MSK disorders Flashcards

1
Q

What drugs are indicated for RA treatment?

A

NSAIDs, steroids, and DMARDS

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2
Q

MOA of non-biologic (traditional) DMARDS?

A
  • Reduces B and T lymphocyte activity

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

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3
Q

Which traditional DMARD is the gold standard?

A

Methotrexate

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4
Q

What are adverse effects of traditional DMARDS?

A

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

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5
Q

What labs should we monitor when giving DMARDs?

A

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

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6
Q

What are other indications for traditional DMARDS?

A

cancer, psoriasis, and abortion

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7
Q

MOA of biological DMARDS?

A

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

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8
Q

Adverse effects of biologic DMARDS?

A

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

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9
Q

Contraindications for biologic DMARDS?

A

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

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10
Q

Who should be cautious in taking biologic DMARDS?

A

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

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11
Q

What is TNF?

A

Causes joint distortion in RA

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12
Q

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

A

Need to have a negative TB test

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13
Q

Which vaccines should not be taken before taking biologic DMARDS?

A

live vaccines like herpes zoster and shingles vaccine

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14
Q

What is neutropenia?

A

neutrophils < 1,500

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15
Q

What is aplastic anemia?

A

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

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16
Q

Indications for colchicine?

A

acute gout exacerbations

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17
Q

Colchicine MOA?

A

unknown but it does not alter urate production or removal

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18
Q

Why should grapefruit be avoided when taking colchicine?

A

It disrupts the hepatic enzyme (CYP3A4) needed for metabolism

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19
Q

Adverse effects of colchicine?

A

GI toxicity and bone marrow suppression (infection)

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20
Q

Which labs should be assessed when taking Colchicine and why?

A

CBC due to bone marrow suppression

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21
Q

Indications for allopurinol?

A

chronic gout, hyperuricemia, chronic tophaceous gout

22
Q

Allopurinol MOA?

A

inhibits xanthine oxidase

23
Q

Adverse effects of allopurinol?

A
  • long term use can cause cataracts

- may cause flare ups after initial tx

24
Q

Indications for Probenecid?

A

chronic gout, hyperuricemia, prevention of tophi

25
Q

MOA of Probenecid?

A

uricosuric drug; promotes urate excretion in the urine

26
Q

Probenecid/ cautions?

A
  • Don’t start during an acute attack b/c it will worse sx.

- drug interaction with ASA

27
Q

Best gout drug for someone with poor kidney function?

A

Allopurinol because it is not a uricosuric drug

28
Q

What is the difference between Allopurinol and Colchicine?

A

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

29
Q

Do gout medications treat pain?

A

No, only decrease uric acid levels and inflammation

30
Q

What should pts w/ gout use for pain relief?

A

NSAIDs

31
Q

What medications will decrease bone resorption in osteoporosis?

A

estrogen, raloxifene, bisphosphonates, calcitonin, denosumab

32
Q

What medications will promote bone formation in osteoporosis?

A

Teriparatide (Forteo)

33
Q

What medications will reduce fx in osteoporosis?

A

Teriparatide, denosumab, and zoledronate

34
Q

Bisphosphonate MOA?

A

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

35
Q

Adverse affects of bisphosphonates?

A

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

36
Q

What is the most widely used oral bisphosphonate?

A

Alendronate (Fosamax, Fosamax Plus D)

37
Q

How should you take Fosamax?

A

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.

38
Q

Adverse effects of Fosamax?

A

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

39
Q

Indications for Selective Estrogen Receptor Modulators (SERM)?

A

osteoporosis, breast cancer, and can lower LDL

40
Q

MOA of SERM with tx of osteoporosis?

A

Preserves BMD and reduces spinal fx by 55%

41
Q

Which drug increases bone formation?

A

Teriparatide (Forteo)

42
Q

Downside of using Forteo?

A

Increases risk for bone cancer

43
Q

Which drug is a RANKL inhibitor?

A

Denosumab (Prolia)

44
Q

Uses of Prolia?

A

post-menopausal osteoporosis and issues r/t bone metastases

45
Q

Adverse effects of Prolia?

A

hypocalcemia, infections, skin rxn, and ONJ

46
Q

What are calcimimetic drugs?

A

Reduce levels of PTH and serum calcium

47
Q

What calcimimetic drug is used to treat hyperparathyroidism?

A

Cinacalcet (Sensipar)

48
Q

How is hyperparathyroidism r/t osteoporosis?

A

in the bones PTH stimulates the release of calcium

49
Q

Adverse effects of Sensipar?

A

N/V/D and hypocalcemia

50
Q

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

A

Fosamax, Actonel, Reclast, Forteo, and Prolia

51
Q

What are the Black Box warnings for Raloxifine?

A

DVT, PE, stroke, fetal harm