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MSK Pharmacology Flashcards

1
Q

Inhibitor of dihydrofolate reductase

A

Methotrexate

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2
Q

Methotrexate inhibits this

A

Dihydrofolate reductase

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3
Q

This drug is slow in onset of benefit (>6 weeks) but can be very effective for a long time

A

Methotrexate

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4
Q

Most commonly used DMARD, alone or in combination with biologics

A

Methotrexate

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5
Q

Methotrexate has bone marrow toxicity when coadministered with these

A

NSAIDs

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6
Q

Methotrexate is contraindicated in these 2 circumstances

A

Pregnancy and Renal failure

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7
Q

Methotrexate has drug interactions with these

A

Protein binding drugs

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8
Q

This DMARD has interactions with protein binding drugs

A

Methotrexate

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9
Q

This DMARD has bone marrow toxicity when coadministered with NSAIDs

A

Methotrexate

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10
Q

Drug that blocks pyrimidine synthesis by inhibiting dihydroorotate dehydrogenase

A

Leflunomide

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11
Q

Leflunomide blocks this by inhibiting dihydroorotate dehydrogenase

A

Pyrimidine synthesis

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12
Q

Leflunomide blocks pyrimidine synthesis by inhibiting this

A

Dihydroorotate dehydrogenase

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13
Q

Leflunomide has this black box warning

A

Hepatotoxicity

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14
Q

Leflunomide is contraindicated in this

A

Prengnancy (teratogenicity)

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15
Q

These two DMARDs together are super additive in benefit and toxicity (especially hepatotoxicity)

A

Methotrexate and Leflunomide

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16
Q

This may bind DNA and disrupt rheumatoid factor synthesis

A

Hydroxychloroquine

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17
Q

2 non-biologic DMARDs that can cause hemolysis in patients with deficiency in glucose-6-phosphate dehydrogenase

A

Hydroxychloroquine and Sulfasalazine

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18
Q

Hydroxychloroquine may bind DNA and disrupt synthesis of this

A

Rheumatoid factor

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19
Q

DMARD with unclear mechanism in Rheumatoid Arthritis, and hemolysis in patients with G6PD deficiency

A

Sulfasalazine

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20
Q

3 TNF inhibitors

A

Etanercept
Infliximab
Adalimumab

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21
Q

Recombinant human TNF receptor 2/IgG1 fusion protein (non-functional receptor fragment), acts as decoy receptor, captures TNF to block inflammation and decrease cytokine release

A

Etanercept

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22
Q

Biologic DMARD that acts as decoy receptor, captures TNF to block inflammation and decrease cytokine release

A

Etanercept

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23
Q

What is Etanercept?

A

Recombinant human TNF receptor 2/IgG1 fusion protein
Acts as a decoy receptor to capture TNF

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24
Q

Etanercept has increased risk of these 2 things

A

Malignancy and infections

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25
Q

DMARD that targets TNF alpha, suppresses cytokine synthesis and release

A

Infliximab

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26
Q

Drug with increased risk of infections and TB reactivation
Increased risk of lymphoma in children/adolescents

A

Infliximab

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27
Q

Infliximab has increased risk of infections, specifically reactivation of this

A

TB

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28
Q

Infliximab has increased risk of this in children/adolescents

A

Lymphoma

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29
Q

Recombinant human monoclonal antibody for TNF alpha, blocks interaction with receptor

A

Adalimumab

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30
Q

Oral Janus Kinase inhibitor (competitive)
Blocks intracellular Janus Kinase (JAK1 & JAK3) signal to disrupt activation of immune system

A

Tofacitinib

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31
Q

What does Tofacitinib do?

A

Blocks intracellular JAK signal to disrupt activation of immune system
(competitive oral janus kinase inhibitor)

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32
Q

Rheumatoid arthritis treatment usually begins with this monotherapy

A

Methotrexate

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33
Q

First line treatment for osteoarthritis

A

Acetaminophen

34
Q

Treatment for moderate to severe osteoarthritis

A

NSAIDs, approved topical diclofenac gel available

35
Q

These injections provide short-term (4-8 weeks) releif for osteoarthritis

A

Intra-articular glucocorticoid

36
Q

Procedure that may be done to treat osteoarthritis

A

Autologous chondrocyte implantation

37
Q

Autologous chondrocyte implantation can be therapy for this condition

A

Osteoarthritis

38
Q

This is the end product of purine degradation in humans

39
Q

Urate is the end product of this process in humans

A

Purine degradation

40
Q

Tumor lysis syndrome/chemo-induced cell death can cause gout through this

A

Overproduction of uric acid

41
Q

Is Colchicine used for acute or long-term gouty arthritis?

42
Q

Are non-steroidal anti-inflammatory drugs used for acute or long-term gouty arthritis?

43
Q

Are glucocorticoids used for acute or long-term gouty arthritis?

44
Q

How is acute gouty arthritis treated?

A

Termination of inflammatory process
(colchicine, NSAID, glucocorticoids)

45
Q

Is allopurinol and febuxostat used for acute or long-term gouty arthritis?

A

Long-term
Inhibit uric acid synthesis

46
Q

Is probenecid and sulfinpyrazone used for acute or long-term gouty arthritis?

A

Long-term
Increase excretion

47
Q

How is long-term gouty arthritis treated?

A

By decreasing uric acid production or increasing excretion

48
Q

2 xanthine oxidase inhibitors

A

Allopurinol and Febuxostat

49
Q

2 uricosuric agents

A

Probenecid and Lesinurad

50
Q

Serum uric acid reduction may mobilize urate from tissue deposits, causing this

A

ULT-induced gouty flare
(urate lowering therapy)

51
Q

Drug that binds tubulin, disrupts leukocyte recruitment to affected joints and inhibits leukotriene synthesis/release

A

Colchicine

52
Q

Colchicine binds this, as it is an antimitotic

53
Q

Colchicine disrupts recruitment of this to affected joints

A

Leukocytes

54
Q

Colchicine inhibits synthesis/release of this

A

Leukotriene

55
Q

Risk of bone marrow toxicity often limits therapy of acute attack with this drug to 7 days or less

A

Colchicine

56
Q

Treatment for gout that may cause severe diarrhea and bone marrow toxicity

A

Colchicine

57
Q

Allopurinol and Febuxostat inhibit this

A

Xanthine oxidase

58
Q

Drugs that are indicated for multiple acute gout attacks per year, and tophi or chronic arthritis on exam

A

Allopurinol and Febuxostat

59
Q

Allele that is strongly associated with Allopurinol hypersensitivity

A

HLA-B*5801

60
Q

HLA-B*5801 allele is strongly associated with hypersensitivity to this

A

Allopurinol

61
Q

Allopurinol should not be used with either of these 2 drugs, which are metabolized by xanthine oxidase

A

Mercaptopurine or azathioprine

62
Q

Mercaptopurine and azathioprine should not be used with this drug

A

Allopurinol

63
Q

Why should mercaptopurine and azathioprine not be used with allopurinol?

A

Both are metabolized by xanthine oxidase, which allopurinol inhibits
Dose should be reduced to 1/4 normal dose when combined with allopurinol

64
Q

Drug that should not be given with allopurinol, because allopurinol inhibits CYP1A2

A

Theophylline

65
Q

Theophylline is metabolized by this, which allopurinol inhibits

66
Q

Allopurinol inhibits CYP1A2, blocking metabolism of this

A

Theophylline

67
Q

Probenecid and Sulfinpyrazone block this

A

Urate reabsorption

68
Q

Two drugs that block urate reabsorption

A

Probenecid and Sulfinpyrazone

69
Q

Drug that blocks urate reabsorption and impacts PK of some drugs

A

Probenecid

70
Q

Common adverse effects of this drug include gouty arthritis and stone formation

A

Probenecid

71
Q

An adverse effect of Probenecid is formation of this

72
Q

An adverse effect of Probenecid is that it can induce this

A

Gouty arthritis

73
Q

Severe adverse effects of this drug include bone marrow depression and hypersensitivity

A

Probenecid

74
Q

Probenecid is contraindicated in cases of this

A

Renal impairment/calculi

75
Q

Probenecid interacts with this type of drug

A

Anti-uricosuric drugs (salicylates, diclofenac, pyrazinamide)

76
Q

Probenecid increases serum levels of this drug

A

Methotrexate

77
Q

Drug that increases serum methotrexate

A

Probenecid

78
Q

Drug that interacts with anti-uricosuric drugs (salicylates, diclofenac, pyrazinamide, et al)

A

Probenecid

79
Q

Drug for gout that has a high risk of anaphylaxis (clinical setting - given only after premedication with antihistamines and corticosteroids)

A

Pegloticase

80
Q

Black box warning of Pegloticase

A

High risk of anaphylaxis

81
Q

Colchicine is used to treat this condition

Skin & MSK (20 decks)

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