Exam 4 - Random Stuff Flashcards
when giving GCs for IBD, what two things should we supplement?
calcium 1000-15000 mg/day
vitamin D 800 U/day
T or F: natalizumab should NOT be used in combo w/ immunosuppressants or TNF inhibitors
T (Natalie works alone)
natalizumab is associated with which CNS disorder related to JC infection?
PML
drugs that end in -kizumab are in what class?
IL23 antag
tofacitinib and upadacitinib black box warning
VTE
which of the following drugs are for both UC and CD?
a. tofacitinib
b. upadacitinib
b. upadacitinib
T or F: upadacitinib is CI in pregnancy
T
T or F: ozanimod and estrazimod are CI in pts with cardiac history in last 6 months
T
are ozanimod and estrazimod used for UC, CD, or both?
UC
if you see the term “transmural”, what should we think?
CD
which drug for gout has an AE of urolithiasis?
probenecid
non-pharm thing we can do that helps with gout
applying ice
indomethacin dose for acute gout
a. 50 mg PO TID
b. 750 mg PO followed by 250 mg q8h
c. 400 mg PO TID
d. 200 mg PO BID
a. 50 mg PO TID
naproxen dose for acute gout
a. 50 mg PO TID
b. 750 mg PO followed by 250 mg q8h
c. 400 mg PO TID
d. 200 mg PO BID
b. 750 mg PO followed by 250 mg q8h
ibuprofen dose for acute gout
a. 50 mg PO TID
b. 750 mg PO followed by 250 mg q8h
c. 400 mg PO TID
d. 200 mg PO BID
c. 400 mg PO TID
sulindac dose for acute gout
a. 50 mg PO TID
b. 750 mg PO followed by 250 mg q8h
c. 400 mg PO TID
d. 200 mg PO BID
d. 200 mg PO BID
which corticosteroid formulation for gout can be given intra-articularly?
a. methylprednisolone
b. prednisone
c. triamcinolone
c. triamcinolone
IA triamcinolone dose for large joints (range)
10-40 mg
IA triamcinolone dose for small joints (range)
5-20 mg
prednisone taper: ___ mg/kg daily for ___-___ days, followed by taper for ___-___ days
0.5; 2-5; 7-10
colchicine dosing for acute gout (day 1 and 2+)
day 1: 1.2 mg PO once, then 0.6 mg one hour later
day 2+: 0.6 mg BID until attack resolves
which drug has AEs of axonal neuromyopathy and neutropenia?
a. NSAIDs
b. methylprednisolone
c. probenecid
d. colchicine
d. colchicine
colchicine renal dose adjustments start at CrCl < ___
30
T or F: colchicine needs to be dose adjusted in hepatic impairment
F (only needs adjustment in renal impairment)
colchicine interacts with what two drug classes we talked about?
3A4 and Pgp inhibitors
3 drugs for gout in “other therapies” (slide 46)
corticotropin - ACTH
anakinra
canakinumab
what two drugs were listed on the “pill-in-pocket” method?
NSAIDs, colchicine
ULT 1st line
a. xanthine oxidase inhibitors
b. uricosurics
c. uricase agents
a. xanthine oxidase inhibitors
ULT 2nd line
a. xanthine oxidase inhibitors
b. uricosurics
c. uricase agents
b. uricosurics
ULT 3rd line
a. xanthine oxidase inhibitors
b. uricosurics
c. uricase agents
c. uricase agents
2 xanthine oxidase inhibitor drugs
allopurinol
febuxostat
T or F: allopurinol needs renal adjustment when eGFR > 30
F (> 60)
allopurinol max dose per day
a. 120 mg
b. 500 mg
c. 800 mg
d. 2000 mg
c. 800 mg
febuxostat max dose per day
a. 120 mg
b. 500 mg
c. 800 mg
d. 2000 mg
a. 120 mg
which drug for gout can cause SJS and TENs?
a. probenecid
b. allopurinol
c. febuxostat
d. pegloticase
b. allopurinol
which drug for gout is the HLA-B*5801 allele important for?
a. probenecid
b. allopurinol
c. febuxostat
d. pegloticase
b. allopurinol
T or F: allopurinol should only be taken during an acute gout attack
F (take even when there are no gout sx)
febuxostat black box warning
inc CV mortality (only used for pts who can’t tolerate allopurinol)
uricosuric drug we need to know
Probenecid
uricase drug to know
pegloticase
pegloticase is used in severe gout:
____ gout flares or more within 18 months
____ tophi or more
_____ damage due to gout
3
1
joint
BBW:
-anaphylaxis and infusion-related rxns
-G6PD deficiency-associated hemolysis and methemoglominemia
a. probenecid
b. pegloticase
c. allopurinol
d. colchicine
b. pegloticase
other ULT medications (2 of them; slide 70)
fenofibrate, losartan
which agent is NOT used for gout prophylaxis?
a. NSAIDs
b. prednisone 10 mg/day
c. colchicine
d. probenecid
d. probenecid
colchicine dose for gout prophylaxis (3 doses)
-0.6 mg once or twice daily
-0.3 mg daily for CrCl < 30
-0.3 mg twice weekly for dialysis
which drug is converted to allantoin?
a. pegloticase
b. probenecid
c. febuxostat
d. colchicine
a. pegloticase
probenecid initial dose and how to titrate. What is the max dose?
initial: 250 mg PO BID x 1-2 wks -> 500 mg BID
titrate by 500 mg every 1-2 wks
max dose: 2 g/day
A patient with extensive ulcerative colitis has disease located:
a. Only in the rectal area
b. In the rectum and sigmoid colon
c. In the terminal ileum
d. Throughout the majority of the colon
d. Throughout the majority of the colon
In patients with ulcerative colitis symptoms may be worsened by which of the following factors?
a. Use of ibuprofen
b. Use of acetaminophen
c. Nicotine use
d. Exercise
a. Use of ibuprofen
(nicotine use is protective in UC)
Which enzyme’s activity should be evaluated prior to initiation of therapy in patients receiving azathioprine?
a. Xanthine oxidase
b. CYP2D6
c. TPMT
d. HLA DRPHLA-DR2
c. TPMT
Which of the following is more characteristic of ulcerative colitis versus Crohn’s disease?
a. Confinement of disease to the small intestine
b. Fistula formation
c. Involvement of the terminal ileum
d. Superficial continuous inflammation of the intestinal mucosa
d. Superficial continuous inflammation of the intestinal mucosa
Which adverse effect may occur at a higher rate in patients receiving the combination of infliximab and azathioprine?
a. Pancreatitis
b. Lymphoma
c. Hepatitis
d. Encephalopathy
b. Lymphoma (hepatosplenic T-cell lymphoma)
Which of the following drugs is administered intravenously?
a. Golimumab
b. Adalimumab
c. Certolizumab
d. Vedolizumab
d. Vedolizumab
Which location best describes the site of action of oral budesonide (Entocort EC)?
a. Sigmoid colon
b. Rectal area
c. Terminal ileum
d. Duodenum
c. Terminal ileum
Which one of the following is a potential adverse effect of ustekinumab?
a. Risk of infection
b. Progressive multifocal leukoencephalopathy
c. Neural tube defects
d. Heart failure
a. Risk of infection (blocks IL-12 and IL-23)
Which drug is recommended for acute treatment of a hospitalized patient with fulminant Crohn’s disease who has failed maximum doses of intravenous corticosteroids?
a. Azathioprine
b. Cyclosporine
c. Budesonide
d. Methotrexate
b. Cyclosporine (or infliximab)
Which medication may induce infertility in male patients with inflammatory bowel disease?
a. Mesalamine
b. Sulfasalazine
c. Certolizumab
d. Golimumab
b. Sulfasalazine
Which medication is most effective for treatment of mild-to-moderate proctitis in a patient with UC?
a. Sulfasalazine
b. Mesalamine suppository
c. Hydrocortisone enema
d. Ciprofloxacin
b. Mesalamine suppository
Which of the following is an extraintestinal manifestation of inflammatory bowel disease?
a. Pyoderma gangrenosum
b. Hypothyroidism
c. Hypertension
d. Glaucoma
a. Pyoderma gangrenosum
Which of the following individuals would be at the highest risk for developing idiopathic SLE?
a. 20-year-old African American female
b. 25-year-old White female
c. 30-year-old Hispanic male
d. 40-year-old Asian male
a. 20-year-old African American female
(SLE occurs most frequently in women of reproductive age, especially in non-White females. It is most common in those of African origin.)
Patients with SLE should be encouraged to stop smoking. Which of the following has been associated with smoking?
a. Decreased effectiveness of hydroxychloroquine
b. Decreased titers of anti-double-stranded DNA
c. Decreased incidence of hemorrhagic cystitis with cyclophosphamide
d. Decreased cutaneous lupus disease activity
a. Decreased effectiveness of hydroxychloroquine
Which of the following drugs decreases survival of B-cells by inhibiting B-lymphocyte stimulator?
a. Abatacept
b. Belimumab
c. Rituximab
d. Tocilizumab
b. Belimumab
A 20-year-old African American woman develops Class III lupus nephritis. What is the recommended induction treatment for her disease?
a. High-dose IV cyclophosphamide
b. Low-dose IV cyclophosphamide
c. Mycophenolate mofetil
d. Rituximab
c. Mycophenolate mofetil
A patient has cutaneous lupus on her face and treatment is needed. She is very concerned about her appearance. Which of the following is most associated with causing skin atrophy and telangiectasias?
a. Hydroxychloroquine
b. Methotrexate
c. Topical pimecrolimus
d. Topical triamcinolone acetonide
d. Topical triamcinolone acetonide
A patient is receiving belimumab for treatment of SLE. His immunization history and needs are being assessed. Which of the following vaccines should be avoided while he is receiving that drug?
a. Hepatitis B
b. Influenza
c. Yellow fever
d. Pneumococcal
c. Yellow fever (no live vaccines)
Which of the following therapies for rheumatoid arthritis should be avoided in a patient with advanced heart failure?
a. Abatacept (Orencia)
b. Tocilizumab (Actemra)
c. Golimumab (Simponi)
d. Tofacitinib (Xeljanz)
c. Golimumab (Simponi)
(all TNF inhibitors should be avoided in pts with advanced HF)
Which of the following would be an appropriate counseling point for adalimumab (Humira) for RA?
a. This medication can cause high blood pressure.
b. This medication should not be interrupted for any reason.
c. This medication should be administered monthly.
d. This medication can be given with methotrexate.
d. This medication can be given with methotrexate.
TK is 69-year-old woman with T2DM, COPD, IBD, and established RA. She has an allergy to sulfa drugs and penicillin. Her disease activity scores remain elevated despite optimized MTX therapy. What would be an appropriate therapeutic intervention to help her achieve her goal of low disease activity?
a. Add sulfasalazine to methotrexate.
b. Add adalimumab to methotrexate.
c. Stop methotrexate and add abatacept.
d. Add abatacept to methotrexate.
b. Add adalimumab to methotrexate (can help with both RA and IBD)
(a. is wrong bc sulfa allergy; abatacept should not be recommended due to COPD)
Which of the following is the most likely site for an acute attack of monoarticular gouty arthritis?
a. First metatarsophalangeal joint
b. Ankle
c. Heel
d. Knee
a. First metatarsophalangeal joint
Which of the following is a first-line therapy to treat an acute gout flare?
a. Adrenocortocotropic hormone
b. Prednisone
c. Allopurinol
d. High-dose colchicine
b. Prednisone
(NSAIDs, GCs, or low-dose colchicine are all first line)
Which of the following agents is a preferred first-line urate-lowering therapy in patient with moderate-to-severe CKD?
a. Febuxostat
b. Pegloticase
c. Allopurinol
d. Probenecid
c. Allopurinol
How long should prophylaxis for acute gout flare be given after initiation of urate-lowering therapy?
a. 1-2 weeks
b. 2-4 weeks
c. 1-3 months
d. 3-6 months
d. 3-6 months
Which of the following is the most appropriate initial dosing strategy for colchicine used to treat an acute gout flare in patient with normal renal function?
a. 0.6 mg one dose
b. 0.6 mg hourly until symptoms subside
c. 1.2 mg initially, followed by 0.6 mg one hour later
d. 1.2 mg hourly until symptoms subside
c. 1.2 mg initially, followed by 0.6 mg one hour later
What is the best option for treatment of acute gouty arthritis of the great toe in a 65-year-old female with a past medical history significant for atrial fibrillation and who takes apixaban?
a. Low-dose colchicine
b. Febuxostat
c. Intra-articular corticosteroid injection
d. Indomethacin
a. Low-dose colchicine
(d. is less viable bc apixaban and inc bleeding risk; c. would be hard to inject)
Which of the following would be the most appropriate initial treatment option for a patient with uncontrolled diabetes, and no other past medical history, experiencing a polyarticular attack of acute gout?
a. Prednisone 40 mg daily for 5 days, then taper by 10 mg every 3 days until off
b. Naproxen 250 mg TID until resolved
c. Colchicine 1.2 mg initially, then 0.6 mg hourly until sx have resolved or diarrhea occurs
d. Triamcinolone 40 mg × 1 dose intra-articularly
b. Naproxen 250 mg TID until resolved
(a. steroid with diabetes could make it worse; c. dosing is wrong; d. is polyarticular)
Which of the following is the best option for a patient with gout taking allopurinol 300 mg daily with a serum uric acid level of 7.4 mg/dL (440 µmol/L)?
a. Add febuxostat 40 mg daily
b. Add probenecid 500 mg daily
c. Add fenofibrate 145 mg daily
d. Increase the allopurinol dose to 400 mg daily
d. Increase the allopurinol dose to 400 mg daily
(optimize dose before dual therapy; a. is in the same class)
if a pt had the HLA-B*5801 allele, what drug would we give them for gout instead of allopurinol?
febuxostat (as long as they don’t have CV disease)
A 38-year-old man with moderate to severe CD has been experiencing numerous relapses on his current medication regimen. He is taking AZA and infliximab for maintenance therapy. What changes would be best to make to his maintenance regimen?
A. Stop infliximab and initiate IV cyclosporine.
B. Stop infliximab and AZA and initiate dexamethasone.
C. Stop infliximab and AZA and initiate vedolizumab.
D. Continue AZA and infliximab and begin natalizumab.
C. Stop infliximab and AZA and initiate vedolizumab.
(failed immunomodulator and TNF antag, change drug class; anti-integrin; a. is only for severe UC exacerbations; b. systemic steroids not rec for maintenance therapy)
Which of the following medications is indicated for the treatment of ulcerative colitis, but NOT Crohn disease?
A. Golimumab
B. Infliximab
C. Adalimumab
D. Ustekinumab
A. Golimumab
TDM of biologics: Detectable ADAs, sub-therapeutic drug levels
a. change to alternate drug, within same class +/- immunomodulator
b. dose escalate
c. repeat TDM levels first, if results are same then switch to out of class biologic
d. switch to out of class biologic
a. change to alternate drug, within same class +/- immunomodulator
TDM of biologics: Undetectable ADAs, sub-therapeutic drug levels
a. change to alternate drug, within same class +/- immunomodulator
b. dose escalate
c. repeat TDM levels first, if results are same then switch to out of class biologic
d. switch to out of class biologic
b. dose escalate
TDM of biologics: Detectable ADAs, therapeutic drug levels
a. change to alternate drug, within same class +/- immunomodulator
b. dose escalate
c. repeat TDM levels first, if results are same then switch to out of class biologic
d. switch to out of class biologic
c. repeat TDM levels first, if results are same then switch to out of class biologic
TDM of biologics: Undetectable ADAs, therapeutic drug levels
a. change to alternate drug, within same class +/- immunomodulator
b. dose escalate
c. repeat TDM levels first, if results are same then switch to out of class biologic
d. switch to out of class biologic
d. switch to out of class biologic
A 38-year-old male patient is newly diagnosed with mild to moderate Crohn disease (CD) confined to the ileum and ascending colon. What is the best recommendation for this patient?
A. Mesalamine enema 1 g PR at bedtime
B. Prednisone 40 mg orally daily
C. Certolizumab pegol 400 mg subcutaneously
D. Budesonide 9 mg orally daily
D. Budesonide 9 mg orally daily
Which of the following is a nonsystemic antibiotic that works by inhibiting bacterial RNA synthesis by binding to the β-subunit of bacterial DNA-dependent RNA polymerase?
A. Cefotaxime
B. Ciprofloxacin
C. Sulfamethoxazole/trimethoprim
D. Rifaximin
D. Rifaximin
TP has been treated for his UC with adalimumab for 6 months. He has failed to experience an improvement in his sx. In this time he received appropriate loading and maintenance dosing and acknowledges proper adherence. Prior to his next dose therapeutic drug monitoring is performed. TP’s labs demonstrate therapeutic levels of infliximab, no detectable level of ADAs to infliximab present, and high levels of inflammatory markers. What is the best strategy in this pt?
A. Discontinue adalimumab and start golimumab.
B. Continue adalimumab and add ustekinumab.
C. Discontinue adalimumab and start vedolizumab.
D. Continue adalimumab and decrease duration to administration every 7 days.
C. Discontinue adalimumab and start vedolizumab.
(No ADAs, therapeutic -> switch biologic class; a. is same class; b. we don’t want to do at once)
Which of the following medications is appropriate as an initial therapy in mild UC of the distal colon?
A. Vedolizumab
B. MTX
C. Mesalamine
D. Natalizumab
C. Mesalamine
Which of the following medications is appropriate for mild CD of the perianal area?
a. sulfasalazine
b. metronidazole
c. budesonide
d. infliximab
b. metronidazole
initial tx for severe-fulminant CD
IV hydrocortisone 100 mg q6-8h
mild-mod active UC tx for distal colon in left-sided disease
a. mesalamine enema
b. mesalamine suppository
a. mesalamine enema
mod-severe active UC in treatment naive pts
a. ustekinumab
b. prednisone + infliximab
c. cyclosporine IV
b. prednisone + infliximab
