Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pharmacology Mod 2 Exam > Drugs for Gout and Rheumatoid Arthritis > Flashcards

Drugs for Gout and Rheumatoid Arthritis Flashcards

1
Q

what is gout

A

build up of uric acid crystals in the kidneys and joints

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what is podagra

A

gout manifestation of pain and inflammation of the big toe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what causes gout

A

purine-rich diet, alcohol and kidney disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what are the types of gout

A

acute vs chronic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the therapeutic strategies for managing gout

A
  1. interfere with uric acid synthesis
  2. increase uric acid excretion
  3. inhibit immune cells entry to joint
  4. decrease inflammation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what are the normal level of uric acid

A

<6mg/dL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what stage of gout does indomethacin work on

A

acute attack

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what does indomethacin do for gout

A

decreases granulocytes in area and anti-inflammatory

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what stage of gout do NSAIDs work on

A

pain control

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what stage of gout does colchicine work on

A

acute attack

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what does colchicine do for gout

A

decrease immune cell chemotaxis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what NSAID do you not use for the treatment of gout

A

Aspirin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what medications are used for acute gout

A

indomethacin, NSAIDs and colchicine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what medications are used for chronic gout

A

allopurinol, probenecid and colchicine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

how is allopurinol used for gout

A

purine analog and inhibits uric acid synthesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

how is probenecid used for gout

A

promote uric acid excretion and inhibits excretion of NSAIDS
More expensive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Why is ASA contraindicated for the treatment of gout

A

it competes with uric acid for the organic acid secretion mechanism in the proximal tubule of the kidneys

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the MOA of colchicine

A

binds and stabilizes tubulin to inhibit microtubule polymerization, impairs neutrophil chemotaxis and degranulation and also inhibits the synthesis and release of leukotrienes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the clinical use of colchicine

A

used for both acute and chronic gout
largely used for prophylaxis of recurrent gouty attacks and must be administered within 24-28 hours of onset attack to be effective

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what are the signs of toxicity with colchicine

A

nausea, vomiting, abdominal pain and diarrhea.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what can the chronic administration of colchicine lead to

A

myopathy, neutropenia, aplastic anemia and alopecia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

when should colchicine be avoided

A

pregnancy and kidney disease patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the MOA of indomethacin and NSAIDs

A

reversibly inhibits both COX-1 and COX-2. Block prostaglandin synthesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the MOA for allopurinol and febuxostat

A

purine analog. inhibits the last two steps in uric acid biosynthesis that are catalyzed by xanthene oxidase (competitively bind to xanthine oxidase)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

when should indomethacin and NSAIDS be avoided for the treatment of acute gout

A

patients with kidney disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

what is the MOA of allopurinol and febuxostat

A

purine analog. inhibits the last two steps in uric acid biosynthesis that are catalyzed by xanthine oxidase (competitively bind to xanthine oxidase)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

what is the clinical use of allopurinol and febuxostat

A

treat primary hyperuricemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

what is hyperuricemia associated with

A

certain malignancies such as lymphomas and leukemias

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

what are the signs of toxicity with allopurinol and febuxostat

A

typically well tolerated but skin rashes are the most common.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

what can allopurinol do if used for acute gout

A

precipitate acute gout attack when initiated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What are uricosuric agents used for chronic gout

A

probenecid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

what is the MOA of probenecid

A

inhibits reabsorption of uric acid in proximal convoluted tubules

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

what is the clinic use of probenecid

A

used to treat primary hyperuricemia in patients with impaired uric acid renal excretion and hyperuricemia associated with certain malignancies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

what is the adverse effects of probenecid

A

well tolerated - recommended LFT monitoring

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What can precipitate an acute gout flare

A

a quick decrease in serum urate concentration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

what happens to local cells during chronic gout

A

the crystals initiate an acute inflammatory response

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What do DMARDS stand for

A

Disease-modifying Anti-rheumatic Drugs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

what are DMARDS used for

A

to treat Rheumatoid arthritis and other types of inflammatory arthritis to slow the course of the disease, induce remission and prevent further damage to joitns

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

what medication should DMARDS be used in conjunction with

A

NSAIDs, low-dose corticosteroids and physical and occupational therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

when should DMARDS be initiated

A

within 3 months of diagnosis for the best response

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

what are the two different types of DMARDS

A

Biologics(bDMARDs) and Non-biologics (sDMARDs)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

what type of DMARD is methotextrate

A

non-biologic DMARD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

what does MTX stand for

A

methotextrate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

how does MTX work for the management of gout

A

MTX interferes with folate metabolism by acting as a competitive inhibitor for the enzyme dihydrofolate reductase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

what needs to be co-administered with MTX

A

folic acid

46
Q

what is the result of MTX

A

results in inhibition of lymphocyte proliferation in RA

47
Q

how quickly does MTX respond

A

3-6 weeks

48
Q

what does MTX do for gout

A

slows the progression of the disease

49
Q

what are the side effects of MTX

A

usually well tolerated
mucosal ulceration and nausea, myelosuppression - cytopenia, hepatotoxicity, rarely cirrosis of the liver,
acute pneumonia-like syndrome - hypersensitivity pneumonitis, and CNS symptoms such as headache, fatigue, malaise or impaired ability to concentrate

50
Q

What needs to be monitored with the use of MTX

A

CBC and LFT 3-4 times per year to assess bone marrow function

51
Q

what type of DMARD is hydrocholorquine

A

non-biologic DMARD

52
Q

what else is hydrocholoquine used for

A

the treatment of malaria and other diseases such as lupus

53
Q

what is the MOA of hydrocholoquine

A

unclear but thought to include inhibition of phospholipase and antagonism of prostaglandins
decrease platelet aggregation
inhibition of endosomal activation
decreased activation through toll-like receptors
suppressed antioxidant activity

54
Q

when should dosages of hydroxychloroquine be reduced

A

in patients with renal insufficiency

55
Q

what are the possible side effects of hydroxychloroquine

A

abdominal pain, nausea/vomiting are the most common
headache, skin rashes, pruritis and occular toxicity (visual changes, retinopathy)

56
Q

what is ocular toxicity

A

visual changes/retinopathy and eye exams are recommended before stating therapy then re-eval within a year of treatment starting

57
Q

what type of DMARD is Leflunomide(Arava)

A

non-biologic DMARD

58
Q

what does leflunomide do within the body

A

causes cell arrest of autoimmune lymphocytes and inhibits pyrimidine syntheses thereby intefering with DNA synthesis

59
Q

what are the potential interactions with leflunomide

A

digoxin, telbivudine and penicillamine

60
Q

DHODH

A

dihydrooroate dehydrogenases enzyme

61
Q

what does lefllunomide act as

A

a reversible inhibitor of DHODH

62
Q

what is DHODH necessary for

A

enzyme that is necessary for pyrimidine synthesis

63
Q

what medication can leflunomide be used in combination with

A

methotrexate

64
Q

what are the side effects of leflunomide

A

headache, nausea, diarrhea

65
Q

when in leflunomide contraindicated

A

pregnancy

66
Q

what needs to be monitored when using leflunomide

A

for signs of infection, CBC and LFTs

67
Q

what is the benefit of Sulfasalazine

A

it is cheap

68
Q

what is Sulfasalazine used for other than RA

A

used for decades to treat IBD

69
Q

where is sulfasalazine metabolized and what does it become

A

metabolized by the gut bacteria into 5-ASA (amino-salicylic acid) and sulfapyridine

70
Q

what does 5-ASA do for the body

A

reduces inflammation by suppressing prostaglandin synthesis

71
Q

what does sulfapyridine do for the cody

A

causes adverse effects

72
Q

what are the common adverse effects of sulfasazine

A

GI reactions such as nausea, vomiting, diarrhea, abdominal pain and dermatologic reactions are also common

73
Q

what needs to be assessed in patients using sulfasalazine

A

CMC and LFTs

74
Q

What are the common Biologic DMARDS

A

anakinra (anti-IL-1)
Etanercept (anti-TNF)
infliximab (anti- TNF)
Adalimumab (anti-TNF)
Rituximab (anti- CD20)

75
Q

-o(s)-

A

bone

76
Q

-c(i)-

A

cardiovascular

77
Q

-I(i)-

A

immune modulating

78
Q

-t(u)-

A

tumor

79
Q

-v(i)-

A

virus

80
Q

-u-

A

human

81
Q

-zu-

A

humanized

82
Q

-xi-

A

chimeric (often human+ animal)

83
Q

-a-

A

rat

84
Q

-mab

A

monoclonal antibody

85
Q

what is Enterecept also known as

A

Enbrel

86
Q

how is Enerecept engineered

A

genetically engineered fusion protein that binds to TNF-a

87
Q

what other medication is Enterecept used with

A

Methotextrate

88
Q

how is Enterecept administered

A

Subcutenous biweekly

89
Q

what are the side effects of enterecept

A

generally well tolerated but may produce inflammatory reaction at the site of injection

90
Q

what is another name for Remicade

A

infliximab

91
Q

what is infliximab

A

biologic chimeric IgG monoclonal antibody that binds to TNF-alpha

92
Q

what other medication is recommended to take in conjunction with infliximab

A

combination therapy with methotrextate - not recommended as monotherapy as anti-infliximab antibodies may develop

93
Q

how is infliximab administered

A

infusion over two hours every few months
more constly

94
Q

what are the adverse effects of infliximab

A

infusion reactions such as fever, chills, pruritus, urticaria and increased risk of infections

95
Q

What is another name for Humera

A

adalimumab

96
Q

what is adalimumab

A

human recombinatn antibody that binds to TNF-alpha

97
Q

is adalimumab recommended as a monotherapy or combination therapy

A

can be used as either monotherapy or combination therapy

98
Q

how is humera administered

A

subcutaneous injections weekly or every other week

99
Q

what are the adverse effects of adalimumab

A

may cause headaches or nausea, develop local inflammatory reactions at the injection site and increased risk of infections

100
Q

what is another name for Rituximab

A

Rituxan

101
Q

what is rituximab

A

genetically engineered chimeric murine/human monoclonal antibody

102
Q

what antibody is rituximab directed against

A

CD20 antigen on cell surface of B cells

103
Q

what could Ritixumab lead to

A

B cell apoptosis )through complement activation and antibody-dependent cell-mediated cytotoxicity

104
Q

when is Rituximab generally indicated

A

indicated in patients who have had an inadequate response to anti-TNF therapies

105
Q

What medication is used in combination with Rituximab

A

methotextrate

106
Q

how is Rituximab administered

A

two 1000-mg infusion separated by two weeks

107
Q

what is administered prior to rituxan infusions and why

A

methylprednisolone is given 30 minutes prior to infusion to reduce the severity of the infusion reactions

108
Q

what are the adverse effects of Rituxan

A

infusion reactions are very common - urticaria, hypotension or angioedema

109
Q

What is Anakinra

A

IL-1 receptor antagonist that blocks IL-1R and prevents endogenous IL-1 binding

110
Q

What type of combination therapy is Anakinra not used with

A

TNF inhibitors

111
Q

what is the benefit of using Anakinra

A

it is a modest pain reducer but not super helpful - therefore its not used often

112
Q

how is Anakinra administed

A

subcutaneous injections daily or every other day in the patients with moderate to severe renal impairment

Pharmacology Mod 2 Exam (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions