Anti-inflammatories, Biologics, Corticosteroids, Gout, & Osteoporosis

Question 1

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

Answer 1

Pegloticase

Question 2

Can occur in the jaw of people using bisphosphonates (or denosumab); can be triggered by dental work

Answer 2

Osteonecrosis

Question 3

Osteoporosis monoclonal antibody therapy that binds RANKL (receptor activator of nuclear factor kappaB ligand) to decrease formation and function of osteoclasts

Answer 3

Denosumab

Question 4

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

Answer 4

DMARD

Question 5

Classic NSAID with COX1 selectivity, remains a drug of choice for treating acute gouty arthritis

Answer 5

Indomethacin

Question 6

Uricosuric agent acting similar to probenicid, both require GFR >60 ml/min

Answer 6

Sulfinpyrazone

Question 7

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

Answer 7

Leflunomide

Question 8

Anti-TNF biologic DMARD, this humanized monoclonal antibody is administered subcutaneously every 2 weeks; also used for psoriatic arthritis, ankylosing spondylitis, and Crohns disease

Answer 8

Adalimumab

Question 9

Antagonist at NMDA-type glutamate receptors that relieves pain; also used to reduce amount of morphine needed by humans; adverse effects include agitation and hallucinations

Answer 9

Ketamine

Question 10

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

Answer 10

Etanercept

Question 11

_________ of methotrexate is associated with its low-dose ability to treat RA and the persistence of beneficial effects for some time after drug discontinuation

Answer 11

Polyglutamation

Question 12

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

Answer 12

Triple therapy

Question 13

Relieves inflammation from gout if administered within 12-24 hrs of symptom onset by blocking the tubulin polymerization (microtubule formation) needed by leukocytes of migration and phagocytosis; can cause GI distress when used for prophylaxis

Answer 13

Colchicine

Question 14

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

Answer 14

Uricase

Question 15

Biologic DMARD of limited efficacy, recombinant version of endogenous human IL-1 receptor antagonist

Answer 15

Anakinra

Question 16

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

Answer 16

Cinacalcet

Question 17

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

Answer 17

Methotrexate

Question 18

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

Answer 18

Stevens Johnson

Question 19

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

Answer 19

Rasburicase

Question 20

Blocking the effects of ______ inflammatory mediator is a common target in tx of RA and various other autoimmune diseases

Answer 20

TNF

Question 21

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

Answer 21

Inflixumab

Question 22

COX-2 inhibitor that can be administered to tx pain and inflammation of RA if benefits > risks (e.g., if pt has ulcers, bleeding risk); only member of its class still marketed in US

Answer 22

Celecoxib

Question 23

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

Answer 23

Tofacitinib

Question 24

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

Answer 24

Febuxostat

Question 25

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

Answer 25

Probenicid

Question 26

Alpha-2-adrenergic agonist administered IV for pain and sedation

Answer 26

Dexmedetomidine

Question 27

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

Answer 27

Sulfasalazine

Question 28

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

Answer 28

Prednisone

Question 29

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

Answer 29

Glucosamine

Question 30

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

Answer 30

Retina

Question 31

Targets CD20 antigen of B cells to cause a B cell “do-over”, used to treat NHL and CLL and can be effective in some antibody-dependent autoimmune diseases

Answer 31

Rituximab

Question 32

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

Answer 32

Pregnancy

Question 33

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

Answer 33

Zolendronic acid

Question 34

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

Answer 34

Uricosurics

Question 35

Refers to the pt with hyperuricemia due to excess synthesis, excess diet intake, and/or excess cell turnover (e.g., tumor lysis syndrome)

Answer 35

Overproducer

Question 36

Antimalarial also used as a traditional DMARD; used alone or in combo, alters antigen presentation by disrupting lysosomal pH

Answer 36

Hydroxychloroquine

Question 37

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

Answer 37

Teriparatide

Question 38

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

Answer 38

Traditional

Question 39

Biologic DMARD that is a humanized antihuman IL-6 receptor antibody, among its effects is to decrease acute-phase response of liver

Answer 39

Tocilizumab

Question 40

Drug class associated with atypical bone fractures (e.g., simple fracture of compact bone like femur)

Answer 40

Bisphosphonates

Question 41

Calcitonin from this species has a longer half-life and greater potency than human calcitonin, can be administered intranasally or parenterally to treat established osteoporosis

Answer 41

Salmon

Question 42

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

Answer 42

Adenosine

Question 43

Competitive xanthine oxidase inhibitor that lowers serum urate levels, preferred/standard-of-care therapy for tx of recurrent gout if low GFR or past urate stone or to reduce effects of urate overproduction (e.g., due to tumor lysis)

Answer 43

Allopurinol

Question 44

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

Answer 44

Raloxifene

Question 45

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

Answer 45

Alendronate

Question 46

Biologic DMARD, fusion protein blocks T cell CD80/86 co-stimulatory signal needed for activation

Answer 46

Abatacept