wolff crosswards- OA, gout Flashcards by Fatima Bilal

Hormone that acts to increase free Ca2+ levels in the plasma, does this increasing bone breakdown promoting reabsorption of Ca 2+ in kidney, and promoting generation of calcitriol

PTH

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Often the dose-limiting adverse effect when colchicine is administered for gout prophylaxis

GI Distress

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Late choice biologic DMARD due to limited efficacy, it is a recombinant version of endogenous human Il-1 receptor antagonist

Anakinra

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Supplementation of this is recommendation for people prescribed methotrexate and/or sulfasalazine for the treatment of RA

Folate

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Abruptly doing this with exogenous glucocorticoids can be deadly

Stopping

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Needed to hasten the nevertheless sow-onset responses for DMARDs such as hydroxychloroquine and leflunomide because of their long half-life

Loading Dose

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Calcitonin from this species has a longer half-life and greater potency than human calcitonin

Salmon

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Agent used as a traditional DMARD alone or in combination and also to treat IBD, GI side effects are a common reason for discontinuing

Sulfasalazine

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Absolute contraindication for treatment of RA with methotrexate, reason to choose hydroxychloroquine instead

Pregnancy

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Drugs that lower serum urate levels by increasing its fractional excretion by the kidneys

Uricosuric

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Very effective pain relievers, unfortunately have a high risk of abuse and misuse so not used for pain of osteoarthritis etc

Opioid

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Biologic DMARD, generally not initial choice, a fusion protein blocks T- cell CD80/86 co stimulatory signal needed for activation

Abatacept

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Microscopic canals between the lacunae of ossified bone; large enough for bacterial but too small for white blood cells so healing with osteomyelitis requires wither that efficacious abx can reach bacteria or that infected bone is removed

Canaliculi

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COX-2 inhibitor that can be administered to treat pain and inflammation of RA if benefits>risks; only member of its class is still marketed in the US

Celecoxib

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Intense and historically feared during acute gout attack

Pain

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Part of dietary intake ( DNA, RNA) that is abundant in, for example organ meats, also synthesized and salvaged as necessary

Purines

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Nonpegylated recombinant uricase administered for prevention of acute uric acid nephropathy due to tumor lysis syndrome

Rasburicase

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Refers to person with hyperuricemia due to excess synthesis, excess dietary intake and/or excess cell turnover

Overproducer

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PEGylated version of recombinant mammalian uricase uses to treat chronic gout in those refractory to conventional therapy

Pegloticase

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Biologic DMARD, generally a later choice, that is humanized antihuman 1L-6 receptor antibody among its effects is to decrease the acute- phase response to liver

Tocilizumab

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Should not be administered to RA patients due to the risk of infection

Live Vaccines

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Blocking the effects of this inflammatory mediator is a common target when treating RA and various other autoimmune disease

TNF- Alpha

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SNRI that is being used to treat osteoarthritis with some success but increased risk for constipation is problematic

Duloxetine

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Important non-pharmacological component of RA management

Exercise

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This of the malignancy can be treated with bisphosphonates or furosemide

Hypercalcemia

Non- Aspirin NSAID with long half-life that can be useful for treating inflammation and/or pain of arthritis a recommendation drug choice when benefits still outweigh concurrent cardiovascular risks

Naproxen

Refers to the use of methotrexate, hydroxychloroquine and sulfasalazine together to treat RA

Triple Therapy

Autoantibodies present in majority of RA patients target arginine residues in proteins that have been converted to a cyclic form of this

Citrulline

Can occur in people using bisphosphonates (or denosumab) jaw is a common site where it can be triggered by dental work = osteonecrosis

Osteonecrosis

Associated with high serum urate levels (and gluttony), exquisitely painful with big toe being a frequent site

Gout

Anti- malarial that is also a traditional DMARD used alone or in combination, alters antigen presentation by disrupting lysosomal pH

Hydroxychloroquine

Happens to methotrexate, appears to be responsible for its low-dose ability to treat RA and reasons its beneficial effects persist for some time after drug discontinuation

Polyglutamation

Type of bone that is broken in the atypical femoral fractures seen with bisphosphonate treatment

Cortical

Patient population at greater risk for serious adverse effects of NSAIDs…and risk for osteoarthritis

Elderly

Expensive non-purine/noncompetitive xanthine oxidase inhibitor useful for reducing urate levels in those with allopurinol intolerance

Febuxostat

Bisphosphonate administered by IV injection once per year; also associated with highest incidence of osteonecrosis of jaw

Zoledronic Acid

Not altered by use of NSAIDs or glucocorticoids in RA

Disease progression

Methotrexate, hydroxychloroquine and sulfasalazine are examples of this type of DMARD

Traditional

Class of drugs widely used for the treatment of pain and inflammation, but significant cardiovascular/respiratory/renal/GI contraindications and can cause hypersensitivity reactions skin reactions

NSAIDs

Refers to the response that can occur in people when foreign peptides or proteins are injected

Hypersensitivity

Calcium- receptor sensitizer, acts to lower PTH secretion in chronic kidney disease

Cinacalcet

Ensuring adequate intake of this is a means of decreasing risk for osteoporosis

Vitamin D

Chimeric ( human and mouse) monoclonal antibody directed against TNF- alpha that can be administered IV every 6 weeks as a biologic DMARD

Infliximab

Anti-TNF- biologic DMARD, this is humanized monoclonal antibody administered subq every 2 weeks; also used for psoriatic arthritis, ankylosing spondylitis Crohns disease ; top selling drug in the world ( Humera))

Adalimumab

JAK3 antagonist used as a biologic DMARD, novel in that it is orally active

Tofacitinib

Poorly soluble end product of purine, metabolism in humans, cause of kidney stones

Uric Acid

Glucocorticoids, prednisolone prodrug, short-term use is useful in therapy for RA until DMARD effects are seen

Prednisone

Refers to receptor activator of nuclear factor kappaB ligand, its ratio to OPG in the bone microenvironment governs the formation/activation of osteoclasts

RANKL

Dexamethasone, betamethasone and triamcinolone are among the______ prednisolones, which have much greater potency and/or half-time than natural hydrocortisone

Fluorinated

Blocks urate reabsorption by URAT1 transporter in proximal tubule to increase fractional excretion of filtered urate in urine

Probenacid

Along with chondroitin, widely used in hope of treating osteoarthritis but little evidence of benefit beyond placebo effect

Glucosamine

Route of administration required whenever administering peptides, antibodies, or fusion proteins

Parenteral

Parenteral route for administration of calcitonin- salmon

Intranasal

Accumulates outside of the cells as a consequence of AICAR accumulation inside cells due to the action of polyglutamated methotrexate; binds to purinergic GPCR on cell surface to exert anti-inflammatory response

Adenosine

Never do this with biologic DMARDs

Combine Them

Dietary supplements for adolescents, postmenopausal women and elderly to treat mild hypocalcemia ( to facilitate bone growth or limit bone loss)

Calcium Salts

Targets CD20 antigen of B cells to cause a B cell “do-over”, used to treat non-Hodgkin’s lymphoma and chronic lymphocytic leukemia, and can be effective in some antibody- dependent autoimmune diseases

Rituximab

Relieves inflammation from gout if administered w/in 12-24 hours of symptom onset by blocking the tubulin polymerization (microtubule formation) needed by leukocytes for migration and phagocytosis

Colchicine

Allopurinol is among the widely used drugs that can cause this potentially fatal syndrome of epidermal necrolysis

Stevens Johnsons Syndrome

1-34 PTH, only agent that forms bone but must be administered in a PULSED manner…otherwise leads to bone resorption

Teriparatide

Drug class associated with atypical bone fractures

Bisphosphonates

Most effective and fastest acting of the traditional DMARDs, monitor for myelosuppression but generally well tolerated at low doses, often added to biologic DMARDs

Methotrexate

Person with hyperuricemia due to lower than normal fractional excretion of urate or low GFR necessitating higher urate plasma concentrations to adequately filter/eliminate urate production per minute

Underexcreter

Noteworthy because it suppresses fever and pain but not inflammation, presumably in part by inhibiting prostaglandin synthesis in the CNS; no longer recommended as first-line therapy for osteoarthritis pain, used as adjunct for pain relief in RA

Acetaminophen

Word applying to pain in joints that suggests a systemic disease such as RA

Bilateral

Fusion protein made from Fc portion of IgG and two TNF receptors, a biologic DMARD administered 1-2x wk by sc injection also used for psoriasis

Etanercept

Refers to 1, 25 dihydroxy vitamin D, a hormone of calcium homeostasis that increases Ca2+ absorption from gut and reabsorption in kidney

Calcitriol

Gouty form of this is due to precipitation of uric acid in tubules if acute and, if chronic, interstitial accumulation of monosodium urate

Nephropathy

A classic NSAID with COX-1 selective, remains a drug of choice for treating acute gouty arthritis

Indomethacin

Prototypical bisphosphonate, drug class of first choice for treating osteoporosis in both women and men, its incorporation into bone inhibits the number and activity of osteoclasts

Alendronate

Increases the risk for developing gout

Hyperuricemia

NSAID ingredient of topical gel that is perhaps the most effective topical pain remedy for osteoarthritis

Diclofenac

Hormone that acts to lower free Ca2+ levels in the plasma, does this in part by suppressing bone breakdown

Calcitonin

Type of therapy for prostate cancer that increase patient risk for developing osteoporosis

Androgen Deprivation

Disrupts pyrimidine synthesis, a second-choice traditional DMARD due to greater prevalence of more serious adverse effects

Leflunomide

Damage to serious side effect of hydroxychloroquine, but little risk from low doses now used to treat RA

Retinal Damage

General name referring to infections more commonly seen in patients using a biologic DMARD

Opportunistic

Uricoduric agent acting similar to probenecid, both require GFR>60 ml/min

Sulfinpyrazone

Competitive xanthine oxidase inhibitor that lowers serum urate levels, preferred/standard of care therapy for treatment of recurrent gout if low GFR or past urate stone of urate overproduction

Allopurinol

SERM with agonist effects on bone but not breast or uterus that is used to treat osteoporosis

Raloxifene

Mammalian enzyme that converts uric acid to allantoin, in mutated/nonfunctional in humans

Uricase

Refers to gout needing a management plan that lowers plasma urate levels

Recurrent

______ urate forms negatively birefringent needle- shaped crystals that can precipitate in and around joints, ear helices, soft tissue, etc, and can impale neutrophils during phagocytosis

Monosodium

Abundant evidence shows people can have this type of predisposition for gout

Genetic

For gout, low-dose colchicine or low-dose NSAIDs can be administered with this as a goal

Prophylaxis

Large aggregations of monosodium urate crystals surrounded by intense inflammatory reaction including large foreign- body giant cells; pathogonomic hallmark of gout

Tophi

Osteoporosis monoclonal antibody therapy that binds RANKL to lower its bone microenvironment levels relative to OPG, and thereby decrease formation and function of osteoclasts

Denosumab

Patients with pain due to RA are often administered NSAIDs or glucocorticoids despite their lack of effect on disease progression while waiting for a drug from this broad class to begin exerting its effects

DMARD

wolff crosswards- OA, gout Flashcards

(88 cards)