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Pharmacology > Lecture 3: Arthritis > Flashcards

Lecture 3: Arthritis Flashcards

1
Q

DMARD’s stands for…

A

Disease Modifying Anti-Rheumatic Drugs

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2
Q

What are four Non-Biological DMARD’s?

A
  1. Hydroxychloroquine Sulfate
  2. Methotrexate
  3. Sulfasalazine
  4. Leflunomide
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3
Q

Entanercept and Infliximab are:
A. Non-Biological DMARD’s
B. Non-TNF Inhibitors
C. TNF Inhibitors

A

C. TNF Inhibitors

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4
Q

Anakinra are:
A. Non-Biological DMARD’s
B. Non-TNF Inhibitors
C. TNF Inhibitors

A

B. Non-TNF Inhibitors

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5
Q

True or False: Due to their toxicity, DMARD’s are often reserved for progressive disease

A

True

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6
Q

True or False: Glucocorticoids are used to treat chronic inflammation

A

False - for acute flares

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7
Q

Salicylates (Aspirin) can be used as an anti-inflammatory agent, typically used at ___ grams/day

A

3

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8
Q

True or False: GI intolerance is the most common side effect seen with salicylate use

A

True

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9
Q

True or fAlse: Typically use of COX1 and 2 NSAID’s result in less GI complaints (exception is indomethacin)

A

True

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10
Q

TNFInhibitors, such as: Infliximab or Etanercept, are often used with _____

A

Methotrexate

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11
Q

True or False: Methotrexate can be used to treat arthritis

A

True

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12
Q

_____: A non-biologic DMARD that inhibits T Lymphocyte activation and cytokines AND is deposited into tissues (EYES!) !!!
A. Hydroxychloroquine
B. Glucocorticoids
C. Salicylates

A

A. Hydroxychloroquine

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13
Q

What is the most serious AE associated with Hydroxychloroquine?
A. HTN
B. Hemorrhaging
C. Ocular toxicity
D. Suicidal Ideation

A

C. Ocular toxicity
- Progressive and irreversible
- Also retinopathy

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14
Q

True or False: Hydroxychloroquine can be deposited into both patient tissues (e.g eyes) and fetal uveal tissues

A

True

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15
Q

Sulfasalazine is composed of: 5-aminosalicylic acid (5-ASA) and sulfapyridine. Where does the major therapeutic action reside?
A. 5-aminosalicylic acid
B. sulfapyridine

A

A. 5-aminosalicylic acid

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16
Q

True or False: Sulfasalazine has low affinity for connective tissue and has immunoactivating properties

A

False - high affinity and immunosuppressive properties

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17
Q

Sulfasalazine is composed of: 5-aminosalicylic acid (5-ASA) and sulfapyridine. Which is responsible for the toxicity?
A. 5-aminosalicylic acid
B. sulfapyridine

A

B. sulfapyridine

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18
Q

True or False: Slow acetylators of sulfapyridine are more likely to experience the AE of Sulfasalazine

A

True

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19
Q

What is the most serious side effect associated with Sulfasalazine?
A. Alopecia - irreversible
B. Neutropenia - reversible
C. Kidney damage
D. Liver damage

A

B. Neutropenia - reversible

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20
Q

Sulfasalazine is a second line agent for treating severe RA. It is often used with other second line agents, such as ____ and ____

A

methotrexate; hydroxychloroquine

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21
Q

Which drug inhibits dihydroorotate dehydrogenase (enzyme involved in pyrimidine synthesis) and has anti-proliferative activity?
A. Methotrexate
B. Hydroxychloroquine
C. Leflunomide

A

C. Leflunomide

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22
Q

Which enzyme allows for the conversion of Dihydroorotate to Orotate and, ultimately, UMP?

A

dihydroorotate dehydrogenase
(inhibited by: Leflunomide)

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23
Q

What is the main AE associated with use of Leflunomide?
A. Hepatotoxicity
B. Alopecia
C. Ocular toxicity
D. Rash

A

A. Hepatotoxicity

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24
Q

_____ is a dimeric fusion protein consisting of ligand binding portion of human 75 kd TNF receptor linked to Fc portion of human IgG1
A. Leflunomide
B. Etanercept
C. Sulfasalazine

A

B. Etanercept

25
Q

How many TNF molecules does Etanercept bind?

A

Two

26
Q

____ binds specifically to TNFa/b, inhibiting their binding to cell surface TNF-R, rendering TNF-a and beta biologically inactive
A. Leflunomide
B. Etanercept
C. Sulfasalazine

A

B. Etanercept

27
Q

True or False: TNF plays an important role in adult and juvenile RA. Elevated levels are found in synovial fluid of RA patients.

A

True

28
Q

What are the three Black Box Warnings associated with Etanercept and Infliximab?

A
  1. Infections (Bacterial, Virus, Tb)
  2. Sepsis
  3. Lymphoma/Malignancies
29
Q

What is the clinical use of Etanercept?

A

Moderate to active RA (often used with methotrex)

30
Q

____ is a chimeric IgG1 monoclonal antibody that is composed of human constant region and murine variable region
A. Leflunomide
B. Etanercept
C. Sulfasalazine
D. Infliximab

A

D. Infliximab

31
Q

How does Infliximab neutralize the biological activity of TNF-a?

A

Binding to its soluble and transmembrane forms, inhibits TNF-alpha receptor binding

32
Q

True or False: Infliximab neutralizies TNF-beta

A

False - it does NOT

33
Q

Which drug could result in hypersensitivity reaction due to murine origin of variable region?
A. Infliximab
B. Leflunomide
C. Etanercept
D. Sulfasalazine

A

A. Infliximab

34
Q

Synovial tissue of individuals with RA show ____ cells that secrete immunoglobulins induce autoantibody rheumatoid factor, which can be identified in 80% of affect individuals

A

B cells

35
Q

True or False: In the synovial tissue of individuals with RA, there are inflammatory mediators such as (prostaglandins, leukotrienes, cytokines, etc.)

A

True

36
Q

Which group of drugs are first line therapy for RA?

A

Salicylates and NSAIDS
1. Aspirin - initial DOC
2. NSAID’s for pts who do not tolerate salicylates

37
Q

True or False: Concurrent use of aspirin and NSAIDs are unlikely to produce drug interactions

A

False - it IS likely to occur!

38
Q

All NSAID’s EXCEPT ____ and ____ can be used to treat RA?

A

Ketorolac and Meloxicam

39
Q

True or False: High dose corticosteroid therapy is used as a bridge between first (NSAID’s and Aspirin) and second line agents (DMARD’s) in RA treatment

A

False - low dose corticosteroids is used as bridge

40
Q

Which two low-dose corticosteroids can be used to bridge first and second line agents for RA treatment?

A

Prednisone
Prednisolone

41
Q

True or False: Progression of RA is treated with high dose corticosteroids

A

False - with DMARD’s (second line agent)

42
Q

True or False: DMARD’s have fast onset of action and low toxicity

A

False - slow onset and high toxicity

43
Q

True or False: Early RA is disease duration that is less than 6 months while Establish RA is disease duration greater than 6 mths

A

True

44
Q

If a patient has early RA that is mild, ____ is used
A. DMARD combination
B. DMARD monotherapy
C. TNF inhibitor + Methotraxate

A

B. DMARD monotherapy

45
Q

If patient has early RA that is moderate or high, ___ is used:
A. DMARD combination
B. DMARD monotherapy
C. TNF inhibitor + Methotraxate

A

A. DMARD combination

46
Q

True or False: If a patient has early RA that is moderate or high, one can use either: A) DMARD combination or B) TNF Inhibitors + Methotrexate

A

True

47
Q

Why should you worry about prescribing Aspirin to a child for Juvenile RA?

A

Reye’s Syndrome

48
Q

Which two drugs are the only NSAID’s labelled for Juvenille RA?

A

Naproxen and Tolmetin

49
Q

Which drug should be AVOIDED in children under 14, due to the possibility of serious AE?
A. Naproxen
B. Indomethacin
C. Tolmetin
D. Methotrexate

A

B. Indomethacin

50
Q

If a juvenile RA patient does not show any benefit with NSAID use, which DMARD should be used?
A. Naproxen
B. Indomethacin
C. Tolmetin
D. Methotrexate

A

D. Methotrexate

51
Q

If methotrexate (DMARD) is not well tolerated in juvenile RA patient, which drug should be trialed?

A

Sulfasalazine

52
Q

What is the drug of choice for juvenile RA patient if Sulfasalazine fails?

A

Hydroxychloroquine

53
Q

What is the chief hazard associated with Hydroxychloroquine?

A

Ocular Toxicity

54
Q

Which biological agent is used to treat JRA (only used when DMARD’s fail)?
A. Indomethacin
B. Tolmetin
C. Sulfasalazine
D. Hydroxychloroquine
E. Etarnecept

A

E. Etarnecept

55
Q

Why should oral corticosteroids not be administered to treat JRA?

A

Possible growth retardation

56
Q

Which simple analgesic can be used to treat osteoarthritis?

A

Acetaminophen

57
Q

Which three NSAIDS should NOT be used to treat osteoarthritis?

A

Ketorolac and Mefenamic Acid and COX-2 Inhibitor

58
Q

True or False: Etanercept neutralizes TNF-alpha only while Infliximab binds to TNF-alpha and beta

A

False - Etanercept binds with TNF-a and beta; Infliximab neutralizes TNF-a only!

59
Q

True or False: HACA antibodies and hypersensitivity reactions are seen with Etanercept

A

False - seen with Infliximab

Pharmacology (53 decks)

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