Musculo/Skeletal Flashcards
1
Q
what drug to use for RRMSif onset is severe
A
Natalizumab
2
Q
OA Hand TX
A
NSAIDCapsaicin
Diclofenac gel
3
Q
Types of Gout
(3)
A
Acute
Chronic
Hyperuricemia
4
Q
RA definition
asymmetrical or symmetrical
M vs F
peak age
A
chronic arthritis w/ inflammation and destruciton of cartilage and bone
symmetrical
F 2x more
35-55
5
Q
Which drugs for OP best for spine BMD
A
zoledronate
denosumab
teriparatide
6
Q
class 2 lupus nephritis
A
proliferative mesangial lupus nephritis
normal SCr
microhematuria
non-nephrotic proteinuria
7
Q
Pegloticase MOA
A
recombinant urate oxidase which converts uric acid to allantoin which has higher solubility and remains easie to excrete
8
Q
TX gait disturbance in MS
A
dalfampridine
9
Q
spasticity tx
4
A
baclofen
tizanidine
Diazepam
dantrolene
10
Q
Neuro probs w/ lupus
7
A
ischemic stroke/TIA
seizures
cognitive dysfunction
major depression
neuropathies
psychosis
myelitis
11
Q
Raloxifen cautions
A
CrCl <50
12
Q
Co-stimulation modulator
disrupt T cell activation
A
Abatacept
13
Q
MOA of anabolic drugs
A
stim bone formation
inc. BMD
dec. fracture risk
14
Q
Class 5 lupus nephritis
A
membraneous lupus nephritis
proteinuria
nephrotic syndrome
normal renal function
15
Q
cause of FSHD
A
4q of D4Z4 repeat units in genome lacking
D4Z4 express DUX4
DUX4 not normally made in skeletal muscle
16
Q
When to avoid interferon in MS
A
severe untreated depression
17
Q
drugs that inhibit urate crystallization
(3)
A
Allopurinol
Febuxostat
Pegloticase
18
Q
what part of mAb make up antigen binding domain
A
variable region
19
Q
DX of DMD
A
abnormal muscle function
inc. serum creatine kinase
gross motor/speech delay
abnormal gait
postive Gower’s maneuver
20
Q
Probenacid and Lesinurad MOA
A
block reabsorption of urate in the proximal convoluted tubules by the URAT-1 organic anion transporter
21
Q
lupus nephritis induction
A
mycophenolate
- for African americans
cyclophosphamide
- for white people
glucocorticoids
22
Q
CD-20 binder
B cell depletion
A
Rituximab
23
Q
purpose to test for synovial fluid analysis in RA
A
rule out other disease
24
Q
Lupus meds to avoid in pregnancy
A
cyclophosphamide
NSAIDs
ACE/ARB
25
Mycophenolate
indication
MOA
SE
induction and maintenance of lupus nerphritis
reversible inhibits inosine 5-monophophate dehydrogenase inhibits proliferation of lymphocyts and adhesion molecule expression, induce T cell apoptosis
red cell aplasia, congenital malformation, myelosuppression
26
Nationalities most likely to have Lupus
5
African
asain
Chaldean
Hispanic
Native American
27
JAK inhibitors
Tofacitinib
Baricitinib
28
what MS treatment to check for TB before giving
Teriflunomide
Alemtuzumab
Ocrelizumab
29
estrogen counseling
monitor for clots
do not take with grapefruit juice
30
Tx of cutaneous lupus erythematosus
2
protect from UV light
topical steroids
31
drugs that cause hypocalcemia
Calcitonin
Denosumab
BPP
32
Tox of Colchicine
| (3)
narrow TI so space ongoing courses by 1-2 weeks to avoid cumulative toxicityes
N/V/D require D/C
myelosuppression
33
OA Hip Tx
APAP
NSAId
tramadol
opioids
34
systemic Lupus erythematosus (SLE) definition
most common form and is more serious
can affect any part
unpredictable pattern of remission and flares
35
Gout symptoms
| (3)
sudden onset of pain, heat, tenderness, swelling, erythema
dec. range of motion
presence of tophi
36
Pegloticase Indication
| (3)
Chronic gout
refractory gout
unable to take conventional therapy
37
immunological criteria of lupus
ANA: antinuclear antibody
dsDNA: anti-double stranded DNA
Antiphospholipid antibody
low complement
direct coomb's test
38
2nd3rd line OP
calcitonin
39
Does drug-induced lupus go away?
yes about 6 months after stopping medication
40
OA pain relief if contraindication or lack of response to NSAIDs
opioids
41
high potency MS tX
Natalizumb
Alemtuzumab
Ocrelizumab
42
MS low potency tx
interferon
Glatiramer
Teriflunomide
43
NSAID GI tox risks
\>60
history of ulcers
high dose and long duration
concurrent drugs
44
BPP counseling
take with water
take on empty stomach
remain upright for 30-60 mins after
45
Lupus triggers/risks
7
genetics
hormones
abnormal immune cells
cigarette smoke
UV light
virus/infection
stress
46
Lesinurad SE
| (6)
renal toxicity
HA
influenza
Inc. SCr
Gi reflex
acute kidney failure
47
Who should be tested for OP
women \>65
men \>70
adults with fractures after 50
48
when to avoid Fingolimod
taking class 1 & 3 antiarrhythmics and those with significant CVD
49
Chronic gout
what happens to joint
can lead to what?
urate crystals deposit in and around joint cartilage
deformint and soft tissue damage and joint destruction
lead to nephrolithiasis (kidney stone) and kidney damage
50
FBM symptoms
| (7)
spontaneous widespread flare ups
musculoskeletal pain
joint stiffness in morning and during day
chronic fatigue
sleep disturbances
depression, anxiety, HA
51
Diclofenac solution application
40 drops/knee
spread evenly with 10 drops and repeat until 40 drops used
52
FRAX calculator
what does it tell you
who can use it
when does it underestimate
10 year probabily of fracture
age 40-90
it pt had multiple previous fractures
53
Class 3 lupus nephritis
focal lupus nephritis
proteinuria and hematuria
ocassional nephrotic syndrome, HTN, inc. SCr
progression depends on % of affected glomeruli
54
role to test for ANA in RA
rule out lupus
55
adjunctive TX lupus nephritis
hydroxychloroquine
ACEi/ARB
56
purpose of Anti-CCP in RA
specific for RA
57
PTH analogs
Abaloparitide
Teriparatide
58
symptoms of lupus
11
fatgue
depression
arthritis/arthralgia
photosensitivity
alopecia
serositis
mycarditis
anemia
swelling in feet, legs, hands, eyes
butterfly rash on cheeks and nose
raynauds
59
Mab
% human
murine
chimeric
humanized
human
and endings
0: omab
65: ximab
\>90: zumab
100: umab
60
DX of OP
women 70+ or men 80+ w/ BMD T score \<-1
women 65-69 or men 70-79 w/ BMD T score \<-1.5
vertebral fracture
patients 50+ w/
* low trauma fracture
* height loss \>1.5in
* prospective height loss \>0.8in
61
hydroxychloroquine indication in RA
mild-mod
62
define Lupus
chronic (\>6 weeks) autoimmune disease that can damage any part of the body
63
MTX indication for RA
any disease activity or prognosis
64
low potency steroid for cutaneous lupus
for face and groin
fluocinolone acetonide 0.01%
hydrocortisone 0.1%
65
are opioids better than APAP or NSAID for OA
no
66
How long can you treat OP for with 1 drug
5 years
67
exacerbation of MS
new symptoms \>24 hors with 30 day separation from other new symptoms
68
cause of gout
excess serum uric acid
69
Zoledronate dose
prevention every 2 years
tx yearly
only treat for 3 yrs
70
JAK indicaiton in RA
mod-severe
with inadequate response or intolerance to MTX
71
IL6 indications in RA
mod-severe
need inadequare response to MTX first
72
Febuxostat MOA
selective inhibitor of xanthine oxidase
73
bp goal lupus nephritis
\<130/80
74
after initiating when do you add another nonbiologic
3 months
75
OA knee TX
APAP
NSAID
capsaicin
diclofenac gel
diclofenac solution
intraarticular steroids
tramadol
opioids
76
DMD and BMD have what genetic carrier trait
X-linked
77
pathophysiology of Lupus
4
altered T and B lymphocyte activation and signaling
abnormal clearance of apoptotic debris
inc. plasma cell count that make autoantibodies
antinuclear antibodies form immune complexes with nuclear material
78
IL1 antagonist
Anakinra
79
FBM
F vs M
F\>M
80
81
Gout when is it monoarticular vs polyarticular
90% of first attacks are monoarticular and as disease progress it becomes polyarticular
82
DMD from what type of mutation
framshift
83
TX fatigue in MS
amantadine
methylphenidate
84
BPP MOA
bind to resorption site and taken up by clasts and released after remodeling cycle to make clasts do apoptosis
85
BPP given PO
AIR
alendronate
ibandronate
risedronate
86
OP 1st line
alendronate
risedronate
zoledronate
denosumab
87
4 subtypes MS
relapsing remitting
secondary progressive
primary progressive
progressive relapsing
88
define lupus nephritis
kidney disease caused by systemic lupus erythematosus
89
Drug classes to prevent inflammatory response to gout
(2)
NSAIDs
Glucocorticoids
Colchicine
90
Define MS
CNS autoimmune disorder characteried by demyelineation and axonal damage
## Footnote
progressive, non-reversible
exacerbations and relapses
91
how long to let anti TNF work before switching
3 months
92
when to avoid teriflunomide in MS
pregnant category X
severe hepatic impairment
93
Hyperuricemia
is it gout?
when to treat it?
goal of treatment?
when to treat if asymptomatic
not actually gout
2-3 episodes of gout per year
goal: control symptoms and targer \<6% UA
kidney disease
94
Diazepam MS indication
not 1st line adjunct to baclofen
95
PTH analog counseling
avoid use in pt prone to osteosarcoma
once d/c BMD declines rapidly
96
Leflunomide and pregnancy
treatogenic
d/c and take cholestyramine for 11 days
97
Treat exacerbation of MS
IV high dose steroid
medrol 500-1000mg/day for 3-10 days
98
level of uric acid that normally causes symtpoms
6mg/dL
99
when to start DMARD in RA
3 months of symptoms
100
symptoms of RA
joint pain/tenderness
symmetrical distribution
prolonged stiffness \>1 hour in AM
fatigue
weight loss
35% have rheumatoid nodule
101
Define Gout
sudden onset of severe acute monoarticular arthritis in peripheral joints
102
way to treat Gout
| (3)
prevent inflammatory response to urate crystals
inhibit urate crystallizaiton
inc. urate excretion
103
Anabolic agents OP
teriparatide
Abaloparatide
104
Class 1 lupus nephritis
minimal mesangial lupus nephritis
normal SCr and urine lab results
105
Gout risk factors
| (8)
Hyperuricemia \>6.8
obesity
alcohol
kidney disease
dehydration
neoplastic diseases
drugs: thiazides, lwo dose salicylates, niacin, caffeine
foods high in purine
106
FBM tx
| (8)
Amitriptyline
* +fluoxetine/sertraline
Venlafaxine
Nortiptyline
Flexeril
Duloxetine
Lyrica
Milnacipran
Tramadol
107
TNFa inhibitor
Infliximab
golimumab
certolizumab
entercept
adalimumab
I'm gonna cry every aday
108
2 types of bone
function
trabecular: strength and flexibility
cortical: structure and weight bearing
109
MTX contraindication
Hep B and C
110
drugs that increase urate excretion
| (2)
probenacid
lesinurad
111
spasticity legs or arms
legs\>arms
112
DMARD small molecules
MTX
leflunomide
hydroxychloroquine
sulfasalazine
113
Drugs that cause drug induced lupus
7
procainamide/quinidine
hydralazine
TNF inhibitors
minocycline
isoniazid
methyldopa
chlorpromazine
114
OA symptoms
joint stiffness \<30 min in AM
bony enlargement
115
MTX MOA
inhibit dihydrofolate reductase
116
Tx of hyper-reflexia in MS
2
anticholinergic
TCA
117
Denosumab counseling
rapid bone loss after D/C so add antiresorptive
118
Calcitonin MOA
inhibit clasts bone resorption via GPCR by causing clasts to detach
119
way to treat hyperuricemia
| (2)
inhibit urate crystallization
increase urate excretion
120
RA are NSAIDs prn or scheduled
prn for sypmtoms only
121
MOA of anti-resorptive agents
suppress clasts
slow resorption
dec. fracture risk
122
What is the most common arthritis?
Fibromyalgia
123
IL6 antagonists
Tocilizumab
Sarilumab
124
med potency for tx of cutaneous lupus
for trunk and arms
traimcinolone acetonide 0.1%
mometasone furoate 0.1%
125
Pegloticase can you use w/ allopurinol or febuxostat
NO
126
when to add/switch anti TNF
after 1-3 nonbiologics
127
Belimumab
indication
MOA
active, autoantibody +, SLE not on standard therapy
bind to B lymphocyte stimular to prevent its binding to B cells
128
can you use probenacid w/ allopurinol
yes
129
cimizia RA indication
mod-severe
130
drugs that cause Osteonecrosis of Jaw and sensitivity of femur to breakage
Denosumab
BPP
131
TX hypo-refelxic bladder symptoms in MS
bethanechol
132
Tox of allopurinol
| (4)
adjust dose for renal impairment
rash (HLA-B\*5801)
GI
serious intx w/ azathioprine or mercaptopurine
133
Denosumab MOA
stops RANKL action to inhibit clasts
134
LDL goal lupus nephritis
\<100
135
BPP given IV
ZIP
zoledronate
ibandroante
pamidroamte
136
tx for intermittent joint pain in lupus
3
NSAIDs
Prednisone 10mg/day
* +/- hydrochloroquine
* +/- MTX
intraarticular corticosteroid injection
137
Abaloparitide counseling
limited to 2 years
orthostatic hypotension
138
Raloxifene role in therapy
to maintain gained bone after use of anabolic agent
139
hydroxychloroquine Se
retinal toxicity
140
DMD or BMD have total loss of dystrophin
DMD
141
class 4 lupus nephritis
diffuse lupus nephritis
most biopsied form
hematuria
proteinuria
nephrotic syndrome
renal failure
HTN
inc. anti-nDNA
142
TX OA inflammation and pain drug classes
Cox 1/2 inhibitors
glucocorticoids
143
Ocrelizumab cause what Se
Hep B reactivation
144
role of estrogen in OP
act on blasts to inhibit RANKL
increase OPG
145
what is uricase
enzyme humans lack that converts uric acid to soluble products
146
is triamcinolone good option as intraarticular steroid
probs not
147
how long of a trial for non tnf biologic tx
6 months
148
Fingolimod needs what for pretesting?
Optical coherence tomography
149
risk factor for MS exacerbation
heat
stress
anemia
infection
sleep depriviation
150
counseling point for baclofen
avoid abrupt withdrawal b/c cause seizures and hallucinaitons
151
drugs that cause hypercalcemia
Teriparitide
Abaloparitide
152
Acute Gout
mono vs polyarticular
which joints
pain?
reccurence?
monoarticular
peripheral joints
severe pain
75% reccur in 1-2 years after acute attack
153
Febuxostat Tox
| (6)
adjust when Crcl \<30
GI
inc. liver enzymes
Rash
Arthralgia
all cause mortality
154
Colchicine dose for prevention and tx
acute attack: 1.2mg PO then 0.6mg at 1-2 hours then 0.6mg QD or BID until resolution
Prevention: 0.6mg QD or BID
155
What does mutation in dystrophin gene cause
loss of muscle
muscle wasting
156
Teriparatide counseling
do not exceed 18-24 months of tx
157
Bowel symptoms tX in MS
fiber
158
what to not combine biologics with
biologics or toacitinib
159
Rituximab indication in RA
severe active RA and failure on one or more TNFa inhibitors
160
Capsaicin MOA
depletes substance P at local sensory nerve endings counterirritant stimulate cutaneous receptors to induce cold/warmth to distract from pain
161
DEXA
what does it tell us
what does it calculate
Scores
density of bones
T score
-5 to +2
higher = higher density
162
M vs F in gout
Men 2-3x more
no difference \>65 yrs
163
MS med potency TX
Dimethyl fumarate
Fingolimod
164
drugs best for non-vertebral OP
terparatide
alendronate
165
when is lupus most severe
children, men and those \>50
166
Allopurinol MOA
inhibit xanthine oxidase
inhibit uric acid synthesis
167
FBM DX
widespread pain for at least 3 months and ALL:
* pain on right and left sides
* pain above and below waist
* pain in axial skeleton
* pain on palpatation in 11 of 18 tnder points in neck, back, and extremitites
168
Colchicine MOA
binds intracellular tubulin and prevents polymerization into microtubules which are needed for cell division and migration so inflammatory cells can't proliferate
169
OA M vs F
early years M\>F
late years F\>M
170
Amitriptyline, nortriptyline, and flexeril put in order of efficacy for FBM
all similar in efficacy and tolerabliity
171
Cutaneous Lupus erthymatosus definition
Discoid lupus
only affects skin and causs rashes
172
what happens in antiphopholipid syndrome
immune system makes antibodies that attack normal proteins in blood causing blood clots to form
173
CrCl for BPP
Alendronate : \< 35
ibandronate: \<30
Risendronate: \<30
Zolendroate: \<30
174
Raloxifen DD-intx
cholestryamine or colestipol inhibits absorption
175
Risk Factors of FBM
| (4)
Stress
Lack of Activity
Poor sleep pattern
migraine
176
types of lupus
4
systemic lupus erythematosus
curaneous lupus erythematosus
drug-induced lupus
neonatal lupus
177
Labs of Gout
serum uric acid
urinary uric acid
\>8%
\<800mg/24 hours of excretion
178
when can you consider prevention of acute gout?
and how long?
\>2-3 attacks/year
treat up to 6-12 months after UA \<6%
179
Duloxetine contraindications
| (4)
MAOIs
CrCl \<30
hepatic insufficiency
alcohol use
180
Lupus
M vs W
women of reproductive age
181
Cyclophosphamide
indication
MOA
SE
lupus nephritis, neurophsychiatric lupus, systemic vasculitis
cross-link DNA leading to cell death and suppress production of B cells, igG, adhesion molecules and cytokines
bladder cancer, myelosuppression, infertility
182
Milnacipran MOA
SNRI
183
OA defintion
loss of cartilage and hypertrophy of bone
184
tizanidine counseling point
monitor for hypotension
185
What criteria is required for a dx of severe OP
fracture with BMD score
186
high potency steroid tx for cutaneous lupus
for scalp, hands, soles of feet
clobetasol propionate
halobetasol propionate 0.05%
187
sypmtoms of MS
7
pain
fatigue
spasticity
cognitive
depression
sensory symptoms
bladder and bowel symptoms
188
OA cymbalta indication
chonic musculoskeletal pain
chronic lower back pain
189
Estrogen moa
suppress RNAKL
190
serious SE of alemtuzumab
thyroid disease
191
best OP combo
anti-resorptive and anabolic
denosumab and terparatide
192
What MS TX cause PML
Dimethyl fumarate
Fingloimod
Natalizumab
Ocrelizumab
