MSR Pharm Cases Flashcards
Your patient has RA. What is your first line DOC?
Methotrexate (Rheumatrix); one pill weekly
When prescribing methotrexate, what must you also prescribe?
Folic Acid (5mg weekly)
What are the special instructions for Rxing methotrexate and folic acid together?
Folic acid must not be taken on the same day as methotrexate; take it the day after.
How long does it take for methotrexate to respond initially and respond fully?
initially - 3-4 weeks; fully - 3-6 months
What is methotrexate’s PG category?
X
What is the one thing you should definitely be sure to monitor when Rxing methotrexate?
CXR - both before and after treatment (side effect of pulmonary fibrosis)
What can you use as a “bridge therapy” while waiting for any RA DMARD to kick in?
Non-steroidals (e.g. ibuprofen) unless contraindicated. If contraindicated, can put on short-term (one month) steroid (prednisone) use.
Your RA patient is unresponsive to methotrexate. What is your next line of therapy?
Add a non-biologic DMARD to therapy. (In our class example, we prescribed Etanercept [Enbrel] because the pt had CKD and COPD)
Which drug would you use for a patient who is trying to manage RA?
Sulfasalazine (Azulfidine) unless sulfa allergy
Are you going to crush this exam?
You’re damn right!
What is the major side effect that we must monitor with hydroxychloroquine (Plaquinil)?
It is bound in melanin-containing tissues like the eyes. Must get ophthmology f/u every 6-12 months. Recommended eye exams every 4-6 weeks.
Your pt. is on Etanercept (Enbrel) and presents with a raging fever and joint problems. What could be going on, and what should you do?
She probably has an infection. DMARDS are C/I for people with infections, so you need to stop the DMARD. Biologic DMARDS are known to reactivate sepsis, hepatitis, and lymphoma, so screen for these conditions.
An elderly woman with glaucoma has chronic rhinorrhea. What is it and how to you treat?
Woahhhh let’s take it back to summer! Vasomotor rhinorrhea - treat with cromolyn sodium because it’s the only NS not C/I for glaucoma.
Pt. is having first episode of acute gout. How do you treat?
NSAIDs around the clock for about a week.
Your patient has a stomach ulcer and cannot be put on an NSAID for his first episode of gout. What is your next step?
Colchicine
What side effect can your patient expect to see with colchicine?
Abdominal pain/diarrhea (80%)
Your patient has had 3 episodes of gout in the last year and is sick of it. What should you do for him?
Put him on a prophylactic med for gout - allopurinol (Zyloprim)
What drugs predispose you to gout?
Thiazide diuretics, HCTZ, aspirin, niacin - all increase uric acid levels
If you have kidney stones, which gout medication are you not indicated to use? Why?
The uricosurics like Probenecid (Benemid). This blocks proximal convoluted tubule reabsorption of uric acid, thus increasing risk for kidney stones.
Your patient is currently on Lisinopril (an ace-inhibitor). He is having recurring episodes of gout, so you want to prescribe him allopurinol. What do you need to be aware of?
Allergic reaction with these 2 meds may occur. Changing his HTN med alone may decrease his uric acid level.
Your patient has arthralgias. Sure, you COULD prescribe an NSAID, but what OTC medication is just as effective?
OTC oral analgesics
Your patient has OA and frequent GI bleeds. What can you prescribe her for her OA?
NOT NSAIDS. Rx acetaminophen instead. If that doesn’t work, try Tramadol If you MUST rx an nsaid, then Celebrex has a lower risk of GI bleeds
If you prescribe an NSAID, how long can you expect for anti-inflammatory relief?
2-3 weeks
What lifestyle modifications can you make to reduce your chances of getting gout?
Avoid alcohol, purine-rich foods like red meat
So allopurinol is a fiesty little drug, and it also interacts with ampicillin/amoxicillin. In what way?
Rash may develop
Your patient was doing yardwork and got severe pain in his lower back. No other symptoms. What do you prescribe?
He has a muscle spasm. Give him Cyclobenzaprine (Flexeril)
What is a side effect that you should be sure to tell your patient about with cyclobenzaprine (Flexeril)?
Drowsiness/dizziness and CNS depression
Your patient has a 3-month old daughter and was prescribed cyclobenzaprine (flexeril) for muscle spasms. What is a possible problem here that needs to be discussed?
Caution with nursing!!
Your patient has MS and wants to control her muscle spasms. What do you prescribe?
Baclofen (Lioresal)
What should you definitely caution your patient about when starting them on Baclofen (Lioresal)?
It is a black box warning, and should not be stopped abruptly! Make sure you taper them off.
Random question, but how are you going to treat a patient who has polyarteritis nodosa?
HD Prednisone and cyclophosphamides.
Patient has alopecia, anorexia, fatigue, and a “butterfly rash” over her face. She is coming to you today for her joint pain. DOC?
She has SLE
First check current medications.
DOC = hydroxychloroquine (Plaquinil)
How long does it take for hydroxychloroquine (plaquinil) to take effect?
What can you do in the meantime?
3-6 months
Can co-rx prednisone (start HD and taper down)
Your patient has a dry mouth and can’t chew or swallow her food. DOC?
She has Sjogren’s.
DOC: pilocarpine
What type of drug would you want to use for Raynaud’s phenomenon?
Calcium channel blockers
You suspect that your patient has CREST syndrome. What is the BIG thing that you should do here?
Refer to rheum!
If your patient has Raynaud’s, what are some lifestyle modifications that could reduce symptoms?
Quit smoking, decrease stress/anxiety, wear gloves in winter
Avoid triggers, avoid vasoconstrictor meds (like decongestants)
Your patient has pseudogout. How do you treat?
The same way that you would gout!
Sooooo… How do I treat gout again?
1st line: NSAIDs
If NSAIDs are C/I, use colchicine
Use allopurinol for gout prophylaxis
Can also use probenicid (benemid) or febuxostat (uloric)
What is the MOA of Allopurinol (zyloprim) vs. probenicid (benemid)?
allopurinol - prevents uric acid crystals from being made
probenicid - increases excretion of uric acid (by blocking its re-absorption)
Your patient has fibromyalgia. What should you rx?
The tricyclic antidepressant Amitriptyline (Elavil)
Your pt. has fibromyalgia. What should you NOT rx, because it won’t help?
NSAIDs
Your patient has Giant Cell Arteritis. What should you do?
HD prednisone
Emergent referral to ENT
YAY! Now what do you deserve?
Some R&R.
Or just grab a drink while you study.
You’re going to do great! :)
