Arthritis and Gout Drugs

Question 1

Name the two non-selective NSAIDs and which of the following functions they provide: elimination of pain, slowing of disease progression or reduction of inflammation

Answer 1

Indomethacin and Naprozen; elimination of pain and reduction of inflammation only

Question 2

What are indomethacin and Naproxen used to treat?

Answer 2

rheumatoid arthritis and gout arthritis

Question 3

Name the class of selective NSAIDs and the functions they provide.

Answer 3

COX-2 inhibitors; eliminate pain and reduce inflammation

Question 4

What are COX-2 inhibitors used to treat?

Answer 4

conventional NSAID for RA

Question 5

What are the 2 common side effects of all NSAIDs?

Answer 5

gastric and duodenal ulcers; COX-2 inhibitors to a lesser extent

Question 6

Name 6 drugs classified as “disease modifying antirheumatic drugs” (DMARDS).

Answer 6

Gold Salts, Quinolones, glucocorticoids, sulfasalazine, methotrexate and leflunomide

Question 7

What is the mechanism of action of Gold Salts?

Answer 7

inhibits the functional activity of macrophages to repress immune response
rarely used anymore

Question 8

What is the mechanism of action of quinolones and what other disease can they be used to treat?

Answer 8

decreases T-Cell activation and chemotaxis; also used for SLE

Question 9

What is the mechanism of action of Glucocorticoids and what other disease can they be used to treat?

Answer 9

1. Inhibits phospholipase A2 (inhibiting release of arachidonic acid and, thus, formation of prostaglandins)
2. Inhibits cytokine production (which prevents induction of COX-2)
   * *also used for acute gout arthritis**

Question 10

What is the mechanism of action of Sulfasalazine?

Answer 10

inhibition of IL-1 and TNF-a release

Question 11

What is the mechanism of action of Methotrexate?

Answer 11

1. Inhibition of aminoimidazolecarboxamide (AICAR) transformylase and
   thymidylate synthetase, with secondary effects on PMN chemotaxis
2. Causes adenosine accumulation, which inhibits inflammation

Question 12

What is the mechanism of action of leflunomide?

Answer 12

Inhibits dihydroorotate dehydrogenase (DHODH), which inhibits T-lymphocyte response to stimuli

Question 13

What is a severe side effect of using quinolones and when are they used?

Answer 13

retinal damage; used when patients aren’t responding to NSAID’s anymore

Question 14

What type of symptoms can be a side effect of using glucocorticoids?

Answer 14

cushingoid symptoms

Question 15

When in the progression of RA are glucocorticoids used and why?

Answer 15

initially after dx because they start working before other drugs

Question 16

Which two DMARD’s cause GI symptoms and hepatotoxicity?

Answer 16

Methotrexate and Leflunomide

Question 17

What are some side effects of taking sulfasalazines?

Answer 17

skin rashes, neutropenia, headaches

issues with d/c

Question 18

Name the class of RA drugs: Etanercept, Infliximab, Adalimumab, Golimumab, Certolizumab, Anakinra, Tocilizumab, Rituximab and Abatacept

Answer 18

Biologic response modifiers

All used to treat RA

Question 19

Which of the following block response to TNF by inhibiting its interaction with the receptor? Etanercept, Infliximab, Adalimumab, Golimumab, Certolizumab, Anakinra, Tocilizumab, Rituximab and Abatacept

Answer 19

Etanercept, Infliximab, Adalimumab, Golimumab, and Certolizumab

Question 20

Which of the following is an IL-1 receptor antagonist? Etanercept, Infliximab, Adalimumab, Golimumab, Certolizumab, Anakinra, Tocilizumab, Rituximab and Abatacept

Answer 20

Anakinra

Question 21

Which of the following is an IL-6 receptor antagonist? Etanercept, Infliximab, Adalimumab, Golimumab, Certolizumab, Anakinra, Tocilizumab, Rituximab and Abatacept

Answer 21

Tocilizumab

Question 22

Which of the following is a monoclonal Ab that is Anti-CD20 (reduces # of B-cells)? Etanercept, Infliximab, Adalimumab, Golimumab, Certolizumab, Anakinra, Tocilizumab, Rituximab and Abatacept

Answer 22

Rituximab

Question 23

Which of the following inhibits T-Cell activation and induces T-Cell apoptosis? Etanercept, Infliximab, Adalimumab, Golimumab, Certolizumab, Anakinra, Tocilizumab, Rituximab and Abatacept

Answer 23

Abatacept

Question 24

Which of the Biologic response modifiers can elicit and antigenic response to murine monoclonal Ab?

Answer 24

Infliximab

Question 25

Which of the biologic response modifiers are fully human monoclonal Ab?

Answer 25

Adalimumab and Golimumab

Question 26

Which two of the biologic response modifiers pose a risk to developing serious infections?

Answer 26

Golimumab and Cartolizumab

Question 27

When is abatacept used and what are the possible side effects?

Answer 27

In patients for RA refractory to MTX or TNF-alpha inhibitors

side effects-headaches, infections

Question 28

When is Rituximab used and what are the possible side effects?

Answer 28

RA refractory to TNF-a inhibitors

side effects-infections and hypersensitivity reactions

Question 29

Name 4 drugs used to treat chronic tophaceous gout.

Answer 29

Probenecid, Allopurinol, Febuxostat and Pegloticase

Question 30

What is the mechanism of action of colchicine and what is it used for?

Answer 30

Prevents tubulin polymerization & inibits leukocyte migration, phagocytosis, and release of cytokines
treats acute gouty arthritis b/c it works in 12-24 hours

Question 31

What is the mechanism of action of Probenecid?

Answer 31

Inhibits urate reabs. by competing with urate at anionic transport site of renal tubule

Question 32

Which two drugs inhibit xanthine oxidase causing a decrease in uric acid synthesis?

Answer 32

Allopurinol and Febuxostat (nonpurine)

Question 33

What is the mechanism of Pegloticase?

Answer 33

converts uric acid to allantoin

Question 34

Which two drugs used to treat chronic tophaceous gout can actually cause an acute gout attack from urate crystal mobilization?

Answer 34

Probenecid and Allopurinol

Question 35

What are the side effects of using long term colchicine?

Answer 35

peripheral neuropathy and neutropenia