MSS-Drugs

Question 1

Acute Gout treatment

Answer 1

NSAIDs:
Used for Gout w/in 24hrs
indomethacin or neproxen
NOT aspirin
consider GI bleed risk
Steroids:
can be used short-term instead of NSAIDs to reduce inflammation
Colchicine:

Question 2

Colchicine

Answer 2

Used for acute gout attacks or chronic gout
antimitotic, binds microtubules in neutrophils, inhibit neutrophil activation, lessens inflammation
Oral, CYP450 and P-glycoprotein substrate
Narrow therapeutic window
Significant GI sides

Question 3

Allopurinol

Answer 3

Used for chronic gout
Blocks xanthine oxidase (less uric acid synthesis
metabolized to active compound, prolongs half-life
sides: hypersensitivity, acute gout attack

Question 4

Pegloticase

Answer 4

Used for chronic gout
PEGylated uricase, converts uric acid to allantoin
IV every 2 weeks, long half-life
sides: gout flare, immune response

Question 5

Probenecid

Answer 5

Used for chronic gout
Increases rate of uric acid excretion by competing with OAT in renal tubules
Oral
Sides: some GI, ineffective in renal insufficiency, not to be used with kidney disease or uric acid overproducers (uric stones in kidney)

Question 6

Chronic Gout treatment

Answer 6

Allopurinol, Pegloticase, Probenecid

Question 7

Rheumatoid Arthritis treatment

Answer 7

NSAIDs (sx relief, GI sides)

Etanercept, Infliximab, Tocilizumab, Tofacitinib

Question 8

Etanercept

Answer 8

Used for RA
Recombinant fusion protein
Inhibits TNF-a to bind to receptor
IV or subcu
sides: risk of infxns, lymphomas in children

Question 9

Infliximab

Answer 9

Used for RA
Antibody binds to all forms of TNF-a, prevents binding to receptor
IV, 2-6 week intervals
sides: infusion rxn, risk of infxn, lymphomas in kids

Question 10

Tocilizumab

Answer 10

Used of RA, if inadequate response to TNF antagonists
antibody binds to membrane-IL6 receptors, inhibits signaling
IV every 4 weeks
sides: alter lipid profile, same as others

Question 11

Tofacitinib

Answer 11

Used for RA, if inadequate response to methotrexate
JAK inhibitor
Oral, CYP3A4 metabolized
sides: risk of infxn, increase cholesterol

Question 12

Alendronate

Answer 12

Used for osteoporosis
Pyrophosphate analog
incorporated into bone matrix, released slowly as bone resorbed
promotes osteoclast apoptosis, prevents osteoclast anchoring (inhibit farnesyl synthase)
poor bioavailability, oral
Sides: GI, jaw osteonecrosis,, maybe atypical femur fractures

Question 13

Calcitonin

Answer 13

Used for osteoporosis
synthetic salmon or human calcitonin
Subcu or IM injection, lasts several hours
Sides: nausea, rhinitis
pts become refractory after a few days, receptor downregulation

Question 14

Teriparatide

Answer 14

used for osteoporosis
synthetic PTH fragment
anabolic effect on bone, stimulates osteoblasts
subcu, half-life=1hr
black box for osteosarcoma

Question 15

Estrogens

Answer 15

Use in osteoporosis ONLY in women with significant ongiong vasomotor symptoms who are not at increased CV disease risk

Question 16

Raloxifine

Answer 16

Used for osteoporosis in post-menopausal
selective estradiol receptor modulator (SERM)
non-steroidal estrogen agonist
stimulates osteoblasts, inhibits osteoclasts
sides: thromboembolism and hot flashes

Question 17

Denosumab

Answer 17

used for osteoporosis in men and high risk fracture
antibody binds RANKL
blocks osteoclast formation and activation
subcu, 25 days
sides: MANY

Question 18

Osteoporosis drugs

Answer 18

Alendronate, Calcitonin, Estrogens, Raloxifene, Teriparatide, Denosumab