answer 40

Untreated hepatitis B, class 3-4 HF patients, patients at risk of infections. Not recommended for patients with a treated solid malignancy in 5 years.

Question 41

Adverse events of TNF alpha inhibitors:

Answer 41

Increased risk of infection, HF, and skin cancer

Question 42

Indicated for the treatment of moderate to sever RA as monotherapy or incombo with csDMARDs. Blocks t-cell and TNF.

Answer 42

Abatcept (Orencia)

Question 43

Contraindications of Orencia:

Answer 43

Use in caution in patients with a history of infections or COPD.

Question 44

First line therapy for chronic gout?

Answer 44

Allopurinol and febuxostat (Uloric)

Question 45

Allopurinol MOA:

Answer 45

Acts directly on purine metabolism

Question 46

Adverse events of allopurinol:

Answer 46

N/V/D, rash

Question 47

Monitoring with allopurinol:

Answer 47

Draw Utica acid levels every 2-5 weeks during titration until desired level is reached, which may take up to 6 months

Question 48

Used for chronic gout when at least one XOI is contraindicated or not tolerated

Answer 48

Probenecid

Question 49

MOA of probenecid:

Answer 49

Increases the excretion of serum Utica acid

Question 50

How long to see effect of probenecid?

Answer 50

Serum uric acid levels will begin to decrease within 2 weeks but may take up to 6 months to see full effect

Question 51

Contraindications for probenecid:

Answer 51

Do not give during acute gout attacks, blood dyscrasias, uric acid kidney stones, or children less than 2

Question 52

Drink 2 liters or more of water a day with:

Answer 52

Probenecid

Question 53

Last line therapy for patients with chronic gout that had not been successfully treated with either an XOI or probenecid

Answer 53

Pegloticase (krystexxa)

Question 54

Used for acute gout attack:

Answer 54

Colchicine

Question 55

Colchicine MOA:

Answer 55

Decreases the inflammation and pain associated with a gout attack.

Question 56

Colchicine dosing:

Answer 56

Take 1.2 mg at first sign of gout flare followed by 0.6 mg 1 hour later

Question 57

How long to see effect with colchicine?

Answer 57

Will provide pain relief in 18-24 hours with full anti inflammatory effect in 48 hours

Question 58

Adverse events with colchicine?

Answer 58

GI effects particularly diarrhea

Question 59

Nonselective NSAID used in gout. Take 3 times a day with food.

Answer 59

Indomethacin

Question 60

Which chronic gout med can increase gout flares on initiation?

Answer 60

Febuxostat