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*OldPharm > Arthritis > Flashcards

Arthritis Flashcards

1
Q

what is another name for osteoarthritis (OA)?

A

Degenerative joint Disease (DJD)

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2
Q

RIsk factors for OA?

A 
Age (>65)
Gender (women)
Obesity 
Activities w/ repetitive motion 
Genetics
Race (black women)
Osteoporosis
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3
Q

there may be an inverse relationship associated between OA and what?

A

osteoporosis

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4
Q

failure of the cartilage in the absence of any known underlying predisposing factor

A

Primary (idiopathic) osteoarthritis

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5
Q

is OA considered an inflammatory condition?

A

No

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6
Q

OA that occurs due to other disease states or trauma, i.e. metabolic or endocrine disorders or congenital factors

A

Secondary osteoarthritis

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7
Q

when is pain relieved w/ OA?

A

rest or removal of weight from joint, but as condition worsens pain may not be relieved by rest

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8
Q

how long does stiffness last w/ OA?

A

less than 30 minutes

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9
Q

what joints are most often affected in idiopathic oA?

A 
DIP and PIP of hand
First carpometacarpal joint
knees
hips
cervical and lumbar spine
first metatarsophalangeal MTP joint of toe
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10
Q

are there specific lab findings w/ OA?

A

No

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11
Q

bony enlargements (osteophytes) of the DIP joints. usually develop slowly, nonpainful, lateral and medial aspects of joint.

A

heberden’s nodes

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12
Q

bony enlargements of the PIP joints.

A

Bouchard’s nodes

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13
Q

what are some non-drug treatments w/ OA?

A 
rest
PT
ROM
muscle strengthening
assistive devices
diet- weight loss
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14
Q

what is the goal of drug therapy w/ OA?

A

relieve pain and inflammation

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15
Q

does OA drug therapy stop the progression of OA?

A

No, just treats where they are at

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16
Q

what analgesics are given for OA?

A 
Tylenol/ NSAIDs
topical capsaicin
gluconsamine/ chondroitin
intra-articular injection 
opioids
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17
Q

what intra-articular injections are available for OA?

A

corticosteroids

viscosupplementation- hyaluronic acid

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18
Q

No more than how many grams of tylenol per day?

A

3 grams/ day

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19
Q

what Inhibits release of substance P in peripheral nerves

A

topical capsaicin

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20
Q

when does topical capsaicin reach maximal efficacy?

A

after 2-4 weeks

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21
Q

Prepared from shells of crabs and other crustaceans

Substrate for production of articular cartilage

A

Glucosamine

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22
Q

how long does it take for symptoms to improve w/ glucosamine?

A

4-8 weeks

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23
Q

Prepared from bovine or porcine cartilage sources, takes longer than NSAIDs

A

Chonroitin sulfate

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24
Q

what steroids are used for OA (especially in knee)?

A

triamcinolone acetonide

methylprednisolone

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25
Q

what is the limit of corticosteroid injections in OA?

A

3-4 times per year

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26
Q

are oral corticosteroids recommended in OA?

A

No

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27
Q

what is a Naturally occurring glycosaminoglycan

that acts as a lubricants for the joint and helps replace the missing cartilage.

A

hyaluronic acid (HA)

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28
Q

what narcotics are used for OA?

A

propoxyphene

codeine/ oxycodone/ hydrocodone

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29
Q

is a chronic systemic inflammatory disease of the joints and related structures.

A

Rheumatoid Arthritis

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30
Q

what does RA attack?

A

Attacks the synovium and other vital organs and tissues

Eyes, heart, kidneys, blood vessels, and RBCs

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31
Q

prior to joint involvement, what will patients with RA experience?

A

prodromal symptoms- fever, fatigue, weakness, anorexia, joint pain, etc

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32
Q

when is RA the worse, and what improves it?

A

worse in the morning, improves w/ activity

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33
Q

What joints are most often involved in RA?

A

hands
wrist
feet

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34
Q

are joints warm with RA?

A

yes, but not as warm as w/ gout

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35
Q

what are some extra-articular involvements of RA

A 
Anemia
vasculitis
pulmonary complications
cardiac
ocular (decrease tear formation)
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36
Q

what is a syndrome with Splenomegaly, neutropenia, and thrombocytopenia associated w/ RA

A

Felty’s syndrome

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37
Q

Non-pharm treatments for RA

A

Rest, OT, PT, assistive devices
Weight reduction or management
Splinting, joint protection

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38
Q

What does DMARD stand for?

A

disease modifying anti-rheumatic drugs

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39
Q

when should you start DMARDs

A

within 3 months, selected based on specific issues

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40
Q

what are nonbiologics DMARDs

A 
Hydroxychloroquine 
Methotrexate 
Sulfasalazine 
Leflunomide 
Minocycline
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41
Q

What are Non-TNF biologics DMARDs

A

Abatacept
Rituximab
Tociluzimab

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42
Q

what are anti-TNF biologics DMARDs

A 
Etanercept 
Adalimumab 
Infliximab 
Golimumab
Certolizumab pegol
43
Q

With low disease activity, what should you start with?

A

Non-biologic medication

monotherapy

44
Q

With moderate disease activity and poor prognosis what therapy do you do?

A

Combine different DMARDs from different categories

45
Q

When do you start to add the anti-TNF and combo therapy

A

very progressed dz state

46
Q

what was hydroxychloroquine originally used for?

A

antimalarial medication

47
Q

First line option, weaker DMARD, good for a person w/ minimal symptoms. Can cause retinal toxicity.

A

hydroxychloroquine

48
Q

how often do you ahve to do an opthalmologic exam w/ hydroxychloroquine?

A

twice yearly

49
Q

does hydroxychloroquine cause liver, kidney or bone toxicities?

A

No

50
Q

what is the onset of hydroxychloroquine?

A

2-6 months

51
Q

ADRS w/ hydroxychloroquine

A

ocular toxicity
N/V/D (take w/ food)
derm- pruritis, rash, alopecia, increase pigmentation
neuro- HA, insomnia, vertigo

52
Q

Who is hydroxychloroquine C/I in?

A

significant visual, hepatic, or renal impairment

53
Q

Mainstay of therapy for patients not responding adequately to NSAIDS (moderate to severe RA). Need to replace folic acid w/ this med. best long term outcome of the DMRDs

A

Methrotrexate

54
Q

Time of onset w/ methotrexate

A

2 weeks - 2 months (max effect w/i 4-8 weeks)

55
Q

what mortality does methotrexate reduce?

A

CV morality

56
Q

ADRs w/ methotrexate

A

hematologic-thrombocytopenia, leukopenia (dose related)
stomatitis (and GI effect) - dose related
pulmonary fibrosis, pneumonitis
elevated liver enzymes

57
Q

NSAIDS may ______ methotrexate clearance and increase ADRs

A

decrease

58
Q

what is an antidote for methotrexate toxicity?

A

Leucovorin (folic acid derivative)

59
Q

what do you need to monitor w/ methotrexate? (every 1-2 months)

A

LFTS, CBC, total bilirubin
Hep B and C
serum creatinine, albumin

60
Q

Prodrug cleaved by bacteria in the colon into sulfapyradine and 5-aminosalicylic acid. treatment for mild RA or in combination

A

Sulfasalazine

61
Q

what should be monitored w/ sulfasalazine

A

CBC then q week for 1 month then q 1-2 months

62
Q

ADRs w/ sulfasalazine

A

lot of GI effects
HA
threatening rxs- d/c if this happens
(don’t use w/ sulfa allergy)

63
Q

Reversible inhibitor of DHODH interferes with RNA and DNA synthesis in lynphocytes
Reduces pain and inflammation w/ RA, slows structural damage

A

Leflunomide

64
Q

ADRs w/ Leflunomide

A

alopecia, rash

caution w/ liver dz

65
Q

what to monitor w/ Leflunomide

A

CBC and LFTs monthly

66
Q

pregnancy category w/ Leflunomide

A

X

67
Q

what washout must you do if a person has been on Leflunomide and wants to get pregnant

A

cholestyramine

68
Q

Soluble TNF receptor that competitively binds 2 TNF molecules rendering inactive
Additive effects when in combination with methotrexate

A

Etanercept

69
Q

Anti-TNF-alpha monoclonal Antibody (IgG)

Inhibits progression of structural damage

A

Infliximab and adalimumab

70
Q

what test do you need to get before starting biologics- TNF antagonist

A

tuberculin skin test

71
Q

what biolocis- TNF antagonists must be combined w/ methotrexate?

A

infliximab

72
Q

ADRs w/ infliximab

A

infusion rxn (pre treat w/ tylenol)

73
Q

ADRs of TNF antagonists

A

worsening of infectious complications
worsen heart failure
lupus-like syndromes, hepatotoxicity
may exacerbate MS

74
Q

IL-1 receptor antagonist used in moderate to severe RA. monotherapy and combo w/ MTX

A

Anakinra

75
Q

what monitoring is needed for Anakinra

A

none

76
Q

ADRs w/ Anakinra

A

injection site rxns

don’t use in combo w/ TNF antagonists

77
Q

what is Anakinra use reserved for?

A

failure after TNF antagonists

78
Q

Biologic medication- Inhibits T lymphocyte activation, used as monotherapy or w/ combo. soluble fusion protein.
Used for moderate- severe or refractory RA
Super expensive

A

Abtacept

79
Q

Depletes B lymphocytes, reducing antibody formation

Used in combo w/ MTX for moderate- severe RA w/ inadequate response to TNF antagonsits

A

Rituximab

80
Q

ROA for rituximab

A

IV infusion separated by 2 weeks

premedicate w/ methylprenisolone

81
Q

what drugs can you give for symptoms relief w/ RA

A 
NSAIDS 
oral prednisone (<10 mg/ day) 
intrarticular injection of glucocorticoids
opioids
surgical tx
82
Q

what are corticosteroids used for w/ RA

A

bridge to control debilitating symptoms until DMARDs take effect

83
Q

Metabolic disorder characterized by high levels of uric acid in blood

A

Gout

84
Q

what drug interferes w/ uric acid synthesis (gout)

A

allopurinol

85
Q

what increases uric acid excretion (gout) by inhibiting resorption of urate at proximal convoluted tubule

A

probenecid or sulfinpyrazone

86
Q

inhibits leukocyte entry into affect joing (gout)

Reduction of pain and inflammation w/in 12 hours of administration

A

cholchicine

87
Q

ADRs w/ colchicine

A

N/V/D
can give it until you have GI side effects
used for short term (don’t start other therapy until 3 days after)

88
Q

NSAID primarily used in Gout

A

Indomethacin

89
Q

ADRs w/ NSAIDS

A

HA
Dizziness
Risk of GI bleed
upset stomach

90
Q

ADRS w/ indomethacin

A

may aggravate depression or other CNS disturbances, epilepsy and parkinsonism.

91
Q

What drugs are C/I w/ gout due to inhibiting uric acid secretion in urine.

A

Aspirin and other salicylates

92
Q

how to prevent gout attacks

A

avoid heavy alcohol use
avoid foods rich in purines
weight loss

93
Q

what foods are rich in purines

A 
fish
poultry
meat
concentrated sweets
rich pastries
fried foods
94
Q

is allopurinol used in an acute gout attack?

A

No

95
Q

indications for allopurinol

A

Hyperuricemia of gout
Pts. w/allergy to uricosuric agents (probenecid, sulfinpyrazone)
Recurrent renal stones

96
Q

ADRs w/ allopurinol

A

GI side effects
jaundice, liver problems
acute exacerbation of gout

97
Q

Drug intreactions w/ allopurinol

A

Allopurinol interferes with metabolism of 6-mercaptopurine (anticancer agent) and
azathioprine

98
Q

when can you start probenecid and sulfinpyrazone?

A

after a gouty attack has subsided

99
Q

ADRs w/ probenecid

A

Ha, dizziness
GI side effects
uric acid stone (kidney stones)
exacerbation of gout

100
Q

what does probenecid block serction of?

A

PCN

101
Q

what does probenecid inhibit the excretion of?

A

naproxen, ketoprofen, and indomethacin

102
Q

probenecid and what have an additive effect?

A

sulfinpyrazone

103
Q

salicylate inhibit uricosuric effects of what?

A

probenecid and sulfinpyrazone

*OldPharm (12 decks)

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