Drugs for Bone & Joint Disorders

Question 1

Three drug classes used in the management of RA

Answer 1

NSAIDs
glucocorticoids
DMARDs

Question 2

Which of the drug classes used in the management of RA does NOT slow disease progression?

Answer 2

NSAIDs

Question 3

List the three types of DMARDs

Answer 3

conventional (traditional)
biologic
targeted

Question 4

What does DMARD stand for

Answer 4

disease modifying antirheumatic drugs

Question 5

What are the differences between the types of DMARDs used for RA?

Answer 5

conventional = nonspecific

biologic = targets one specific component of immune system

targeted = targets one specific component of RA immune response

Question 6

Drug classes that are biologic DMARDs

Answer 6

TNF antagonists
B lymphocyte depleting agent
T cell activation inhibitor

Question 7

Drug classes that are targeted DMARDs

Answer 7

IL-6 receptor antagonists
IL-1 receptor antagonist
JAK inhibitors

Question 8

mechanism of action of methotrexate

Answer 8

folate antagonism

Question 9

adverse effects of methotrexate

Answer 9

hepatic fibrosis
bone marrow suppression
GI ulceration
pneumonitis

Question 10

all DMARDs result in:

Answer 10

immunosuppression (risk for infection)

Question 11

cautions with DMARDs and vaccinations?

Answer 11

live vaccinations are contraindicated

inactivated vaccinations may not be as effective

Question 12

Adverse effects of TNF antagonists

Answer 12

infection/neutropenia (black box warning)
injection site reactions
infusion reactions
skin reactions

Question 13

Drugs used for the management of gout flare up

Answer 13

NSAIDs
glucocorticoids
colchicine

Question 14

Potential mechanism of action of colchicine?

Answer 14

inhibition of WBC infiltration via disruption of cellular microtubules

Question 15

adverse effects of colchicine

Answer 15

toxicity to rapidly proliferating cell groups:

• GI ulcers/perforation
• myelosuppression
• myopathy

Question 16

Drugs used in long term preventative therapy of gout

Answer 16

xanthine oxidase inhibitors
probenecid
pegloticase & rasburicase

Question 17

Goal of long term gout preventative therapy?

Answer 17

decrease uric acid concentrations

Question 18

methods to decrease uric acid concentrations in the plasma?

Answer 18

1. inhibit formation
2. accelerate excretion
3. convert to metabolite

Question 19

List a xanthine oxidase inhibitor

Answer 19

allopurinol
febuxostat

Question 20

mechanism of action of xanthine oxidase inhibitors

Answer 20

inhibit xanthine oxidase (which is required for uric acid formation)

Question 21

adverse effects of xanthine oxidase inhibitors

Answer 21

GI reactions
drowsiness
headaches

initial therapy can induce a gout attack

Question 22

treatment options for hypocalcemia

Answer 22

PO or IV calcium

Question 23

treatment options for hypercalcemia

Answer 23

mild = drugs that inhibit calcium absorption (see future flashcard)

severe = IV saline + loop diuretic

Question 24

two types of IV calcium

Answer 24

calcium chloride
calcium gluconate

Question 25

what is cinacalcet used for

Answer 25

hyperparathyroidism

Question 26

mechanism of action of cinacalcet

Answer 26

mimics calcium at PTH receptor = negative feedback & prevention of further PTH secretion

Question 27

adverse effects of cinacalcet

Answer 27

N/V diarrhea hypocalcemia

Question 28

how does exogenous vitamin D increase blood levels of calcium?

Answer 28

increased intestinal absorption increased bone resorption decreased renal excretion

Question 29

mechanism of action of calcitonin

Answer 29

inhibition of osteoclasts (inhibits bone resorption) inhibition of tubular calcium resorption (increases excretion)

Question 30

What are bisphosphonates

Answer 30

structural analog of pyrophosphate, which is a normal constituent of bone

Question 31

mechanism of action of bisphosphonates

Answer 31

incorporate into bone & remain active for years (decreases osteoclast activity, decreases bone resorption)

Question 32

adverse effect of bisphosphonates

Answer 32

esophagitis! (drink with full glass of water & remain upright)

Question 33

List some bisphosphonates

Answer 33

alendronate risedronate ibandronate zoledronate

Question 34

Both IV bisphosphonates can cause:

Answer 34

renal damage

Question 35

administration of exogenous estrogen decreases bone resorption via what mechanism?

Answer 35

inhibits the increase in osteoclast number

Question 36

Why may a SERM be preferred to exogenous estrogen in the treatment of bone demineralization?

Answer 36

increases bone density with less risks