MSK Pharm

Question 1

What is the goal of these meds?

Answer 1

reduce pain, inflammation

Question 2

What is the one drug that doesn’t affect inflammation in any significant way?

Answer 2

Acetaminophen

Question 3

Acetaminophen

Answer 3

Drug: N-acetylpara-aminophenol (APAP) or paracetamol

Indications: pain mild-mod, fever

MOA: partial COX inhibitor and reduction of prostaglandins in CNS, may inhibit the COX pathway in the central nervous system but not peripheral tissues

Result: analgesic and antipyretic

Question 4

NSAIDS

Answer 4

Indications: pain mild-severe, including OA, RA, gout (indomethacin, naproxen)

MOA: inhibits cyclooxygenase, reduces prostaglandin and thromboxane synthesis

Result: analgesia and decreased inflammation

Drugs: ibuprofen, naproxen, diclofenac, indomethacin, meloxicam

Question 5

What is the first line treatment for severe pain?

Answer 5

NSAIDS

Question 6

COX 2 inhibitors

Answer 6

Indications: OA, RA, ankylosing spondylitis, and acute pain

MOA: selectively inhibits cyclooxygenase 2 (COX-2) and reduces prostaglandin synthesis

Result: analgesia and decreased inflammation

Drug: celecoxib(celebrex)

Question 7

Central opioid agonists

Answer 7

Indications: mod-severe pain acute or chronic

MOA: unknown, binds to mu opioid receptors, weakly inhibits NE(norepi)/serotonin uptake

Result: analgesia

Drug: tramadol

*abuse, dependence, and overdose risk

Question 8

Anti-rheumatologic drugs

Answer 8

-Used to modulate the immune system

-Often have indications for many rheumatologic diseases

-Corticosteroids

-DMARDS: Disease modifying antirheumatic drugs (impacts the progression of the disease)
Conventional
Anti-TNF
B-cell depletors
Others

Question 9

T/F Anti-rheumatologic drugs reduces the number of flares but does NOT slow disease progression

Answer 9

False, it does

Question 10

Conventional DMARDs

Answer 10

Indications: rheumatoid arthritis (RA), IBD, psoriatic arthritis (methotrexate); some leukemia/lymphomas (methotrexate)

Azathioprine: inhibits T-lymphocytes

Methotrexate: exact mechanism unknown, folate antagonist: inhibits lymphocyte proliferation, inhibits dihydrofolate reductase

Sulfasalazine: exact mechanism unknown, blocks cyclooxygenase and inhibits prostaglandin production

Result: alters immune response and reduces inflammation, reduce disease progression, reduce exacerbations

Question 11

Anti-TNF DMARDs

Answer 11

Indications: RA, IBD, ankylosing spondylitis, psoriatic arthritis

MOA: binds and inhibits TNFa

Result: reducing inflammation and altering immune response

Drugs
Adalimumab
Etanercept
Infliximab

Question 12

Corticosteroids

Answer 12

Indications: acute inflammatory processes or exacerbations of chronic rheumatologic diseases (OA, RA, gout, psoriatic arthritis, ankylosing spondylitis, etc.)

MOA: glucocorticoid and mineralocorticoid effects, inhibits multiple inflammatory cytokines

Result: decreases inflammatory response

Drugs: prednisone, methylprednisolone, triamcinolone (intra-articular)

Question 13

What are the 2 drugs used for gout?

Answer 13

1. Allopurinol
2. Colchicine

Question 14

Allopurinol

Answer 14

Indications: gout prophylaxis

MOA: inhibits conversion of precursors to uric acid to decrease uric acid levels

Result: decreased uric acid so fewer exacerbations

Question 15

Colchicine

Answer 15

Indications: gout acute or prophylaxis

MOA: inhibits neutrophil aggregation and reduces inflammation that worsens gout symptoms

Results: reduced symptomatology and decreased number/severity of flares

Question 16

What is an acute gout attack?

Answer 16

overproduction or under secretion of uric acid and it forms crystals that deposit in synovial fluid and it causes pain

Question 17

Which drug cannot be given to someone with an acute gouty attack because it makes it worse

Answer 17

Allopurinol

Question 18

Osteoperosis

Answer 18

occurs in different populations, generally the patients are older- post menopausal women b ut can be seen in male pateits and younger pts who have undergone hystercetomy. deproprovera can be linked to it, pts w hyperthyroidism and vit d deficiecny

Question 19

What is the main treatment of Osteoporosis ?

Answer 19

Bisphosponates

Question 20

Bisphosponates

Answer 20

Indications: osteoporosis
MOA: Inhibits osteoclast activity
Result: Reduces bone resorption and turnover
Drugs: alendronate, risedronate, ibandronate, zoledronic acid

Question 21

Estrogenic agents

Answer 21

Indications: osteoporosis and breast cancer prevention (raloxifene)
MOA: selectively binds to estrogen receptors
Result: decreases bone turnover and resorption
Drugs: estradiol(not used specifically for osteoporosis, just for perimenopausal symptoms) , raloxifene

Question 22

RANKL inhibitors

Answer 22

Indications: osteoporosis, cancer-treatment induced bone loss
MOA: inhibits osteoclast formation and maintenance
Result: reduces bone resorption and turnover
Drug: Denosumab (prolia)

Question 23

PTH Analogs

Answer 23

Indications: severe osteoporosis
MOA: Regulates bone metabolism, increased intestinal calcium resorption, and increased renal tubular calcium resorption
Result: builds bone if given for less than 2 years cumulatively
Drug: teraparatide

Question 24

What is the end line treatment of osteoperosis

Answer 24

PTH analogs