gout, OP, and RA

Question 1

3 agents for acute gout attacks

Answer 1

NSAIDS, steroids, colchicine

Question 2

MOA of colchicine

Answer 2

inhibits leukocyte infiltration which prevents the destructive lysosomal enzymes

Question 3

AE of colchicine

Answer 3

GI (25%), d/c if this occurs

Question 4

dosing of colchicine

Answer 4

1.2 mg loading, 0.6 mg 1 hr later. 1.8 mg/24 hrs

Question 5

rare but serious SE of colchicine

Answer 5

BM suppression, rhabdo, severe kidney/liver disease

Question 6

other considerations for colchicine

Answer 6

NO grapefruit juice, d-d interactions: PGP or CYP3A4

Question 7

prototype for inhibiting uric acid formation

Answer 7

allopurinol

Question 8

what special considerations do you have to think about with allopurinol?

Answer 8

may cause acute gout attack!!

Question 9

what other times can allopurinol be used?

Answer 9

in cancer, chemo, and blood dyscrasias.

increased levels of uric acid with chemotherapy because of cell death!

Question 10

common AE of allopurinol

Answer 10

GI

Question 11

rare but serious AE of allopurinol

Answer 11

hypersensitivity syndrome

Question 12

d-d interactions with allopurinol

Answer 12

warfarin

Question 13

pt teaching with allopurinol

Answer 13

increase fluids to flush kidneys and protect from urate crystals

Question 14

vitamin supplementation for OP

Answer 14

vitamin D, Ca

Question 15

drugs that decrease bone resorption AKA inhibit osteoclasts (classes of drugs)

Answer 15

calcitonin-salmon
bisphosphonates
estrogen replacement
SERMS
monoclonal antibodies

Question 16

drugs that increase bone formation

Answer 16

PTH (forteo)

Question 17

Calcium supplementation general info

Answer 17

1200 mg/day, divided doses
take Ca Carbonate!
lots of food interactions– leafy greens, beans, whole grains. separate by 1 hour.

Question 18

vitamin D general info

Answer 18

diet and sunlight
oral supplementation– 800-1000 mcg/daily
characteristics of a hormone

Question 19

calcitonin- salmon MOA

Answer 19

keeps Ca in the bone and prevents pulling Ca into the blood stream

Question 20

SE of calcitonin

Answer 20

nausea, nasal drying, increased malignancies

Question 21

admin of calcitonin

Answer 21

intranasal or subq

Question 22

prototype of bisphosphonates

Answer 22

alendronate

Question 23

MOA of bisphosphonates

Answer 23

undergo incorporation into the bone and decreases the osteoclast activity
integrates themselves into the bone!

Question 24

alendronate bioavailability

Answer 24

0.7%, if taken with food- NONE is absorbed

Question 25

AE of alendronate

Answer 25

esophagitis, atypical fracture of femur, MS pain, ocular inflammation, osteonecrosis of the jaw

Question 26

pt teaching of alendronate

Answer 26

``` take on an empty stomach nothing to eat or drink for 30 mins remain upright for 30 mins take with a full glass of water don't chew or suck tablets ```

Question 27

estrogen replacement general info

Answer 27

no longer standard therapy suppresses osteoclast activity increase risk of breast cancer and endometrial cancer, cholecystitis and MI/Stroke

Question 28

SERMS MOA

Answer 28

block or mimic estrogen receptors. mimics on bone, lipid metabolism, or blood clot blocks on breasts

Question 29

prototype of SERM

Answer 29

raloxifene

Question 30

general info of SERM

Answer 30

improve bone density improve lipid profiles and improves CV risk risk of DVT and PE no help with hot flashes and can cause them!

Question 31

prototype of monoclonal antibodies

Answer 31

Denosumab

Question 32

denosumab admin

Answer 32

subq every 6 months

Question 33

SE of denosumab

Answer 33

back pain, MS pain, pain in extremities, UTI, hypercholesterolemia injection site reaction

Question 34

rare but serious SE of denosumab

Answer 34

serious infections, derm reactions, osteonecrosis of the jaw

Question 35

MOA of denosumab

Answer 35

prevents activation of RANK

Question 36

prototype of drugs that increase bone formation

Answer 36

teriparatide

Question 37

MOA of teriparatide

Answer 37

form of PTH made by recombinant DNA technology

Question 38

admin of teriparatide

Answer 38

given subq

Question 39

SE of teriparatide

Answer 39

nausea, HA, back pain, leg cramps, ortho/hypo initially | increased risk of osteosarcoma

Question 40

3 classes of drugs for RA

Answer 40

NSAIDS, steroids, DMARDS

Question 41

Non-biological DMARD prototype

Answer 41

methotrexate

Question 42

methotrexate general info

Answer 42

immunosuppressive takes 3-6 weeks to work (take NSAID until it kicks in) take folic acid 5mg/week

Question 43

methotrexate SE

Answer 43

hepatic fibrosis, BM suppression, GI ulceration, pneumonitis

Question 44

methotrexate other considerations

Answer 44

reduced life expectancy from CV disease, infection and certain cancers category X!!

Question 45

Bio DMARDS prototype

Answer 45

etanercept

Question 46

bio DMARDs MOA

Answer 46

immunosuppresive drugs that target specific parts of the inflammatory process - tumor necrosis factor - promotes destruction of B cells - inhibits activation of t-cells

Question 47

other considerations of bio DMARDs (etanercept)

Answer 47

high risk of serious infection: test for TB!!!, fungal infection, hep B made with recomb DNA EXPENSIVE used for other autoimmune infections too

Question 48

AE of etanercept

Answer 48

injection site rxn

Question 49

special considerations for etanercept

Answer 49

``` test for TB watch for Hep B reactivation no active infections while on it no live vax risk of HF, cancer, CNS disorders, rarely serious skin rxns. ```