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OPT 537 > Exam 1 -- Rheumatology #1 > Flashcards

Exam 1 -- Rheumatology #1 Flashcards

1
Q

How much of the primary care workload is rheumatology?

A

20-30%

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2
Q

What is another term for rheumatology?

A

Collagen vascular diseases

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3
Q

Does a ligament connect bone to bone or muscle to bone?

A

LBB (Ligament connects bone to bone)

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4
Q

Does a tendon connect bone to bone or muscle to bone?

A

TMB (Tendon connects muscle to bone)

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5
Q

How does the enthesis (end of a bone) differ from the shaft of the bone?

A

The enthesis is more porous and is vascularized; the shaft is denser and avascular

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6
Q

Articular cartilage is a specific type of what cartilage?

A

Hyaline

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7
Q

Is articular cartilage vascular or avascular?

A

Avascular

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8
Q

Articular cartilage is made of what type of collagen?

A

Type 2

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9
Q

Where can type 2 collagen be found?

A

Articular cartilage and the vitreous humor of the eye

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10
Q

Extracellular fluid is made of what components?

A

Collagens, elastins, glycoproteins, proteoglycans, and cells

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11
Q

Collagens make up how much of the synovial fluid?

A

90%

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12
Q

What role do glycoproteins have in joints?

A

Tissue remodeling (they are also known as fibronectin)

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13
Q

True or false: cytokines stimulate fibronectin

A

False; they inhibit fibronectin, decreasing tissue rebuilding

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14
Q

What purpose do proteoglycans have in the extracellular fluid?

A

They are GAG chains that bind the fluid together and retain nutrients

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15
Q

What is the name for nutrient rich fluid that is secreted by cells in the ECM?

A

Hyaluronan

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16
Q

Matrix Metalloproteinases (MMPs) 2 and 9 degrade CT. What specific portions of the ECM do they degrade?

A

Collagen, proteoglycans, and fibronectin

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17
Q

True or false: MMPs are upregulated during inflamation

A

True.

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18
Q

What is a common drug used to decrease MMP activity?

A

Doxycycline

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19
Q

Are bursitis, carpal tunnel syndrome, and tenosynovitis rheumatologic in nature?

A

No, but they are dealt with by rheumatologists often

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20
Q

What can cause bursitis?

A

Repetitive motion, pressure, RA, gout, trauma

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21
Q

True or false: bursitis normally presents bilaterally and symmetrically

A

False; it presents unilaterally and asymmetrically

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22
Q

In what way (relating to activity and rest) does bursitis differ from reheumatoid arthritis?

A

Bursitis is exacerbated by activity and improved by rest; RA is the opposite.

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23
Q

True or false: bursitis is more common than RA and lupus

A

True.

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24
Q

What is a good way to treat buritis?

A

PRICE (Protect, Rest with a little activity, Ice, Compress, Elevate); NSAIDs (higher doses); massage; corticosteroid (only if not bacterial in nature); possibly antibiotics; surgery in extreme cases

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25
Q

True or false: carpal tunnel syndrome is the most common entrapment neuopathy

A

True.

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26
Q

What causes carpal tunnel syndrome?

A

Prolonged pressure and/or use, arthritis, pregnancy

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27
Q

How would you treat carpal tunnel syndrome?

A

Splint at night, corticosteroid injection, surgery

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28
Q

What is tenosynovitis?

A

Inflammation of the synovium around a tendon (not inflammation of the tendon itself

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29
Q

What is another name for tenosynovitis?

A

Trigger finger

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30
Q

What causes tenosynovitis?

A

Repetitive use, RA, injury, genetics

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31
Q

How would you treat tenosynovitis?

A

Split, corticosteroid injection, surgery

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32
Q

True or false: tenosynovitis is more common in diabetics

A

True.

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33
Q

What treatment strategies can be employed for not only bursitis, carpal tunnel syndrome, and tenosynovitis, but also for RA?

A

Rest and light exercise, physical therapy, smoking cessation, alcohol reduction, weight loss, Omega-3, fish oil supplements, medications

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34
Q

What role do omega-3 and fish oil supplements play in treating RA or other conditions that involve the joints?

A

They inhibit MMPs

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35
Q

Treatment of conditions involving the joints can consist of different classes of drugs. Which classes are meant to relieve the pain?

A

NSAIDs, corticosteroids, analgesics

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36
Q

Treatment of conditions involving the joints can consist of different classes of drugs. What class is meant to treat the actual condition, not just relieve the pain?

A

DMARDs (including biologics and tetracyclines)

37
Q

What enzyme do corticosteroids target?

A

Phospholipase A2 (releases arachidonic acid from the cell membrane–AA is the precursor molecule for thromboxanes, protacyclins, and prostaglandins

38
Q

The COX-1 pathway leads to what kind of prostaglandins?

A

Cytoprotective–protection of gastric mucosa; also aid in platelet aggregation

39
Q

What are some side effects that can arise from COX-1 inhibition?

A

GI upset, GI bleeding, nausea

40
Q

The COX-2 pathway leads to what kind of prostaglandins?

A

Inflammatory–recruitment of inflammatory cells, sensitization of skin pain receptors.

41
Q

The COX-2 pathway is active in the kidneys. What is its result in the kidney?

A

Regulation of BP

42
Q

The COX-2 pathway results in prostacyclins. What is the role of prostacyclins?

A

They cause vasodilation and keep thromboxanes in check. Hence, inhibition of COX-2 results in vasoconstriction (an increase in BP) and an increase in clot formation due to the thromboxanes.

43
Q

What are the 4 benefits of NSAIDs?

A

Anti-pyresis (fever-reducing); anti-platelet (clot reduction); analgesic (pain-reducing); anti-inflammatory (in higher doses)

44
Q

True or false: NSAIDs can damage the liver

A

True.

45
Q

Which NSAIDs are very COX-1 selective? Which are COX-2 selective?

A

Aspirin and piroxicam are very COX-1 selective; celecoxib and meloxicam are COX-2 selective

46
Q

Patients with what type of allergy should not be given celecoxib?

A

Sulfa

47
Q

Which NSAIDs are used as topical agents to reduce macular swelling after cataract surgery (and prophylactically, too)?

A

Ketorolac, diclofenac

48
Q

What are some side effects that can arise from corticosteroid use?

A

Osteoporosis, diabetes, HTN, weight gain, infections, Cushing’s syndrome (not disease), cataracts, glaucoma

49
Q

Corticosteroid use is contraindicated in what common condition?

A

Pregnancy

50
Q

What is the upper limit of how long a corticosteroid should be used?

A

About 3 months

51
Q

How long do DMARDs take for their full effect?

A

6 weeks to 6 months

52
Q

What type of infection can be reactivated with DMARD use?

A

Usually TB

53
Q

Methotrexate causes a decrease in what cellular substance?

A

Folic acid, decreasing the ability of the cell to contribute to the inflammatory response. This leads to apoptosis.

54
Q

True or false: methotrexate is safe to take during pregnancy

A

False.

55
Q

What are some of the side effects of methotrexate use?

A

Nausea, liver damage, pulmonary toxicity, mouth ulcers, alopecia, infections

56
Q

Which DMARDs act as folic acid inhibitors?

A

Methotrexate and sulfasalazine

57
Q

How long do patients take to respond to sulfasalazine treatment?

A

3-6 months

58
Q

True or false: sulfasalazine is safe to take during pregnancy

A

True.

59
Q

What are some of the side effects of sulfasalazine use?

A

Nausea, rash, reversible infertility in males

60
Q

How does hydroxychloroquine work?

A

It impairs the cytokine response

61
Q

How long do patients take to respond to hydroxychloroquine treatment?

A

3-6 months

62
Q

What is a normal dose of hydroxychloroquine for RA?

A

200-400mg (usually 200mg) bid

63
Q

Hydroxycloroquine binds to melanin, making it especially toxic for what part of the eye?

A

The macula

64
Q

What are some of the side effects of hydroxychloroquine use?

A

Irreversible retinopathy (bull’s eye retinopathy) 1 in 2000; GI upset, nightmares, psychosis

65
Q

True or false: hydroxychloroquine is safe to take during pregnancy

A

True.

66
Q

True or false: azathioprine and leflunomide (DMARDs) are safe to take during pregnancy

A

False.

67
Q

Which DMARD might be used if previous DMARDs haven’t been working?

A

Cyclophosphamide

68
Q

How does cyclophosphamide work?

A

Suppresses B and T cell function by 30-40%

69
Q

How long can cyclophosphamide be used for?

A

3-6 months

70
Q

What are some of the side effects of cyclophosphamide use?

A

Herpes zoster, alopecia, nausea/vomiting, infertility in males and females

71
Q

True or false: cyclophosphamide is safe to take during pregnancy

A

False.

72
Q

How does cyclosporine work?

A

It inhibits IL-1 and IL-2 and T cells

73
Q

What ophthalmic solution contains cyclosporine?

A

Restasis (for dry eye)

74
Q

What are some of the side effects of cyclosporine use?

A

HTN, kidney problems (in 50%), infection

75
Q

True or false: cyclosporine is safe to take during pregnancy

A

False.

76
Q

Which DMARDs are tetracyclines?

A

Minocycline and doxycycline

77
Q

True or false: doxycycline has both antibiotic and anti-inflammatory effects

A

True.

78
Q

How does doxycycline work?

A

It inhibits MMPs, TNF, T cells, and cytokines

79
Q

What are some of the side effects of doxycycline use?

A

Skin rash, GI upset, sensitivity to sun, dizziness, decreases effectiveness of birth control, increases potency of blood thinners, causes teeth and bone deformity in children (CI pregnancy and breast feeding)

80
Q

Use of doxycycline is contraindicated in what populations?

A

Pregnant, breast-feeding, or kids (causes bone and teeth deformity)

81
Q

True or false: all biologic drugs for RA are injections

A

True.

82
Q

If a biologic drug is used to treat RA, it is usually given with what other DMARD?

A

Methotrexate

83
Q

What are the side effects of biologic drugs?

A

Infection risk, TB activation, increased risk of malignancy, demyelination

84
Q

Use of biologic drugs for a patient with RA is contraindicated if the patient has what other condition?

A

MS

85
Q

The biologic drugs have what type of suffix?

A

“-mab”

86
Q

True or false: all biologic drugs for RA are safe to use in pregnancy

A

False; none of them are safe to use during pregnancy

87
Q

Which biologic drug for RA is approved for children?

A

Tocilizumab

88
Q

True or false: using two biologic drugs is completely safe for treatment of RA

A

False; it decreases the immune response too much

OPT 537 (21 decks)

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