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7262 MS Block 1 > Drugs > Flashcards

Drugs Flashcards

1
Q

nsaids should not be used as monotherapy for RA.

a. true
b. false

A

a. true

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2
Q

How are corticosteroids used for RA?

A

NOT used as monotherapy, but used as bridge therapy

can be given intra-articularly

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3
Q

How often is MTX given for RA?

A

once WEEKLY

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4
Q

What is the DMARD of choice for initial RA therapy?

A

MTX

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5
Q

What should MTX be premedicated with?

A

folic acid

5mg/week

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6
Q

The synthetic DMARD for FA leflunomide is NOT recommended if ALT is > ___ ULN.

A

2

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7
Q

What is used for elimination of leflunomide?

A

cholestyramine

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8
Q

What is the half life of teriflunomide?

A

14-18 days

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9
Q

Is vaccination with live vaccines recommended with leflunomide?

A

no

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10
Q

How long is contraception needed after d/c of leflunomide?

A

3 months

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11
Q

When can the synthetic RA DMARD hydroxychloroquine be used as monotherapy?

A

mild RA where MTX is contraindicated

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12
Q

Does hydroxychloroquine need hepatic/renal dose adjustment?

A

no

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13
Q

What synthetic RA DMARD can cause retinal/visual changes?

A

hydroxychloroquine

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14
Q

What time period of use/dose of hydroxychloroquine can cause disorder for the cornea?

A

use > 5 years or daily dose > 5mg/kg/day ABW or 400mg

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15
Q

What kind of drug is sulfasalazine?

A

synthetic DMARD

prodrug

used for RA

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16
Q

The synthetic DMARD sulfasalazine should not be used in pts with what allergies?

A

sulfa

salicylate

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17
Q

What should sulfasalazine be premedicated with/

A

antihistamine or steroids

to prevent serum sickness

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18
Q

What two things can decrease absorption of sulfasalazine?

A

antibiotics

iron

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19
Q

What synthetic DMARD can cause yellow to orange urine/skin discoloration?

A

sulfasalazine

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20
Q

What is drug class of tofacitinib, barcitinib, upadacitinib?

A

JAK inhibitors

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21
Q

The RA JAK inhibitor tofacitinib dose should be reduced to __mg daily (IR) in moderate to severe renal impairment and moderate hepatic impairment.

A

5

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22
Q

The RA JAK inhibitor tofacitinib should be avoided in pts with counts less than?

lymphocyte < __?
ANC < __?
Hgb < __?

A

lymphocyte: 500
ANC: 1000
Hgb: 9

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23
Q

How should the RA JAK inhibitor barcitinib be dose adjusted in pts with GFR 30-60?

A

1mg once daily

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24
Q

The RA JAKL inhibitor barcitinib should not be used in pts with eGFR < __

A

30

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25
Q

The RA JAK inhibitors barcitinib and upadacitinib should not be used if

lymphocytes < __?
ANC < __?
Hgb < __?

A

500, 1000, 8

tofacitinib is same except Hgb < 9 instead of 8

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26
Q

Which two RA JAK inhibitors should not be used with biologic DMARDS or strong immunosuppressants?

A

barcitinib

upacitinib

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27
Q

What is dose for RA JAK inhibitor upadacitinib?

A

15mg PO once daily

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28
Q

Which RA JAK inhibitor can be given as monotherapy or in combo with MTX or other non-biologic DMARDS?

A

upadacitinib

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29
Q

What drug class is adalimumab?

A

TNF alpha inhibitor

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30
Q

What drug class is etanercept (Enbrel)?

A

TNF alpha inhibitor

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31
Q

What drug class is infliximab (Remicade)?

A

TNF alpha inhibitor

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32
Q

What drug class is golimumab (Simponi)?

A

TNF alpha inhibitor

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33
Q

Doses of infliximab > ___ mg should not be give n in CHF or to pts with hypersensitivity to murine proteins.

A

5

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34
Q

Which two TNF alpha inhibitors for RA must be taken in combo with MTX?

A

infliximab

golimumab

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35
Q

What might infliximab be premedicated with?

A

diphenhydramine
acetaminophen

to prevent infusion rxn

36
Q

What is abatacept (for RA) MOA?

A

CD80/CD86

37
Q

How is the RA drug abatacept given?

A

IV infusion based on pt weight

38
Q

What drug class is certolizumab?

A

TNF alpha inhibitor

39
Q

What drug class should the RA drug abatacept NOT be given with?

A

TNF alpha inhibitors

40
Q

What screening is done at baseline for the RA drug abatacept?

A

TB

Hep B

41
Q

What is the RA drug rituximab MOA?

A

chimeric antibody to CD20

42
Q

What is the RA drug rituximab given in combo with?

A

MTX

premedicate with diphenhydramine, glucocorticoid, acetaminophen to prevent infusion rxns

43
Q

What screening is done for the RA drug rituximab?

A

TB

Hep B

44
Q

What is the MOA of the RA drug tocilizumab?

A

humanized antibody that inhibits IL-6

45
Q

Which RA drug is a CYP3A4 inducer, and should NOT be given in combo with biologic DMARDS?

A

tocilizumab

NABs can develop

46
Q

Does tociluzmab have hepatic dose adjustments?

A

yes

47
Q

Do not give the RA drug tociluzumab if

ANC < __?
platelets < __?
ALT/AST > __ x ULN?

A

2000, 100,000, 1.5

48
Q

The RA drug tociluzimab can cause elevated ___

A

lipids

transaminitis

49
Q

What screening is done for RA drug tociluzumab?

A

TB

50
Q

NSAIDS should be given within at least ___ hours for acute gout attack?

A

24

51
Q

What nsaid should not be given if allergy to sulfa?

A

celecoxib

52
Q

nsaids should be use with caution with ___ impairment and the ___ trimester of pregnancy

A

renal, third

53
Q

What is colchicine MOA?

A

prevents migration of neutrophils

54
Q

What is max dose of colchicine for acute gout?

A

1.8mg daily

55
Q

What is max dose of colchicine for gout prophylaxis?

A

1.2mg daily

56
Q

Which gout med is contraindicated with concomitant use of P-gp or 3A4 inhibitors in the presence of hepatic/renal impairment?

A

colchicine

57
Q

What is main AE of colchicine?

A

diarrhea

58
Q

Can corticosteroids for acute gout be given with live or live attenuated vaccines?

A

no

59
Q

What is MOA of gout drug allopurinol?

A

xanthine oxidase inhibitor

60
Q

What is the max dose of allopurinol for chronic gout management?s

A

800mg/day

61
Q

What is starting dose of allopurinol for pts with stage 4 or 5 CKD?

A

50mg daily

62
Q

Which chronic gout management drug is contraindicated with HLAB*5801 allele?

A

allopurinol

severe cutaneous rxn

63
Q

Which xanthine oxidase inhibitor can cause maculopapular eruption, DRESS, SJS, and TENS?

A

allopurinol

64
Q

What is allopurinol dose for pts with stage 3 or higher CKD?

A

100mg per day

65
Q

What is the MOA of febuxostat (Uloric)?

A

xanthine oxidase inhibitor

66
Q

What is the dose of the chronic gout drug febuxostat if CrCl < 30?

A

40mg daily

67
Q

Should xanthine oxidase inhibitors (allopurinol, febuxostat) be d/c during gout attack?

A

no

68
Q

Which chronic gout med has FDA warning of increased death in pts with cardiovascular disease?

A

febuxostat

xanthine oxidase inhibitor

69
Q

Febuxostat should only be prescribed if pts have contraindications, treatment failure, or intolerance to allopurinol.

a. true
b. false

A

a. true

70
Q

What is main AE of febuxostat?

A

transaminitis

71
Q

What is the MOA of the chronic gout drug lesinurat?

A

Inhibits renal apical transporters (URAT1 and OAT4)

72
Q

The chronic gout drug lesinurad (URAT1/OAT4 inhibitor) should be taken in combo with what?

A

a xanthine oxidase inhibitor

73
Q

Lesinurad is not recommended imp ts taking allopurinol doses < ___mg daily or < __ mg daily if CrCl is less than 60.

A

300, 200

74
Q

If treatment with xanthine oxidase inhibitor is interrupted lesinurad should be continued.

a. true
b. false

A

b. false

should also be witheld

75
Q

2 main AEs of lesinurad?

A

nephrolithiasis

renal failure

76
Q

What is pegloticase MOA?

A

pegylated recombinant uricase

chronic gout management

77
Q

When is pegloticase (Krystexxa) contraindicated?

A

G6PD deficiency

risk of hemolysis

78
Q

What is the MOA of probenecid?

A

uricosuric agent

79
Q

What is the max dose of probenecid?

A

2000mg/day

80
Q

Should probenecid be initiated during an acute gout attack?

A

no

81
Q

Probenecid is contraindicated with concomitant use of what drug class?

A

salicylates

82
Q

What is main AE of probenecid?

A

urolithiasis

83
Q

2 main AEs of the chronic gout drug pegloticase?

A

antibody development

infusion reaction

84
Q

Which gout drug is used refractory to XOI or uricosuric agents?

A

pegloticase

85
Q

2 IL-1 inhibitors for gout?

A

anakinra
canakinumab

can be considered in refractory cases

86
Q

which antihypertensive is the drug of choice for gout?

A

losartan

7262 MS Block 1 (11 decks)

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