Bone + Joints

Question 1

Probenecid, Sulfinpyrazole

Answer 1

Urate reabsorption inhibitor; chronic gout

Question 2

Hydroxychloroquine

Answer 2

Cytokine release modulator, inhibit lysosomal enzyme release and macrophage function; mild/early RA

Question 3

MTX

Answer 3

inhibits AICAR transformylase, increasing adenosine release; RA

Question 4

Prenisone, methylprednisolone

Answer 4

GR agonist, inhibit prostaglandin + leukotriene, reduce NF-Kb, suppress inflammatory cytokine, killing immune cells; advanced OA and unresponsive gout, acute flareups of RA, SE: osteoporosis, thin skin, moon-like facies, easy bruising, poor wound healing, abdo fat

Question 5

Allopurinol, Febuxostat

Answer 5

Xanthine oxidase inhibitor; chronic gout, SE: acute gout

Question 6

Indomethacin, naproxen, ibuprofen, sulindac, diclofenac

Answer 6

reversible, non-selective inhibitor of cyclooxygenase; acute gout attack, osteoarthritis- pain, fever, inflammation, SE: bleeding, peptic ulcer

Question 7

Leuflonomide

Answer 7

Pyrimidine synthesis inhibitor; RA

Question 8

Raloxifene

Answer 8

SERM, same actions as estrogen, no increased risk of breast/uterine CA; Osteoporosis prevention, SE: thromboembolic, hot flashes

Question 9

Adalimumab, infliximab

Answer 9

monoclonal Ab against TNF-a; RA, SE: risk of infection

Question 10

Colchicine

Answer 10

inhibits MT assembly, block replication of inflammatory cells; acute gout attack, SE: BM suppression, kidney/liver injury

Question 11

Acetaminophen

Answer 11

reversible COX inhibitor (cox2 in CNS); pain, fever, OA, SE: acute hepatitis

Question 12

Meloxicam

Answer 12

reversible, somewhat selective inhibitor of COX-2; OA- pain, fever, inflammation, SE: bleeding, peptic ulcer

Question 13

Hyaluronic acid

Answer 13

reduces breakdown of proteoglycans, protease inhibition, inhibition of prostaglanding synthesis; OA, increase joint lubrication, relieve pain

Question 14

Codeine, oxycodone, tramadol

Answer 14

mu receptor agonist; OA, SE: resp depression, constipation

Question 15

Anakinra

Answer 15

IL-1 receptor antagonist; RA, SE: risk of infection

Question 16

Sulfasalazine

Answer 16

COX inhibitor and 5-lipoxygnenase inhibitor, modulates B cell responses and angiogenesis; RA, UC

Question 17

Bisphosphonates (alendronate, risedronate, ibandronate)

Answer 17

Pyrophosphate analog, osteoclast inhibitor by inducing apoptosis; prevention/treatment of osteoporosis, paget disease

Question 18

Cyclosporine A

Answer 18

inhibits calcineurin, suppress T cell function and replication; refractory RA, SE: nephrotoxicity, diabetes, HTN, facial dysmorphology, risk of infection

Question 19

Aspirin

Answer 19

Irreversible, non-selective inhibitor of cyclooxygenase; osteoarthritis- pain, fever, inflammation, SE: bleeding, peptic ulcer

Question 20

Tofacitinib

Answer 20

JAK/STAT pathway inhibitor; RA, SE: risk of infection

Question 21

Teriparatide

Answer 21

PTH hormone agonist in pulsatile manner activates osteoblasts more than osteoclasts; Severe osteoporosis, contraindicated in bone cancer and pagets diseaseSE: ONJ

Question 22

Celecoxib

Answer 22

reversible, selective inhibitor of COX-2; pain, inflammation, OA, SE: thromboembolic events

Question 23

Denosumab

Answer 23

Monoclonal Ab against RANK-L (signal for maturation of osteoclasts); osteoporosis, bone mets, drug-induced bone loss, SE: ONJ

Question 24

Phenylbutazone

Answer 24

reversible, non-selective inhibitor of COX, inhibitor of urate reabsorption in kidney; acute gout attack, SE: bleeding, peptic ulcer

Question 25

Pegloticase

Answer 25

recombinant uricase that metabolizes urate to allantoin; severe chronic gout

Question 26

Etanercept

Answer 26

TNF-a receptor fused to Fc region; RA, SE: risk of infection

Question 27

Zoledronic acid

Answer 27

long-acting pyrophosphate analog, osteoclast inhibitor by inducing apoptosis; osteoporosis, paget disease, malignancy-associated hypercalcemia, bone mets, SE: ONJ