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Skeletal Muscle > GOUT Med Chem > Flashcards

GOUT Med Chem Flashcards

1
Q

This is the strucutre of a purine. The structure circled in blue is a ____ and the strucutre circled in red is a ____.

A. Pyrimidine, Imidazole

B. Imidazole, Pyrimidine

A

A

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2
Q

What is the function of purines in the body? (select all)

A. To break down nucleic acids

B. To synthesize nucleic acids for DNA

C. To create inflammatory mediators for Gout

D. To synthesize nucleic acids from RNA

A

B, D

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3
Q

Which of the following are purine bases? (Select All)

A. Adenine

B. Cytosine

C. Thiamine

D. Guanine

E. Uracil

A

A,D

Remember PURE AS GOLD

Purine=Adenine and Guanine

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4
Q

Catabolism of ____ bases leads to the synthesis of uric acid.

A. Pyrimidine

B. Purine

A

B

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5
Q

The following picture shows the Purine Adenine being metabolized in the body. What is happening between the first two steps seen here?

A. Reduction

B. Hydrolysis

C. Deamination

D. None of the above

A

D

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6
Q

Hypoxanthine is created when Adenine is deaminated. Hypoxanthine is then metabolized to _____ by the enzyme _____.

A. Uric acid, Xanthine Oxidase

B. Xanthine, Adenine Deaminase

C. Uric Acid, Adenine Deaminase

D. Xanthine, Xanthine Oxidase

A

D

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7
Q

Xanthine is formed when hypoxanthine undergoes metabolism by Xanthine Oxidase. From there, Xanthine will undergo metabolism via the enzyme____ in order to form ____.

A. Xanthine Deaminase, Uric Acid

B. Xanthine Oxidase, Uric Acid

C. Xanthine Deaminase, Urate

D. None of the above

A

B

In order to remember the strucutre of uric acid remember its a purine base with 3 hydroxy groups.

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8
Q

What enzyme is responsible for metabolizing Guanine into Xanthine?

A. Adenosine Deaminase

B. Xanthine Oxidase

C. Guanine Deaminase

D. None of the above

A

C

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9
Q

Based on the picture provided, which statements are true regarding the solubility of these molecules? (Select All)

A. Purines are the most soluble of all of them

B. Hypoxanthine is less soluble than Uric Acid

C. Xanthine is less soluble than Hypoxanthine

D. Uric acid is the least soluble of all of them

E. Uric acid is the most soluble of all of them

A

A, C, D

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10
Q

Answer the following question provided:

A

A

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11
Q

When comparing the structures of Hypoxanthine to Uric Acid the blue bonds represent ____ bonds and the red bonds represent _____ bonds

A. Intramolecular, Intermolecular

B. Intermolecular, Intramolecular

A

A

Intermolecular bonds- bonds between two different atoms between two different molecules

Intramolecular bonds- bonds between two different atoms within the same molecule

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12
Q

Based on the picture provided comparing Hypoxanthine to Uric Acid, why is it that Hypoxanthine is more soluble than Uric Acid? (select all)

A. More Intramolecular bonds are present on Hypoxanthine and allow it to bind to H2O molecules and become soluble

B. Three Intramolecular bonds and one Intermolecular bond are present on Uric Acid and limit its solubility in water.

C. 3 Intermolecular bonds are one Intramolecular bond are present on Hypoxanthine and allow it to interact more with water, increasing its solubility

D. They both have equal solubility due to their similar structures

A

B, C

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13
Q

Uric acid becomres ___ soluble at lower temperatures and ___soluble at higher temperatures

A. More, Less

B. Less, More

A

B

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14
Q

Uric Acid is ____ soluble at a lower pH and ____ soluble at a higher pH.

A. Less, More

B. More, Less

A

A

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15
Q

At physiologic pH uric acid exists as:

A. A completely unionized form

B. Partially ionized form (Sodium Urate)

C. A completely Ionized form

D. none of the above

A

B

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16
Q

T/F The Sodium Urate form of Uric Acid has a very LOW solubility.

A

T

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17
Q

Which NSAID should NOT be used for treating gout?

A. Naproxen

B. Ibuprofen

C. Indomethacin

D. Aspirin

A

D

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18
Q

If an acute gout attack has occured and I want to treat my patient, which agents will I use first? (Select All)

A. NSAIDs

B. Colchicine

C. Probenacid

D. Allopurinol

E. Glucocorticoids

A

A, B, E

19
Q

Which of the following agents should you use In order to prevent recurrent flare-ups of gout attacks? (Select All)

A. Probenecid

B. NSAIDs

C. Colchicine

D. Allopurinol

E. Febuxostat

A

A, D, E

20
Q

Which of these agents is meant to decrease the formation of uric acid? (Select All)

A. Colchicine

B. Probenecid

C. Allopurinol

D. Glucocorticoids

E. Febuxostat

A

C, E

21
Q

Which of the agents listed is meant to increase uric acid excretion from the body?

A. Probenecid

B. Allopurinol

C. Febuxostat

D. Naproxen

E. Prednisone

A

A

22
Q

How are corticosteroids typically given when treating gout? (Select All)

A. Systemically

B. Rectally

C. Inhaled

D. Intraarticular injection

A

A, D

23
Q

All of the following are mechanisms of action in the treatment of gout for corticosteroids EXCEPT:

A. Inhibits the Phospholipase A2 (PLA2)

B. Decreases PMN migration and vasodilation

C. Suppresses the immune system by decreasing levels of monocytes and decreasing IL-1 and TNF-a production.

D. Decreases uric acid synthesis by blocking Xanthine Oxidase

A

D

24
Q

When using corticosteroids, triamcinolone is typically given as a(an) ______ and prednisone is typically given as a _____.

A. Intraarticular injection, Systemic agent

B. Systemic agent, Intraarticular injection

A

A

25
Q

When Prednisone is metabolized it loses its ketone group to form an alcohol on the ____ form of the molecule known as___.

A. Inactive, Methylprednisolone

B. Active, Methylprednisolone

C. Inactive, Prednisolone

D. Active, Prednisolone

A

D

26
Q

The MOA of colchicine is not completely known. All of the following are suspected MOA of colchicine EXCEPT:

A. Decreased leukocyte chemotaxis (Anti-mitotic)

B. Reduces phagocytosis of urate crystals in joint

C. Reduces lactic acid and production by PMN leukocytes.

D. Reduces the formation of lactic acid by blocking Xanthine Oxidase

A

D

27
Q

When looking at the metabolism of Colchicine (Colcrys) what is the reaction that is happening and what enzyme is taking place?

A. CYP3A4, Amide Hydrolysis

B. CYP3A4, Ester Hydrolysis

C. CYP2C9 Amide Hydrolysis

D. CYP2C9 Ester Hydrolysis

A

A

28
Q

T/F Colchicine is a substrate for PgP

A

T

This is important because being a substrate for PgP could mean that the drug may not be absorbed very well if somone has strong PgP activity or if someone is taking a PgP inducer it could redcue the bioavailability of colchicine

29
Q

T/F Colchicine has a narrow therapeutic window and needs to be renally adjusted in patients with renal dysfunction

A

T

30
Q

What enzyme are the drugs Allopurinol and Febuxostat blocking here?

A. Deaminase

B. Xanthine Oxidase

C. CYP3A4

D. CYP2C9

A

B

31
Q

What is the MOA of allopurinol?

A. It is a substrate for xanthine oxidase and reversibly inhibits it in order to reduce uric acid levels in the body.

B. It will increase uric acid secretion in the body

C. Reduces inflammation by reducing monocyte activity

D. Inhibits the microtubules from forming and decreases leukocyte chemotaxis

A

A

32
Q

Which of the following statements are true about Allopurinol? (Select All)

A. It is a substrate for Xanthine oxidase and reversibly inhibits its action.

B. When metabolized it will produce a less potent metabolite called Oxypurinol with a longer half-life (18-30 hr)

C. It is excreted primarily in the urine so it must be dosed renally in those with renal impairment

D. Metabolized primarily in the liver and does not require renal dosing.

E. Very useful medication for an acute attack rather than a management medication.

A

A, B, C

33
Q

Allopurinol can have DDIs with certain medications that are also metabolized by Xanthine Oxidase. Which of these medications are also metabolized by xanthine oxidase? (select all)

A. 6-Mercaptopurine

B. Azathioprine

C. Warfarin

D. HCTZ

E. Theophyline

A

A, B, E

However it also has DDIs with Warfarin and Thiazide diuretics

DDI with Warfarin= Increases anticoagulant effect

DDI with Thiazides= Risk of hypersensitivity

34
Q

Allopurinol is contraindicated when administered with___.

A. Ibuprofen

B. Piroxicam

C. Didanosine

D. 6-Mercaptopurine

A

C

6-mercaptopurine is a DDI but it can still be used with allopurinol

35
Q

(Information slide) When comparing the strucuture of Allopurinol to a purine they look identical with the exception of the hydroxyl group on the pyrimidine ring and the Nitrogen position on the Imidazole ring on the right-hand side of the molecule.

A
36
Q

T/F When comparing the structures of a purine, allopurinol and febuxostat, it can be concluded that Febuxostat is a non-purine drug that can block Xanthine Oxidase

A

T

37
Q

Which of the following statements are true regarding Febuxostat?

A. it is more potent at inhibiting Xanthine Oxidase thatn allopurinol

B. Has identical DDIs to Allopurinol

C. Febuxostat exhitibs more plasma protein binding than allopurinol (negligible) due to the carboxylic acid on the drug

D. All of the above

A
38
Q

What is the MOA of Probenacid?

A. Completely inhibits the reabsorption of Uric Acid at the proximal convoluted tubule by blocking the URAT1 transporter

B. Inhibits xanthine oxidase in order to reduce uric acid production

C. Blocks the synthesis of nucleic acids in order to create an immunosuppresive effect

D. Inhibits PLA2 in order to reduce inflammation

A

A

39
Q

Which of these medications will counteract the uricosuric effect of probenecid (Decreasing its effectiveness)?

A. Allopurinol

B. Salicylates

C. ACE Inhibitors

D. Statins

A

B

40
Q

What is the MOA of Pegloticase?

A. Blocks the URAT1 transporter and decreases the reabsorption of uric acid back into the serum

B. Blocks Xanthine Oxidase and prevents the preoduction of uric acid

C. Converts uric acid into a more soluble molecule known as Allantoin in order to prevent crystalization.

D. Causes immunosuppression in order to reduce inflammation caused by an acute gout flare-up

A

C

41
Q

Which of the following statements is NOT true regarding Pegloticase?

A. Must be given as a slow IV infusion

B. Patients must be premedicated with antihistamines or corticoteroids

C. Gout flare-ups are likely in early stages of pegloticase treatment in which case you want to treat with NSAIDs or colchicine

D. Pegloticase can be used for the acute treatment of gout-flare ups despite being a management medication.

A

D

42
Q

Pegloticase is a recombinant uricase that is attached to a methody polyethylene glycol (mPEG). What is the purpose of the mPEG in the function of this drug?

A. mPEG functional group will increase the half-life of the medication

B. mPEG does not have any particular function in this medication

C. mPEG functional group will decrease the immune response to the uricase that it is bound to

D. A and C

A

D

43
Q

Which of the following drugs decrease production of Uric Acid?

A. Colchicine

B. Indomethacin

C. Allopurinol

D. Probenecid

E. Pegloticase

A

C

44
Q

T/F Probenacid blocks the filtratin of uric acid into the proximal tubule

A

False

It blocks the reabsorption of uric acid into the proximal tubule

Skeletal Muscle (7 decks)

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