MOS Pharm

Question 1

glucocorticoid role

Answer 1

potent anti-inflammatory with rapid onset of action

Question 2

glucocorticoid MOA

Answer 2

regulation of transcription: suppression of macrophage activation, cellular immunity, cytokine production, WBC trafficking to sites of inflammation

suppressive action on hypothalamic pituitary axis

Question 3

glucocorticoid adverse effects

Answer 3

CNS effects, fluid retention, weight gain, hyperglycemia, cushings, HTN, infection, osteoporosis, cataracts, avascular necrosis, proximal myopathy

Question 4

What to do before starting glucocorticoids?

Answer 4

PPD testing
review/update immunizations
consider bone health

Question 5

Hydroxychloroquine action

Answer 5

anti-malarial agent
anti-inflammatory effects: inhibition of TLR, decreased cytokines, lymphocytes and NK cell activity
mild anti-coagulant

Question 6

hydroxychloroquine indications

Answer 6

SLE, RA, Sjogren

Question 7

hydroxychloroquine contra-indications

Answer 7

pre-existing retinopathy

G6PD deficiency

Question 8

Hydroxychloroquine side effects/adverse effects

Answer 8

rash, GI

retinal toxicity, myopathy, cardiomyopathy

Question 9

hydroxychloroquine is known to prevent what?

Answer 9

SLE flare ups

Question 10

methotrexate moa

Answer 10

dihydrofolate reductase inhibition

Question 11

methotrexate indications

Answer 11

rheumatic diseases, inflammatory myopathy or arthritis

Drug of choice RA

Question 12

methotrexate side effects

Answer 12

nausea, fatigue, mucosal ulcerations, hepatotoxicity, bone marrow toxicity, pneumonitis

Question 13

methotrexate warnings

Answer 13

teratogenic

drug interaction with sulfamethoxazole

Question 14

leflunomide actions

Answer 14

dihydroorate dehydrogenase inhibitor
reduces de novo pyrimidine synthesis
reduces activated T cells

Question 15

leflunomide indications

Answer 15

inflammatory arthritis, SLE

Question 16

unique about leflunomide?

Answer 16

long half life

Question 17

side effects and toxicities of leflunomide

Answer 17

side-effects: rash, alopecia, diarrhea

toxicities: liver, bone marrow

Question 18

azathioprine moa

Answer 18

immunosuppressant

Question 19

azathioprine indications

Answer 19

SLE, systemic vasculitis (maintenance therapy in ANCA vasculitis), inflammatory myopathy

Question 20

azathioprine side effects and toxicities

Answer 20

SE: GI, fever, rash, anaphylaxis
tox: infections, bone marrow, hepatotoxicity, malignancy

Question 21

draw backs and advantage of azathioprine

Answer 21

drug interactions: allopurinol, sulfasalazine, trimethoprim, ACEi
Advantage: Safe in pregnancy!

Question 22

mycophenolate mofetil moa and application

Answer 22

immunosuppressant

application in organ transplantation, SLE, scleroderma lung disease, inflammatory myopathy, vasculitis

Question 23

mycophenolate mofetil side effects and adverse effects

Answer 23

SE: dyspepsia, diarrhea, abdominal pain, headache, rash
adverse: infection, bone marrow suppression, malignancy

Question 24

cyclophosphamide moa and indications

Answer 24

alkylating agent

organ threatening manifestations of SLE, systemic vasculitis, systemics sclerosis-lung, and RA

Question 25

cyclophosphamide administration

Answer 25

oral: greater toxicity and efficacy | monthly IV is preferred, protects bladder from dysplasia (lupron preserves ovarian function in women)

Question 26

cyclophosphamide side effects and tox

Answer 26

SE: nausea, alopecia Tox: infection risk, bone marrow, infertility, hemorrhagic cystitis, bladder malignancy, hem malignancy

Question 27

TNF alpha inhibitors (5)

Answer 27

etanercept, infliximab, adalimumab, certolizumab, golimumab

Question 28

TNF alpha inhibitor indications

Answer 28

RA, psoriasis, psoriatic arthritis, JIA, AS, Crohn's | avoid in lupus! worsens disease

Question 29

TNF alpha inhibitor adverse effects

Answer 29

TB and hepatitis B re-activation

Question 30

TNF alpha inh cautions

Answer 30

pancytopenia, transaminitis, autoantibody formation, | NO LIVE VACCINES

Question 31

Rituximab MOA

Answer 31

monoclonal antibody CD20 | MOA: B cell depletion

Question 32

rituximab indications

Answer 32

RA, ANCA vasculitis (GPA and MPA) | also, but less often: cryoglobulinemia, SLE, Sjogren

Question 33

rituximab adverse effects

Answer 33

infusion reactions, HTN, athralgias | INFECTIONS, NO LIVE VACCINES

Question 34

Tocilizumab moa

Answer 34

blocks IL6 signaling

Question 35

tocilizumab indications

Answer 35

RA, JIA, Giant cell arteritis

Question 36

tocilizumab adverse effects

Answer 36

infusion reactions, infections, cytopenia, dyslipidemia, GI perforation NO LIVE VACCCINES

Question 37

belimumab moa

Answer 37

blocks action of B lymphocyte stimulator

Question 38

Belimumab indication

Answer 38

SLE which has been refractory to standard therapy | used for moderate, non-organ threatening disease, no role in first line therapy for renal or CNS

Question 39

belimumab adverse effects

Answer 39

hypersensitivity reactions, serious infections, depression

Question 40

IVIg indications

Answer 40

SLE | safe in pregnancy