MSK disorders

Question 1

What drugs are indicated for RA treatment?

Answer 1

NSAIDs, steroids, and DMARDS

Question 2

MOA of non-biologic (traditional) DMARDS?

Answer 2

• Reduces B and T lymphocyte activity

- Inhibits folic acid metabolism which prevents cell reproduction leading to death of rapidly replicating cells.

Question 3

Which traditional DMARD is the gold standard?

Answer 3

Methotrexate

Question 4

What are adverse effects of traditional DMARDS?

Answer 4

hepatotoxicity, bone marrow suppression, GI ulceration, kidney damage, pneumonitis, and fetal death

Question 5

What labs should we monitor when giving DMARDs?

Answer 5

Kidney function
Liver: hepatotoxicity
CBC and platelet counts: risk of infection and bleeding

Question 6

What are other indications for traditional DMARDS?

Answer 6

cancer, psoriasis, and abortion

Question 7

MOA of biological DMARDS?

Answer 7

Neutralizes tumor necrosis factors (TNF) which promotes destruction of B lymphocytes and inhibits activation of T lymphocytes

Question 8

Adverse effects of biologic DMARDS?

Answer 8

infection, reactivation of HBV and TB; new onset or worsening HF; increase risk for lymphoma or other malignancies; neutropenia, thrombocytopenia, and aplastic anemia.

Question 9

Contraindications for biologic DMARDS?

Answer 9

demyelinating disorders (MS), severe HF, active HBV and TB

Question 10

Who should be cautious in taking biologic DMARDS?

Answer 10

immunocompromised, mild HF, liver dysfunction, latent HBV, and DM

Question 11

What is TNF?

Answer 11

Causes joint distortion in RA

Question 12

What should we tell a patient who has latent TB before taking biologic DMARDS?

Answer 12

Need to have a negative TB test

Question 13

Which vaccines should not be taken before taking biologic DMARDS?

Answer 13

live vaccines like herpes zoster and shingles vaccine

Question 14

What is neutropenia?

Answer 14

neutrophils < 1,500

Question 15

What is aplastic anemia?

Answer 15

leads to pancytopenia (reduction in RBC, WBC, and platelets)

Question 16

Indications for colchicine?

Answer 16

acute gout exacerbations

Question 17

Colchicine MOA?

Answer 17

unknown but it does not alter urate production or removal

Question 18

Why should grapefruit be avoided when taking colchicine?

Answer 18

It disrupts the hepatic enzyme (CYP3A4) needed for metabolism

Question 19

Adverse effects of colchicine?

Answer 19

GI toxicity and bone marrow suppression (infection)

Question 20

Which labs should be assessed when taking Colchicine and why?

Answer 20

CBC due to bone marrow suppression

Question 21

Indications for allopurinol?

Answer 21

chronic gout, hyperuricemia, chronic tophaceous gout

Question 22

Allopurinol MOA?

Answer 22

inhibits xanthine oxidase

Question 23

Adverse effects of allopurinol?

Answer 23

• long term use can cause cataracts

- may cause flare ups after initial tx

Question 24

Indications for Probenecid?

Answer 24

chronic gout, hyperuricemia, prevention of tophi

Question 25

MOA of Probenecid?

Answer 25

uricosuric drug; promotes urate excretion in the urine

Question 26

Probenecid/ cautions?

Answer 26

- Don't start during an acute attack b/c it will worse sx. | - drug interaction with ASA

Question 27

Best gout drug for someone with poor kidney function?

Answer 27

Allopurinol because it is not a uricosuric drug

Question 28

What is the difference between Allopurinol and Colchicine?

Answer 28

Allopurinol is used to prevent gout and Colchicine is to treat acute gout attacks

Question 29

Do gout medications treat pain?

Answer 29

No, only decrease uric acid levels and inflammation

Question 30

What should pts w/ gout use for pain relief?

Answer 30

NSAIDs

Question 31

What medications will decrease bone resorption in osteoporosis?

Answer 31

estrogen, raloxifene, bisphosphonates, calcitonin, denosumab

Question 32

What medications will promote bone formation in osteoporosis?

Answer 32

Teriparatide (Forteo)

Question 33

What medications will reduce fx in osteoporosis?

Answer 33

Teriparatide, denosumab, and zoledronate

Question 34

Bisphosphonate MOA?

Answer 34

decrease osteoclast activity. May also help prevent and tx bone metastases in patients with cancer.

Question 35

Adverse affects of bisphosphonates?

Answer 35

ocular inflammation, osteonecrosis of the jaw (ONJ), atypical femur fx, and A fib

Question 36

What is the most widely used oral bisphosphonate?

Answer 36

Alendronate (Fosamax, Fosamax Plus D)

Question 37

How should you take Fosamax?

Answer 37

on an empty stomach, first thing in the morning, with a full glass of water, and should remain upright for @ least 30 minutes to prevent esophageal irritation.

Question 38

Adverse effects of Fosamax?

Answer 38

esophageal ulceration, atypical femoral fx, esophageal cancer, MSK pain, ocular problems, ONJ, hyperparathyroidism, A fib

Question 39

Indications for Selective Estrogen Receptor Modulators (SERM)?

Answer 39

osteoporosis, breast cancer, and can lower LDL

Question 40

MOA of SERM with tx of osteoporosis?

Answer 40

Preserves BMD and reduces spinal fx by 55%

Question 41

Which drug increases bone formation?

Answer 41

Teriparatide (Forteo)

Question 42

Downside of using Forteo?

Answer 42

Increases risk for bone cancer

Question 43

Which drug is a RANKL inhibitor?

Answer 43

Denosumab (Prolia)

Question 44

Uses of Prolia?

Answer 44

post-menopausal osteoporosis and issues r/t bone metastases

Question 45

Adverse effects of Prolia?

Answer 45

hypocalcemia, infections, skin rxn, and ONJ

Question 46

What are calcimimetic drugs?

Answer 46

Reduce levels of PTH and serum calcium

Question 47

What calcimimetic drug is used to treat hyperparathyroidism?

Answer 47

Cinacalcet (Sensipar)

Question 48

How is hyperparathyroidism r/t osteoporosis?

Answer 48

in the bones PTH stimulates the release of calcium

Question 49

Adverse effects of Sensipar?

Answer 49

N/V/D and hypocalcemia

Question 50

Which 5 drugs have been approved for osteoporosis tx in men?

Answer 50

Fosamax, Actonel, Reclast, Forteo, and Prolia

Question 51

What are the Black Box warnings for Raloxifine?

Answer 51

DVT, PE, stroke, fetal harm