Content

Question 1

Localized deep, aching pain
Early am stiffness
crepitus
instability of weight bearing joints

Answer 1

osteoarthritis

No lab test –> diagnosed by clinical presentation

Question 2

OA - general pharmacology

Answer 2

APAP
NSAIDS, COX 2 inhibitors
Corticosteroids - oral and injectable
Hyaluronate
Glucosamine

Question 3

Acetonide, Diacetate, Hexacetonide - class?

Answer 3

injectable CS

Question 4

How often can you give injectable CS for OA?

Answer 4

q 4-6 months (max 3-4 times year)

Question 5

Injectable CS risks

Answer 5

scarring and infection

Never inject an infected joint

Question 6

What can be given for pain management in patients with OA that fail pharmacological and analgesic therapy?

Answer 6

Hyaluronate injections (only for the knee)

Question 7

Hyaluronate injections - MOA

Answer 7

replicates viscoelastic properties

Question 8

Supartz, Synvisc, Hyalgan, Nuflexxa - class?

Answer 8

Hyaluronate injection

Question 9

Hyaluronate injection - caution and education

Answer 9

Caution: allergy to avian protein, eggs, feathers

Avoid weight bearing x 48 hrs (b/c given with 18-22g and med can leak out the track)

Question 10

OTC product to reduce arthritic pain and slow narrowing of joint

Answer 10

Glucosamine

No SE, No DDI, well tolerated, works for 40-50%

Question 11

Gout - acute treatment options

Answer 11

Colchicine
NSAIDS
corticosteroids

Question 12

Gout - chronic treatment options

Answer 12

Allopurinol or Febuxistat
Colchicine
Colchicine + Probenacid
Pegloticase (Krystexxa)

Question 13

Gout treatment option if resistant case or not able to take Colchicine or NSAIDS

Answer 13

CS
Injectable triamcinolone hexacetonide if single joint
Oral prednisone x 3-5 days then taper over 10-14 days to avoid rebound

Question 14

Why are xanthine oxidase inhibitors not given in acute gout attack?

Answer 14

may cause the uric acid crystals to mobilize and settle in another joint (but if on for chronic management, can keep giving)

Question 15

What urate-oxidase enzyme can be given as the last resort for gout treatment?

Answer 15

Pegloticase (Krystexxa)
Given IV (premeditate for infusion reaction Antihistamine + CS)

Question 16

When is Krystexxa contraindicated?

Answer 16

G6PD

Question 17

Krystexxa adverse reactions/SE

Answer 17

anaphylaxis
infusion reaction
gout attack
HF exacerbation

Question 18

Diet management for gout

Answer 18

decrease red meat (high in blood = purine)

Question 19

Probenacid, Sulfinpyrazone - class?

Answer 19

uricosuric agents

Question 20

Uricosuric agents - MOA

Answer 20

increase renal uric acid clearance by inhibiting renal tubual reabsorption

Question 21

Methotrexate, Azathioprine, Hydroxychloroquine, Leflunomide - class?

Answer 21

DMARDS

Question 22

Why are DMARDS used for RA?

Answer 22

reduce and prevent join damage (start within 3 months of diagnosis)

Question 23

Education - DMARDS

Answer 23

can take 1-6 months
give NSAIDs +/- steroids until effective
effective contraception (teratogenic)

Question 24

RA - DOC

Answer 24

Methotrexate

if fails, combine with biologic agent

Question 25

Antidote Methotrexate

Answer 25

Leucovorin

Question 26

Azothiaprine (Immuran) DDI

Answer 26

Allopurinol and febuxostate (increases levels of allopurinol and increases risk for myelosuppression)
decrease azothiaprine 1/3 to 1/2

Question 27

Adalimubab (Humira), Infliximab (Remicade) - class?

Answer 27

TNF alpha antagonists

Question 28

TNF alpha antagonists SE

Answer 28

worsening of CHF (Caution: do not use in NYHA III and IV CHF)
Increased invasive infections (listeria, viral, fungal, etc.)
Increased risk of TB (must to skin test to check latent TB)

because decreases immune system

Question 29

Amphetamine derivative - MOA

Answer 29

increase release of norepinephrine and dopamine

Question 30

Methylphenidate product - MOA

Answer 30

inhibits re-uptake of norepinephrine and dopamine

Question 31

Lisdexamphetamine - advantage over other stimulants

Answer 31

PO - only absorbed from GI tract (less chance of diversion)

Question 32

Which stimulant comes as a patch?

Answer 32

Methylphenidate

Question 33

Atomoxetine (Straterra), Clonidine, Guanfacine - Stimulants or non-stimulants?

Answer 33

Non-stimulants

Question 34

Alzheimer’s - DOC

Answer 34

Donepizil (Cholinesterase Inhibitor)

best tolerated - less N/V

Question 35

Donepazil, Rivastigmine, Galantamine - class?

Answer 35

Cholinesterase Inhibitors (AChEl)

Question 36

AChEl - SEs

Answer 36

N/V

diarrhea

Question 37

Dosing of AChEl’s

Answer 37

Donepazil (easiest) - 5-10 po qd

Galantamine and Rivastigmine are BID and titrate dose up

Question 38

Which AChEl is available as a patch?

Answer 38

Rivastigmine

Question 39

Pharmacologic options for ED

Answer 39

PDE5 inhibitors and synthetic prostaglandin E1 analog (Alprostadil)

Question 40

PDE5 inhibitors - MOA

Answer 40

inhibits breakdown of cGMP by PDE5

Question 41

PDE5 inhibitors contraindication

Answer 41

concurrent use of nitrates

Question 42

PDE5 inhibitors SE

Answer 42

hypotension, flushing, HA

Rare: CV risks (angina, MI, stroke), sudden hearing loss, priapism

Question 43

PDE5 inhibitors DDI

Answer 43

organic nitrates
CYP3A4 inhibitors (PI, Emycin, itraconazole…)
ETOH (hypotension risk)

Question 44

Avanavil (Stendra), Sildenafil (Viagra), Tadalafil (Cialis) - class?

Answer 44

PDE5 inhibitor

Question 45

Anticholinergic agents - MOA

Answer 45

anticholinergic activity through a competitive inhibition of the muscarinic receptors in the bladder

Question 46

Darifenacin, Fesoterodine, Oxybutynin, Solifenacin, Tolterodine (Detrol), Trospium - class?

Answer 46

anticholinergics

Question 47

Which populations may experience negative side effects on anticholinergics?

Answer 47

elderly
myasthenia gravis
BPH
glaucoma

Question 48

Anticholinergics - DDI

Answer 48

CYP450 (2D6 and 3A4)

except trospium

Question 49

Gout treatment - UA level goal

Answer 49

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