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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

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2
Q

what is podagra

A

gout manifestation of pain and inflammation of the big toe

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3
Q

what causes gout

A

purine-rich diet, alcohol and kidney disease

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4
Q

what are the types of gout

A

acute vs chronic

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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
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6
Q

what are the normal level of uric acid

A

<6mg/dL

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7
Q

what stage of gout does indomethacin work on

A

acute attack

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8
Q

what does indomethacin do for gout

A

decreases granulocytes in area and anti-inflammatory

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9
Q

what stage of gout do NSAIDs work on

A

pain control

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10
Q

what stage of gout does colchicine work on

A

acute attack

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11
Q

what does colchicine do for gout

A

decrease immune cell chemotaxis

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12
Q

what NSAID do you not use for the treatment of gout

A

Aspirin

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13
Q

what medications are used for acute gout

A

indomethacin, NSAIDs and colchicine

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14
Q

what medications are used for chronic gout

A

allopurinol, probenecid and colchicine

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15
Q

how is allopurinol used for gout

A

purine analog and inhibits uric acid synthesis

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16
Q

how is probenecid used for gout

A

promote uric acid excretion and inhibits excretion of NSAIDS
More expensive

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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

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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

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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

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20
Q

what are the signs of toxicity with colchicine

A

nausea, vomiting, abdominal pain and diarrhea.

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21
Q

what can the chronic administration of colchicine lead to

A

myopathy, neutropenia, aplastic anemia and alopecia

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22
Q

when should colchicine be avoided

A

pregnancy and kidney disease patients

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23
Q

What is the MOA of indomethacin and NSAIDs

A

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

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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)

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25
when should indomethacin and NSAIDS be avoided for the treatment of acute gout
patients with kidney disease
26
what is the MOA of allopurinol and febuxostat
purine analog. inhibits the last two steps in uric acid biosynthesis that are catalyzed by xanthine oxidase (competitively bind to xanthine oxidase)
27
what is the clinical use of allopurinol and febuxostat
treat primary hyperuricemia
28
what is hyperuricemia associated with
certain malignancies such as lymphomas and leukemias
29
what are the signs of toxicity with allopurinol and febuxostat
typically well tolerated but skin rashes are the most common.
30
what can allopurinol do if used for acute gout
precipitate acute gout attack when initiated
31
What are uricosuric agents used for chronic gout
probenecid
32
what is the MOA of probenecid
inhibits reabsorption of uric acid in proximal convoluted tubules
33
what is the clinic use of probenecid
used to treat primary hyperuricemia in patients with impaired uric acid renal excretion and hyperuricemia associated with certain malignancies
34
what is the adverse effects of probenecid
well tolerated - recommended LFT monitoring
35
What can precipitate an acute gout flare
a quick decrease in serum urate concentration
36
what happens to local cells during chronic gout
the crystals initiate an acute inflammatory response
37
What do DMARDS stand for
Disease-modifying Anti-rheumatic Drugs
38
what are DMARDS used for
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
39
what medication should DMARDS be used in conjunction with
NSAIDs, low-dose corticosteroids and physical and occupational therapy
40
when should DMARDS be initiated
within 3 months of diagnosis for the best response
41
what are the two different types of DMARDS
Biologics(bDMARDs) and Non-biologics (sDMARDs)
42
what type of DMARD is methotextrate
non-biologic DMARD
43
what does MTX stand for
methotextrate
44
how does MTX work for the management of gout
MTX interferes with folate metabolism by acting as a competitive inhibitor for the enzyme dihydrofolate reductase
45
what needs to be co-administered with MTX
folic acid
46
what is the result of MTX
results in inhibition of lymphocyte proliferation in RA
47
how quickly does MTX respond
3-6 weeks
48
what does MTX do for gout
slows the progression of the disease
49
what are the side effects of MTX
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
What needs to be monitored with the use of MTX
CBC and LFT 3-4 times per year to assess bone marrow function
51
what type of DMARD is hydrocholorquine
non-biologic DMARD
52
what else is hydrocholoquine used for
the treatment of malaria and other diseases such as lupus
53
what is the MOA of hydrocholoquine
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
when should dosages of hydroxychloroquine be reduced
in patients with renal insufficiency
55
what are the possible side effects of hydroxychloroquine
abdominal pain, nausea/vomiting are the most common headache, skin rashes, pruritis and occular toxicity (visual changes, retinopathy)
56
what is ocular toxicity
visual changes/retinopathy and eye exams are recommended before stating therapy then re-eval within a year of treatment starting
57
what type of DMARD is Leflunomide(Arava)
non-biologic DMARD
58
what does leflunomide do within the body
causes cell arrest of autoimmune lymphocytes and inhibits pyrimidine syntheses thereby intefering with DNA synthesis
59
what are the potential interactions with leflunomide
digoxin, telbivudine and penicillamine
60
DHODH
dihydrooroate dehydrogenases enzyme
61
what does lefllunomide act as
a reversible inhibitor of DHODH
62
what is DHODH necessary for
enzyme that is necessary for pyrimidine synthesis
63
what medication can leflunomide be used in combination with
methotrexate
64
what are the side effects of leflunomide
headache, nausea, diarrhea
65
when in leflunomide contraindicated
pregnancy
66
what needs to be monitored when using leflunomide
for signs of infection, CBC and LFTs
67
what is the benefit of Sulfasalazine
it is cheap
68
what is Sulfasalazine used for other than RA
used for decades to treat IBD
69
where is sulfasalazine metabolized and what does it become
metabolized by the gut bacteria into 5-ASA (amino-salicylic acid) and sulfapyridine
70
what does 5-ASA do for the body
reduces inflammation by suppressing prostaglandin synthesis
71
what does sulfapyridine do for the cody
causes adverse effects
72
what are the common adverse effects of sulfasazine
GI reactions such as nausea, vomiting, diarrhea, abdominal pain and dermatologic reactions are also common
73
what needs to be assessed in patients using sulfasalazine
CMC and LFTs
74
What are the common Biologic DMARDS
anakinra (anti-IL-1) Etanercept (anti-TNF) infliximab (anti- TNF) Adalimumab (anti-TNF) Rituximab (anti- CD20)
75
-o(s)-
bone
76
-c(i)-
cardiovascular
77
-I(i)-
immune modulating
78
-t(u)-
tumor
79
-v(i)-
virus
80
-u-
human
81
-zu-
humanized
82
-xi-
chimeric (often human+ animal)
83
-a-
rat
84
-mab
monoclonal antibody
85
what is Enterecept also known as
Enbrel
86
how is Enerecept engineered
genetically engineered fusion protein that binds to TNF-a
87
what other medication is Enterecept used with
Methotextrate
88
how is Enterecept administered
Subcutenous biweekly
89
what are the side effects of enterecept
generally well tolerated but may produce inflammatory reaction at the site of injection
90
what is another name for Remicade
infliximab
91
what is infliximab
biologic chimeric IgG monoclonal antibody that binds to TNF-alpha
92
what other medication is recommended to take in conjunction with infliximab
combination therapy with methotrextate - not recommended as monotherapy as anti-infliximab antibodies may develop
93
how is infliximab administered
infusion over two hours every few months more constly
94
what are the adverse effects of infliximab
infusion reactions such as fever, chills, pruritus, urticaria and increased risk of infections
95
What is another name for Humera
adalimumab
96
what is adalimumab
human recombinatn antibody that binds to TNF-alpha
97
is adalimumab recommended as a monotherapy or combination therapy
can be used as either monotherapy or combination therapy
98
how is humera administered
subcutaneous injections weekly or every other week
99
what are the adverse effects of adalimumab
may cause headaches or nausea, develop local inflammatory reactions at the injection site and increased risk of infections
100
what is another name for Rituximab
Rituxan
101
what is rituximab
genetically engineered chimeric murine/human monoclonal antibody
102
what antibody is rituximab directed against
CD20 antigen on cell surface of B cells
103
what could Ritixumab lead to
B cell apoptosis )through complement activation and antibody-dependent cell-mediated cytotoxicity
104
when is Rituximab generally indicated
indicated in patients who have had an inadequate response to anti-TNF therapies
105
What medication is used in combination with Rituximab
methotextrate
106
how is Rituximab administered
two 1000-mg infusion separated by two weeks
107
what is administered prior to rituxan infusions and why
methylprednisolone is given 30 minutes prior to infusion to reduce the severity of the infusion reactions
108
what are the adverse effects of Rituxan
infusion reactions are very common - urticaria, hypotension or angioedema
109
What is Anakinra
IL-1 receptor antagonist that blocks IL-1R and prevents endogenous IL-1 binding
110
What type of combination therapy is Anakinra not used with
TNF inhibitors
111
what is the benefit of using Anakinra
it is a modest pain reducer but not super helpful - therefore its not used often
112
how is Anakinra administed
subcutaneous injections daily or every other day in the patients with moderate to severe renal impairment

Pharmacology Mod 2 Exam (2 decks)

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