Anti-inflammatory agents/ DMARDS/ Anti-gout

Question 1

It is a non-selective COX inhibitor that is the only irreversible one. This is mostly used as an anti-platelet. They are used to prevent clot formation or thrombosis and is one of the emergency regimens for ACS. It is given 80 mg once daily

Answer 1

Aspirin

Question 2

It is one of the propionic acid derivatives that has less irritation than ASA but should not be given with it

Answer 2

Ibuprofen

Question 3

It is one of the propionic acid derivatives that has the longest half-life/ duration of action. It is C/I in patients with previous history of MIand those who had stroke who underwent CABG
ADR: Severe gastric irritation, emergence of MI

Answer 3

Flurbiprofen

Question 4

The propionic acid derivatives of non-selective COX inhibitors

Answer 4

Ketoprofen
Ibuprofen
Flurbiprofen

Question 5

It is a non-selective COX inhibitor that has minimal gastric irritation

Answer 5

Naproxen

Question 6

It is the only non-acid derived NSAID because it is a ketone

Answer 6

Nabumetone

Question 7

They are non-selective COX inhibitors used for post-operational therapy as substitutes for morphine

Answer 7

Etodolac
Ketorolac

Question 8

It is a non-selective COX inhibitor that is related to sulfonamide
ADR: SJS

Answer 8

Sulindac

Question 9

It is a non-selective COX inhibitor that inhibits PLA2. It is used for the closure of Patent Ductus Arteriosus and is given through the IV route (if unavailable, use paracetamol IV)

Answer 9

Indomethacin

Question 10

Non-selective COX inhibitors

Answer 10

Aspirin
Ibuprofen
Ketoprofen
Flurbiprofen
Naproxen
Nabumetone
Etodolac
Ketorolac
Piroxicam
Sulindac
Indomethacin

Question 11

COX-2 Selective Drugs

Answer 11

Celecoxib
Parecoxib
Etoricoxib
Lumiracoxib (phased out)
Valdecoxib (phased out)
Rofecoxib (phased out - due to thrombus formation)

Question 12

It is a group of drugs used for RA that is used for pain. It is used for acute cases but it cannot stop the formation of new deformity and do not slow the progression of the disease

Answer 12

NSAIDS

Question 13

It is a group of drugs used for RA for severe pain. It is too toxic for chronic use, so it is recommended for acute treatment only.
ADR: Cushing syndrome (chronic use); adrenal crisis (sudden stop)

Answer 13

Glucocorticoids

Question 14

This is the main treatment which addresses the cause of RA. It is used in chronic cases as it prevents the formation of a new deformity and arrest the progression of the disease. They act as immunosuppressants
ADR: immunocompromised

Answer 14

DMARDS

Question 15

DMARDS

Answer 15

Abtacept
Azathioprine
Cyclophosphamide
Cyclosporine
Chloroquine and hydroxychloroquine
Methotrexate
Mycophenolate
Sulfasalazine
Leflunomide
TNF alpha blocker: infliximab, adalimumab, etanercept

Question 16

This is a DMARD that targets the CD80 and CD86, which are responsible for sending signals to the immune cells to attack
ADR: URTI

Answer 16

Abatacept

Question 16

This is a DMARD prodrug that is converted to 6-thioguanine and this can inhibit the DNA synthesis by affecting the inosinic acid production

Answer 16

Azathioprine

Question 17

It is a DMARD and an anti-cancer agent that acts as an alkylating agent- it donates an alkyl group to the DNA strand
ADR: Leukopenia, NDV, Hemorrhagic cystitis (rescue drug: Mesna)

Answer 17

Cyclophosphamide

Question 18

It is a DMARD that targets calcineurin
ADR: hirsutism and gingival hyperplasia

Answer 18

Cyclosporine

Question 19

It is a DMARD that is now an anti-malarial drug
ADR: Ocular toxicity and prolongation of QT interval

Answer 19

Chloroquine and hydroxychloroquine

Question 20

It is a DMARD that inhibits dihydroorotate dehydrogenase that is used in purine and pyrimidine synthesis
ADR: GI toxicity and hepatotoxicity

Answer 20

Leflunomide

Question 21

It is the current DMARD of choice that inhibits the folate synthesis by inhibiting:
AICAR Transformylase
Thymidylate synthetase
Dihydrofolate reductase
Rescue drug is folinic acid/ leucovorin
ADR: Mucositis

Answer 21

Methotrexate

Question 22

It is a DMARD that inhibits cytosine monophosphate (CMP). Its full name is mycophenolate mofetil
ADR: Aplastic anemia

Answer 22

Mycophenolate

Question 23

It is a DMARD that is a sulfonamide, and its metabolite, sulfapyridine, is the one giving the drug action
ADR: SJS

Answer 23

Sulfasalazine

Question 24

It is a DMARD that inhibits THF alpha
ADR: reactivation of tuberculosis

Answer 24

TNF alpha blockers

Question 25

They are DMARDs that are monoclonal antibodies

Answer 25

Infliximab and Adalimumab

Question 26

It is a DMARD that blocks the TNF alpha receptor
ADR: TB

Answer 26

Etanercept

Question 27

This is a drug for acute gout that inhibits tubulin synthesis which is important for WBC migration. It has a short DOA and is C/I to patients undergoing dialysis
ADR: Diarrhea, GI disturbance, Hepatotoxicity, Nephrotoxicity, Alopecia

Answer 27

Colchicine

Question 28

This is a drug for chronic gout that is a xanthine oxidase inhibitor. It prevents the conversion of purine to uric acid. It is a prodrug with an active metabolite called alloxanthine

Answer 28

Allopurinol

Question 29

This is a drug for chronic gout that is the first non-purine xanthine oxidase inhibitor. It prevents the conversion of purine to uric acid

Answer 29

Febuxostat

Question 30

These are drugs for chronic gout that are used to inhibit the reabsorption of uric acid in PCT. They are known to be uricosuric agents

A drug from this class has an important interaction with penicillin. It prolongs the half-life of penicillin by inhibiting the tubular secretion of penicillin. However, prolonged duration makes penicillin toxic

Answer 30

Probenecid and Sulfapyrazone

Probenecid