MSK/CT - Pharm

Question 1

Acetominophen MOA

Answer 1

REVERSIBLY inhibits COX, mostly in CNS

Inactivated peripherally

Question 2

Acetominophen use

Answer 2

Antipyretic and analgesic, but NOT anti-inflammatory

use in kids with viral illnesses

Question 3

Acetominophen toxicity

Answer 3

Zone III hepatic necrosis

NAPQI = toxic, depletes glutathione (regenerate with NAC = antidote)

Question 4

Asprin MOA

Answer 4

IRREVERSIBLY inhibits COX-1 and COX-2 via acetylation.

Causes decrease in TXA2 (increase bleeding time via decreased platelet aggregation) and prostaglandins

Question 5

Asprin use:

Answer 5

LD = anti-coagulant
MD = antipyretic and analgesic
HD = anti-inflammatory

Question 6

Asprin toxicity:

Answer 6

• Tinitus
• Gastric ulcers
• Chronic = GI bleed, ARF, AIN
• Reyes in kids with viruses
• Early respiratory alkalosis, then mixed with metabolic acidosis

Question 7

Celecoxib MOA

Answer 7

REVERSIBLY inhibit COX-2 - inflammatory cells and endothelium for pain and inflammation [NOT gastric mucosa or platelets]

Question 8

Celecoxib Use

Answer 8

RA
OA
NO GI effects

Question 9

Celecoxib toxicity

Answer 9

Thrombosis:
Block endothelium VD without blocking platelet aggregation –> pro-coagulant state

sulfa

Question 10

NSAIDs

Answer 10

REVERSIBLY inhibit COX 1 and COX 2

Question 11

NSAIDs specific use

Answer 11

Indomethacin closes PDA, acute gout attacks, treats DI,

Question 12

NSAID toxicity

Answer 12

• interstitial nephritis
• gastric ulcers
• renal ischemia

Question 13

Bisphosphonates:

Answer 13

Alendronate, other ___dronates

Question 14

Bisphosphonate mechanism

Answer 14

PPi analog: bind hydroxyapatite in bone, and inhibit osteoclast activity

Question 15

Bisphosphonates use

Answer 15

OP
Hypercalcemia (from malignancies)
Pagets

Question 16

Bisphosphonates toxicity

Answer 16

• Erosive esophagitis

- Jaw osteonecrosis

Question 17

Teriparatide MOA

Answer 17

Recombinant PTH analog: give SubQ daily to INCREASE osteoblast activity

Question 18

Teriparatide use

Answer 18

OP: actually causes bone growth, not just stopping resorption like bisphosphonates

Question 19

Teriparatide toxicity

Answer 19

Transient hypercalcemia

Risk of osteosarcoma

Question 20

Alloputinol MOA

Answer 20

inhibits XO after being converted to alloxanthane:

• decreases hypoxanthane to xanthate
• decreases xanthine to uric acid

Question 21

Allopurinol use

Answer 21

Gout

Question 22

Allopurinol Toxicity

Answer 22

Increases levels of 6-MP and azathioprine because they are metabolized by XO

Question 23

Feboxutat

Answer 23

Inhibits XO (like allopurinol)

Question 24

Pegloticase

Answer 24

uric acid to allantoin (water soluble)

Question 25

Rasburicase

Answer 25

uric acid to allantoin (water soluble)

Question 26

Probenecid MOA

Answer 26

Inhibits uric acid reabsorption in PCT

Question 27

Probenecid use

Answer 27

Gout | Give with cidofovir to decrease nephrotoxicity

Question 28

Probenecid toxicity

Answer 28

prevents penicillin secretion Uric acid crystals (urate nephropathy) Sulfa

Question 29

Drugs for chronic gout (prevention)

Answer 29

``` Allopurinol Feboxustat Pegloticase Rasburicase Probenecid Colchicine ```

Question 30

Drugs for acute gout

Answer 30

NSAIDs (indomethacin and naproxen) Glucocorticoids: oral or injections Colchicine

Question 31

Colchicine MOA

Answer 31

Stabilize tubulin inhibiting MT polymerization and thus PMN chemotaxis and degranulation

Question 32

Colchicine AE

Answer 32

GI: N/V/D

Question 33

Sialycilates in gout

Answer 33

BAD! | inhibit uric acid clearance

Question 34

TNF-a inhibitor AE

Answer 34

increase infections and reactivation of TB (needed for granulomas)

Question 35

Etanercept

Answer 35

Fusion protein of TNF-a-R and IgG1-Fc

Question 36

Etanercept use

Answer 36

RA, psoriasis, ankylosing spondylitis

Question 37

Infliximab

Answer 37

anti-TNF-a monoclonal Ab

Question 38

Infliximab use

Answer 38

IBD, RA, ankylosing, psoriasis

Question 39

Adalimumab

Answer 39

anti-TNF-a monoclonal Ab

Question 40

Adalimumab use

Answer 40

IBD, RA, ankylosing, psoriasis