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gold stat Flashcards

1
Q

T/F

oxipurinol is a (covalent) suicide inhibitor of XO

A

True

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2
Q

Mechanism of action of colchicine

A. Inhibits leukocyte function and reduces release of interleukins and free radicals
B. Inhibits formation of uric acid by blocking conversion of xanthine and hypoxanthine
C.PDE4 inhibitor reducing synthesis and release of TNF alpha
D. Prevents formation of IL-2 and activation of T-cells

A

A.
Inhibits leukocyte function and reduces release of interleukins and free radicals

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3
Q

T/F

Tacrolimus and pimecrolimus, calcineurin inhibitors, carry a risk of nephrotoxicity and
malignancies

A

True

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4
Q

T/F

In both gout and pseudogout, a patient can have increased uric acid levels, but in gout, you will see needle-like crystals upon pathologic review

A

True

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5
Q

HW is a 69 year old man who presents to the urgent care center with an acute gout attack in his left great toe. His labs are WNL except for a serum creatinine of 1.7mg/dL and a uric acid level of 13 mg/dL. Which of the following is an appropriate treatment for the acute attack?

A. Colchicine 1.2 mg po STAT and 0.6 mg one hour later B. Oxycodone 10mg po q6h prn pain x 5 days
C. Methylprednisolone 1000mg IM q
D. Allopurinol 100mg po q day

A

A.
Colchicine 1.2 mg po STAT and 0.6 mg one hour later

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6
Q

In the acne case, reasonable treament options for JG include all except

A. BP + topical ABX
B. Topical retinoid + BP + topical abx
C. Topical retinoid + BP
D. Topical abx + oral abx

A

D.
Topical abx + oral abx

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7
Q

In the acne case, the patient picked up Differin gel (0.1%) over the counter because her friend used it and said it really worked for her. She reports that it seems to be making her acne worse. Which of the following is the most appropriate response to the patient?

A. This medication is inducing acne and will continue to make it worse if you keep using
B. This is a serious side effect and you should discontinue it immediately.
C. This is the wrong drug to treat your acne. You need a strong prescription medication.
D. This is expected from this medication. It is a known effect to make acne worse

A

D.
This is expected from this medication. It is a known effect to make acne worse

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8
Q

Xanthine oxidase enzymes contains:

a) Tetrahydrofolate as a cofactor
b) Molybdopterin as a cofactor
c) Zn2+ as a cofactor
d) Heme iron as a cofactor

A

b) Molybdopterin as a cofactor

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9
Q

Following is true for Pegloticase except

a) It is present endogenously in humans
b) It has favorable pharmacokinetic profile and is less immunogenic
c) It oxidatively degrades uric acid into allantoin
d) It is a pegylated uricase
e) It produces hydrogen peroxide as a byproduct

A

a) It is present endogenously in humans

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10
Q

Pegloticase (Krystexxa)

a) Mammalian uricase
b) Uricosuric (increases uric acid elimination)
c) Inhibits URAT1 (uric acid transporter)
d) Reduction of IL1-beta
e) Inhibits xanthine oxidase

A

a) Mammalian uricase

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11
Q

SATA

Which of the following is responsible for cell lysis in acute eczematous dermatitis:

a) CD8 lymphocytes
b) CD4 lymphocytes
c) Langerhans cells
d) none of the above

A

a) CD8 lymphocytes
c) Langerhans cells

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12
Q

Antiacne drug azelaic acid -
a) Blocks IL-12
b) Blocks IL-17
c) Blocks IL-23
d) Inhibits 5-alpha-reductase
e) increases/elevates IL-10

A

d) Inhibits 5-alpha-reductase

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13
Q

What important counseling point would you include for a patient you dispensed tretinoin 0.05% cream to?

a) You should wait at least 1⁄2 hour after washing your face before applying this medication
b) This drug may increase your cholesterol levels.
c) BE sure to apply sunscreen with an SPF of at least 50.
d) Your acne will begin to improve within 3 days of starting this medication.

A

a) You should wait at least 1⁄2 hour after washing your face before applying this medication

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14
Q

In which clinical scenario would an immunobiologic agent be an appropriate choice for treatment?
a)75 year old female who is having ADR from high dose topical steroids and has psoriasis on 5% of BSA
b) 23 year old male with a history of latent TB has failed topical steroids
c) 66 year old female with low platlets and HIV
d) 54 year old male who has failed acitretin and has psoriasis on 65% of BSA

A

d) 54 year old male who has failed acitretin and has psoriasis on 65% of BSA

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15
Q

Mr. Smith is a 62 year old man who had one episode of gout in his ankle about 2 months ago. It responded well to treatment and he’s just now following up with his physician. He has had no further gouty episodes and on physical examination his ankle looks fine. His vital signs are WNL and his labs are WNL except for the uric acid, which is 7.5 mg/dL. Which of the following treatments do you recommend?

a) Probenecid 250 mg po bid
b) Allopurinol 100 mg po daily
c) Colchicine 0.6 mg po bid
d) No treatment is necessary at this time.

A

d) No treatment is necessary at this time.

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16
Q

T/F

Endogenous retinoids are prone to undergo cis-trans-isomerization

A

True

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17
Q

Which of the following is mainly associated with psoriasis?
a) Intraepidermal edema
b) Open comedones
c) Thickened epidermis
d) None of the above

A

c) Thickened epidermis

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18
Q

Which of the following drugs are an oral retinoid binding to the retinoic acid receptor (RAR) and is antiproliferative?

a) Calcipotriene (Dovonex), calcitriol (Vectical)
b) Alefacept (Amevia)
c) Cyclosporine, pimecrolimus (Elidel), and tacrolimus (Protopic)
d) Ustekinumab (Stelara)
e) Acitretin (soriatane)

A

e) Acitretin (soriatane)

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19
Q

SATA

CO is a 27 year old male with severe inflammatory acne who just started oral isotretinoin therapy. Which of the following are important monitoring parameters for this medication?

a) monitor triglycerides
b) monitor blood pressure
c) monitor hepatic function
d) monitor renal function

A

a) monitor triglycerides
c) monitor hepatic function

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20
Q

Secukinumab (Cosentyx)

a) Inhibits 5-alpha-reductase
b) blocks IL-23
c) blocks IL-12
d) blocks IL-17
e) Increases/elevates IL-10

A

d) blocks IL-17

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21
Q

T/F

Patients with psoriasis should continue the use of an emollient at every stage of their disease.

A

True

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22
Q

Allopurinol (Zylorim):

a) Uricosuric (increase uric acid elimination) Reduction of IL1-beta
b) Reduction of IL1-beta
c) Inhibits URAT 1 (uric acid transporter) Reduction of TNF-alpha
d) Reduction of TNF-alpha
e) Inhibits xanthine oxidase

A

e) Inhibits xanthine oxidase

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23
Q

MI presents to your pharmacy with a new prescription for minocycline 50 mg BID. His current medication profile is:
- Current Medication list
- Dapsone gel 5% twice daily
- Adapalene 0.1% once daily at night
- Benzoyl peroxide 3% facial wipes use BID

Which of the following is the most appropriate to recommend discontinuing?

a) Adapalene 0.1%
b) Dapsone 5% gel
c) Benzoyl peroxide 3%
d) Stop all topical agents

A

b) Dapsone 5% gel

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24
Q

Which of the following is an alpha-2 agonist?

a) Bimatoprost (Lumigan)
b) Brimonidine (Alphagan)
c) Brinzolamide (Azopt)
d) Levobetaxolol (Betaxon)

A

b) Brimonidine (Alphagan)

25
Q

The -COOH group in prostaglandin analogs such as latanoprost, travoprost, unoprostone, bimatoprost, and latanoprostene bunod for the treatment of glaucoma are usually either esterified or amidated because

a) -COOH group is not essential to FP receptor binding
b) -COOH group is unstable
c) Esters and amides provide better corneal absorption than -COOH d) -COOH group causes GI irritation

A

c) Esters and amides provide better corneal absorption than -COOH

26
Q

SATA

Betaxolol (Betopic), Levobunolol (Betagan), and Timolol (timoptic)

a) Reduce synthesis of aqueous humor
b) Cytoprotective for ganglion cells
c) Increase outflow of aqueous humor
d) Increase uveoscleral outflow of aqueous humor

A

a) Reduce synthesis of aqueous humor

27
Q

NK presents your pharmacy with psoriasis. Currently she has several thick, well-defined erythematous plaques on her elbows and knees that were covered with silvery scales (<10% of her body). Her medication profile includes:
- Fluocinolone acetonide 0.01% cream BID
- Naproxen 500mg 1 tablet po BID (Naproxen is a Nonsteroidal anti inflammatory agent - NSAID)

After reviewing NKs case, you and the prescriber decide to stop all the current meds. The best recommendation to treat her psoriasis:

a) Start betamethasone dipropionate ointment BID
b) Start alefacept 15 mg weekly
c) Start acitretin 25 po daily
d Start calcipotriene 0.05% cream

A

d) Start calcipotriene 0.05% cream

28
Q

The physician on your team is looking for a medication to treat a patient’s psoriasis and is requesting something that is non-staining and not a retinoid. Which of the following products would you recommend to the prescriber as options?

a) Calcipotriene
b) Anthralin
c) Tars
d) Tazarotene (retinoid)

A

a) Calcipotriene

29
Q

MEDCHEM

Which of the following -OH group in tetracycline class of antibiotics is not an acidic (PIC)

A

A

not allylic/not next to double bond

30
Q

Anthralin inhibits DNA synthesis by which of the following mechanisms:

A) It forms a bi-functional covalent adduct with the DNA
B) It intercalates between the DNA base pairs via non-covalent binding
C) It forms a mono-functional covalent adduct with the DNA

A

B) It intercalates between the DNA base pairs via non-covalent binding

31
Q

NI is a 21-year-old female who comes to your pharmacy after her first mild noninflammatory acne breakout. What would you recommend?

a) Topical salicylic acid
b) Topical erythromycin
c) Topical Benzoyl peroxide
d) Oral isotretinoin

A

c) Topical Benzoyl peroxide

32
Q

Irregularly shaped crystals are associated with which of the following joint diseases?

a) Calcium crystal-induced arthritis
b) Rheumatoid arthritis
c) Gout
d) None of the above

A

c) Gout

33
Q

MEDCHEM

The following structure become acetylcholine when R is:

a) -C(=O)H
b) -C(=O)CH2CH2Ch3
c) -C(=O)CH3
d) -C(=O)CH2CH3

A

c) -C(=O)CH3

34
Q

NK presents your pharmacy with psoriasis. Currently she has several thick, well-defined erythematous plaques on her elbows and knees that were covered with silvery scales (<10% of her body). Her medication profile includes:
- Fluocinolone acetonide 0.01% cream BID
- Naproxen 500mg 1 tablet po BID

Which of the following drug therapy problems do you identify based on the info provided in this case?
a) Dose too low/ineffective drug
b) Dose too high group 4 mid potency
c) Need for additional therapy
d) Nonadherence

A

a) Dose too low/ineffective drug

35
Q

Joe is a 70 yo man with a history of gout. Because of an elevated uric acid, his MD is going to start him on urate lowering therapy (ULT). Which of the following regimens is appropriate for acute gout prophylaxis while starting ULT?

A) No prophylaxis is needed
B) lesinurad 200 mg po daily x 3-6month
C) Colchicine 0.6 mg po daily x 3-6 months
D) Acetaminophen 650 mg po bid x 3-6month

A

C) Colchicine 0.6 mg po daily x 3-6 months

36
Q

33) Which of the following releases nitric oxide relaxing the trabecular meshwork and is a PGF2 alpha analog?

A) Brimonidine (Alphagan)
B) Latanoprost (Xalatan)
C) Latanoprostene bunod (Vyzulta)
D) Levobunolol (Betagan)

A

C) Latanoprostene bunod (Vyzulta)

37
Q

DO is a 20 year old male, suffering from severe
acne (-2 dozen cysts and nodules) on face and back for past 4 years. Current medication history:
● topical benzoyl| peroxide 2 5% (nof using this at present due to skin irritation)
● adapalene 0.1% apply HS- go through tubes very quickly due to acne on face and ba
● Minocycline 50 mg BID - has been taking for 6 months and continues to have severe acne
● Social history - university student, living with friends, non-smoker, moderate alcohol, no illicit drug use.
● Vitals and Labs: wt 72 kg. ALT 25, AST 19, Serum Creatine 0.67, Total cholesterol 195, LDL 115, HDL 43

Which of the following recommendations are correct to provide?

a) Start isotretinoin 20 mg BID
b) Start isotretinoin 40 mg BID
c) Increase minocycline to 100 mg BID
d) Sarecyckine 60 mg once daily

A

a) Start isotretinoin 20 mg BID

38
Q

MECHEM

35) Which of the following moiety in Physostigmine is transferred to a serine residue of acetylcholinesterase?
A) Square
B) Rectangle
C) Circle

A

A) Square

39
Q

Tazarotene

a) Inhibits inosine monophosphate dehydrogenase, inhibiting T- & B- cell proliferation
b) Binds to CD2 reducing T-cell number and activation, apoptosis occurs
c) Binds to RAR (retinoic acid receptors), suppressing hyperplasia
d) Blocks synthesis and release of IL-2

A

c) Binds to RAR (retinoic acid receptors), suppressing hyperplasia

40
Q

Which of the following best describes the mechanism of action of tacrolimus?

a. Inhibition of Phosphodiesterase 4
b. Inhibition of Calcineurin
c. Inhibition of retinoic acid receptor d. Inhibition of IL-12 receptor
e. Inhibition of Vitamin D3 receptor

A

b. Inhibition of Calcineurin

41
Q

which of the following is mainly associated with acne:

a) A family history of allergies
b) Elevated levels of androgens
c) Autoimmune antibodies
d) None of the above

A

b) Elevated levels of androgens

42
Q

a 27 year old female with a history of psoriasis is currently taking acitretin. For how long after discontinuing acitretin should patients be advised to avoid pregnancy?

a) 6 months
b) 5 years
c) 3 years
d) 1 year

A

c) 3 years

43
Q

MECHEM

following structure becomes carbachol when R is:

A) -C(=O)NH2
B) -C(=O)NHCH3
C)-C(=O)CH3
D) -C(=O)NHOH

A

A) -C(=O)NH2

44
Q

Lesinurad (Zurampic) -

a) Reduction in TNF-alpha
b) Inhibits URAT1 (uric acid transporter)
c) Reduction of IL1-beta
d) Inhibits xanthine oxidase
e) Uricosuric (increases uric acid elimination)

A

b) Inhibits URAT1 (uric acid transporter)

45
Q

Tretinoin is the:

A) Hydrolyzed form of Vitami A
B) Reduced form of Vitamin A
C) Oxidized form of Vitamin A

A

C) Oxidized form of Vitamin A

46
Q

Alefacept (Amevie)

a) Binds to CD2 reducing T-cell number and activation, apoptosis occurs
b) Blocks synthesis and release of IL-2
c) Inhibits inosine monophosphate dehydrogenase, inhibiting T-& B-cell proliferation Binds to d)RAR (retinoic acid receptors), suppressing hyperplasia

A

a) Binds to CD2 reducing T-cell number and activation, apoptosis occurs

47
Q

MEDCHEM

Which of the following R group is in the benzoxaborole analog is detrimental for PDE4 (Phosphodiesterase 4)

a) A
b) D
c) C
d) B

A

C- SO2NH2

48
Q

a patient comes into your pharmacy asking for advice on how to avoid gout attacks. He has had attacks in the past 18 months. He said that he read something on the internet about adjusting his diet or taking an over-the-product. Which of the following would you tell him?

a) Take acetaminophen 325mg twice daily
b) Limit his intake of certain meats like liver, beef, or lamb
c) Take a calcium supplement, about 1000mg per day
d) Drink 1-2 cans of beers each evening.

A

b) Limit his intake of certain meats like liver, beef, or lamb

49
Q

MEDCHEM

Which of the double bonds in methoxsalen are photosensitve and are known to undergo crosslinking with the thymine base of DNA strand?

a)AandD
b)AandB
c)AandE
d)AandC

A

c)AandE

50
Q

Which of the following drugs are toxic to the liver and especially the kidney? Acute toxicity is reduced renal elimination (glomerular filtration) while long term toxicity includes kidney damage.

a) Calcipotriene (Dovonex), calcitriol (Vectical)
b) Cyclosporine, pimecrolimus (Elidel), and tacrolimus (Protopic)
c) Ustekinumab (Stelara)
d) Acitretin (soriatane)
e) Alefacept (Amevia)

A

b) Cyclosporine, pimecrolimus (Elidel), and tacrolimus (Protopic)

51
Q

Which of the following is an appropriate counseling point to a glaucoma patient starting therapy with an ophthalmic solution?

a) Wash your eyes before instilling the medication
b) Use nasolacrimal occlusion to increase the absorption of the medication into the eye
c) Always store eye drops in the refrigerator
d) To make sure the drop gets in, touch the tip of the dropper to the corner of your eye.

A

b) Use nasolacrimal occlusion to increase the absorption of the medication into the eye

52
Q

Which of the following drugs bind to the Vitamin D receptor?

a) Alefacept (Amevia)
b) Acitretin (soriatane)
c) Calcipotriene (Dovonex), calcitriol (Vectical)
d) Ustekinumab (Stelara)
e) Cyclosporine, pimecrolimus (Elidel), and tacrolimus (Protopic)

A

c) Calcipotriene (Dovonex), calcitriol (Vectical)

53
Q

SATA

stekinumab (Stelara)

a. Inhibits 5-alpha-reductase
b. Blocks IL-12
c. Blocks IL-17
d. Blocks IL-23
e. increases/elevates IL-10

A

b. Blocks IL-12
d. Blocks IL-23

54
Q

LS is a 73 yo male with a history of gout, hypertension and he had a myocardial infarction 2 years ago. He comes to his MD for his annual physical exam. Over the past year he has had 3 attacks of gout but today he is fine. In reviewing his labs, the MD noted that LS’s uric acid level is 10.8 mg/dL. Current medications are allopurinol 100 mg, enalapril 20mg daily, rosuvastatin 20mg daily, and aspirin 81 mg daily. Which of the following is correct?

a) Change allopurinol to febuxostat 80 mg daily
b) The enalapril should be discontinued since it increases uric acid
c) No change in his regiment is needed
d) The dose of allopurinol should be increased

A

d) The dose of allopurinol should be increased

55
Q

SATA

which of the following classes of medications can increase intraocular pressure?

a) Opioids
b) Antibiotics
c) Corticosteroids
d) Anticholinergics

A

c) Corticosteroids
d) Anticholinergics

56
Q

MEDCHEM

In the following scheme identify correct R groups
a) R1 = NH2 and R2 = OH
b) R1 and R2 both OH
c) R1 = OH and R = H
d) R1 = OH and R2 = NH2

A

b) R1 and R2 both OH

57
Q

John is a 34 yo man with plaque psoriasis primarily on his elbows and knees. His physician is prescribing a topical corticosteroid and asks your opinion about the best and most effective vehicle for John’s lesions.

A) Cream
B) Gel
C) Ointment
D) Lotion

A

C) Ointment

58
Q

CM is a 57 year old woman diagnosed with glaucoma. Her PMH is significant for HTN and dyslipidemia. She is currently on metoprolol succinate 25mg daily, hydrochlorothiazide 25mg daily, and atorvastatin 10 mg at bedtime. Her ophthalmologist starts her on latanoprost 0.005% 1 drop in each eye qhs. What concerns do you have about this prescription?

A) Pulse should be monitored for bradycardia because of a drug interaction
B) It should be dosed q 8 hr
C) It can reduce night vision
D) It can cause overgrowth of her eyelashes

A

D) It can cause overgrowth of her eyelashes

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