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IP3 > Musculo/Skeletal > Flashcards

Musculo/Skeletal Flashcards

1
Q

what drug to use for RRMSif onset is severe

A

Natalizumab

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2
Q

OA Hand TX

A

NSAIDCapsaicin

Diclofenac gel

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3
Q

Types of Gout

(3)

A

Acute

Chronic

Hyperuricemia

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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

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5
Q

Which drugs for OP best for spine BMD

A

zoledronate

denosumab

teriparatide

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6
Q

class 2 lupus nephritis

A

proliferative mesangial lupus nephritis

normal SCr

microhematuria

non-nephrotic proteinuria

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7
Q

Pegloticase MOA

A

recombinant urate oxidase which converts uric acid to allantoin which has higher solubility and remains easie to excrete

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8
Q

TX gait disturbance in MS

A

dalfampridine

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9
Q

spasticity tx

4

A

baclofen

tizanidine

Diazepam

dantrolene

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10
Q

Neuro probs w/ lupus

7

A

ischemic stroke/TIA

seizures

cognitive dysfunction

major depression

neuropathies

psychosis

myelitis

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11
Q

Raloxifen cautions

A

CrCl <50

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12
Q

Co-stimulation modulator

disrupt T cell activation

A

Abatacept

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13
Q

MOA of anabolic drugs

A

stim bone formation

inc. BMD
dec. fracture risk

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14
Q

Class 5 lupus nephritis

A

membraneous lupus nephritis

proteinuria

nephrotic syndrome

normal renal function

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15
Q

cause of FSHD

A

4q of D4Z4 repeat units in genome lacking

D4Z4 express DUX4

DUX4 not normally made in skeletal muscle

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16
Q

When to avoid interferon in MS

A

severe untreated depression

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17
Q

drugs that inhibit urate crystallization

(3)

A

Allopurinol

Febuxostat

Pegloticase

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18
Q

what part of mAb make up antigen binding domain

A

variable region

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19
Q

DX of DMD

A

abnormal muscle function

inc. serum creatine kinase

gross motor/speech delay

abnormal gait

postive Gower’s maneuver

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20
Q

Probenacid and Lesinurad MOA

A

block reabsorption of urate in the proximal convoluted tubules by the URAT-1 organic anion transporter

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21
Q

lupus nephritis induction

A

mycophenolate

  • for African americans

cyclophosphamide

  • for white people

glucocorticoids

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22
Q

CD-20 binder

B cell depletion

A

Rituximab

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23
Q

purpose to test for synovial fluid analysis in RA

A

rule out other disease

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24
Q

Lupus meds to avoid in pregnancy

A

cyclophosphamide

NSAIDs

ACE/ARB

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25
Q

Mycophenolate

indication

MOA
SE

A

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

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26
Q

Nationalities most likely to have Lupus

5

A

African

asain

Chaldean

Hispanic

Native American

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27
Q

JAK inhibitors

A

Tofacitinib

Baricitinib

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28
Q

what MS treatment to check for TB before giving

A

Teriflunomide

Alemtuzumab

Ocrelizumab

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29
Q

estrogen counseling

A

monitor for clots

do not take with grapefruit juice

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30
Q

Tx of cutaneous lupus erythematosus

2

A

protect from UV light

topical steroids

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31
Q

drugs that cause hypocalcemia

A

Calcitonin

Denosumab

BPP

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32
Q

Tox of Colchicine

(3)

A

narrow TI so space ongoing courses by 1-2 weeks to avoid cumulative toxicityes

N/V/D require D/C

myelosuppression

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33
Q

OA Hip Tx

A

APAP

NSAId

tramadol

opioids

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34
Q

systemic Lupus erythematosus (SLE) definition

A

most common form and is more serious

can affect any part

unpredictable pattern of remission and flares

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35
Q

Gout symptoms

(3)

A

sudden onset of pain, heat, tenderness, swelling, erythema

dec. range of motion

presence of tophi

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36
Q

Pegloticase Indication

(3)

A

Chronic gout

refractory gout

unable to take conventional therapy

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37
Q

immunological criteria of lupus

A

ANA: antinuclear antibody

dsDNA: anti-double stranded DNA

Antiphospholipid antibody

low complement

direct coomb’s test

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38
Q

2nd3rd line OP

A

calcitonin

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39
Q

Does drug-induced lupus go away?

A

yes about 6 months after stopping medication

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40
Q

OA pain relief if contraindication or lack of response to NSAIDs

A

opioids

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41
Q

high potency MS tX

A

Natalizumb

Alemtuzumab

Ocrelizumab

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42
Q

MS low potency tx

A

interferon

Glatiramer

Teriflunomide

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43
Q

NSAID GI tox risks

A

>60

history of ulcers

high dose and long duration

concurrent drugs

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44
Q

BPP counseling

A

take with water

take on empty stomach

remain upright for 30-60 mins after

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45
Q

Lupus triggers/risks

7

A

genetics

hormones

abnormal immune cells

cigarette smoke

UV light

virus/infection

stress

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46
Q

Lesinurad SE

(6)

A

renal toxicity

HA

influenza

Inc. SCr

Gi reflex

acute kidney failure

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47
Q

Who should be tested for OP

A

women >65

men >70

adults with fractures after 50

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48
Q

when to avoid Fingolimod

A

taking class 1 & 3 antiarrhythmics and those with significant CVD

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49
Q

Chronic gout

what happens to joint

can lead to what?

A

urate crystals deposit in and around joint cartilage

deformint and soft tissue damage and joint destruction

lead to nephrolithiasis (kidney stone) and kidney damage

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50
Q

FBM symptoms

(7)

A

spontaneous widespread flare ups

musculoskeletal pain

joint stiffness in morning and during day

chronic fatigue

sleep disturbances

depression, anxiety, HA

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51
Q

Diclofenac solution application

A

40 drops/knee

spread evenly with 10 drops and repeat until 40 drops used

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52
Q

FRAX calculator

what does it tell you

who can use it

when does it underestimate

A

10 year probabily of fracture

age 40-90

it pt had multiple previous fractures

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53
Q

Class 3 lupus nephritis

A

focal lupus nephritis

proteinuria and hematuria

ocassional nephrotic syndrome, HTN, inc. SCr

progression depends on % of affected glomeruli

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54
Q

role to test for ANA in RA

A

rule out lupus

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55
Q

adjunctive TX lupus nephritis

A

hydroxychloroquine

ACEi/ARB

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56
Q

purpose of Anti-CCP in RA

A

specific for RA

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57
Q

PTH analogs

A

Abaloparitide

Teriparatide

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58
Q

symptoms of lupus

11

A

fatgue

depression

arthritis/arthralgia

photosensitivity

alopecia

serositis

mycarditis

anemia

swelling in feet, legs, hands, eyes

butterfly rash on cheeks and nose

raynauds

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59
Q

Mab

% human

murine

chimeric

humanized

human

and endings

A

0: omab
65: ximab

>90: zumab

100: umab

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60
Q

DX of OP

A

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
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61
Q

hydroxychloroquine indication in RA

A

mild-mod

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62
Q

define Lupus

A

chronic (>6 weeks) autoimmune disease that can damage any part of the body

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63
Q

MTX indication for RA

A

any disease activity or prognosis

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64
Q

low potency steroid for cutaneous lupus

A

for face and groin

fluocinolone acetonide 0.01%

hydrocortisone 0.1%

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65
Q

are opioids better than APAP or NSAID for OA

A

no

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66
Q

How long can you treat OP for with 1 drug

A

5 years

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67
Q

exacerbation of MS

A

new symptoms >24 hors with 30 day separation from other new symptoms

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68
Q

cause of gout

A

excess serum uric acid

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69
Q

Zoledronate dose

A

prevention every 2 years

tx yearly

only treat for 3 yrs

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70
Q

JAK indicaiton in RA

A

mod-severe

with inadequate response or intolerance to MTX

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71
Q

IL6 indications in RA

A

mod-severe

need inadequare response to MTX first

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72
Q

Febuxostat MOA

A

selective inhibitor of xanthine oxidase

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73
Q

bp goal lupus nephritis

A

<130/80

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74
Q

after initiating when do you add another nonbiologic

A

3 months

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75
Q

OA knee TX

A

APAP

NSAID

capsaicin

diclofenac gel

diclofenac solution

intraarticular steroids

tramadol

opioids

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76
Q

DMD and BMD have what genetic carrier trait

A

X-linked

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77
Q

pathophysiology of Lupus

4

A

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
Q

IL1 antagonist

A

Anakinra

79
Q

FBM

F vs M

A

F>M

80
Q
A
81
Q

Gout when is it monoarticular vs polyarticular

A

90% of first attacks are monoarticular and as disease progress it becomes polyarticular

82
Q

DMD from what type of mutation

A

framshift

83
Q

TX fatigue in MS

A

amantadine

methylphenidate

84
Q

BPP MOA

A

bind to resorption site and taken up by clasts and released after remodeling cycle to make clasts do apoptosis

85
Q

BPP given PO

A

AIR

alendronate

ibandronate

risedronate

86
Q

OP 1st line

A

alendronate

risedronate

zoledronate

denosumab

87
Q

4 subtypes MS

A

relapsing remitting

secondary progressive

primary progressive

progressive relapsing

88
Q

define lupus nephritis

A

kidney disease caused by systemic lupus erythematosus

89
Q

Drug classes to prevent inflammatory response to gout

(2)

A

NSAIDs

Glucocorticoids

Colchicine

90
Q

Define MS

A

CNS autoimmune disorder characteried by demyelineation and axonal damage

progressive, non-reversible

exacerbations and relapses

91
Q

how long to let anti TNF work before switching

A

3 months

92
Q

when to avoid teriflunomide in MS

A

pregnant category X

severe hepatic impairment

93
Q

Hyperuricemia

is it gout?

when to treat it?

goal of treatment?

when to treat if asymptomatic

A

not actually gout

2-3 episodes of gout per year

goal: control symptoms and targer <6% UA

kidney disease

94
Q

Diazepam MS indication

A

not 1st line adjunct to baclofen

95
Q

PTH analog counseling

A

avoid use in pt prone to osteosarcoma

once d/c BMD declines rapidly

96
Q

Leflunomide and pregnancy

A

treatogenic

d/c and take cholestyramine for 11 days

97
Q

Treat exacerbation of MS

A

IV high dose steroid

medrol 500-1000mg/day for 3-10 days

98
Q

level of uric acid that normally causes symtpoms

A

6mg/dL

99
Q

when to start DMARD in RA

A

3 months of symptoms

100
Q

symptoms of RA

A

joint pain/tenderness

symmetrical distribution

prolonged stiffness >1 hour in AM

fatigue

weight loss

35% have rheumatoid nodule

101
Q

Define Gout

A

sudden onset of severe acute monoarticular arthritis in peripheral joints

102
Q

way to treat Gout

(3)

A

prevent inflammatory response to urate crystals

inhibit urate crystallizaiton

inc. urate excretion

103
Q

Anabolic agents OP

A

teriparatide

Abaloparatide

104
Q

Class 1 lupus nephritis

A

minimal mesangial lupus nephritis

normal SCr and urine lab results

105
Q

Gout risk factors

(8)

A

Hyperuricemia >6.8

obesity

alcohol

kidney disease

dehydration

neoplastic diseases

drugs: thiazides, lwo dose salicylates, niacin, caffeine

foods high in purine

106
Q

FBM tx

(8)

A

Amitriptyline

  • +fluoxetine/sertraline

Venlafaxine

Nortiptyline

Flexeril

Duloxetine

Lyrica

Milnacipran

Tramadol

107
Q

TNFa inhibitor

A

Infliximab

golimumab

certolizumab

entercept

adalimumab

I’m gonna cry every aday

108
Q

2 types of bone

function

A

trabecular: strength and flexibility
cortical: structure and weight bearing

109
Q

MTX contraindication

A

Hep B and C

110
Q

drugs that increase urate excretion

(2)

A

probenacid

lesinurad

111
Q

spasticity legs or arms

A

legs>arms

112
Q

DMARD small molecules

A

MTX

leflunomide

hydroxychloroquine

sulfasalazine

113
Q

Drugs that cause drug induced lupus

7

A

procainamide/quinidine

hydralazine

TNF inhibitors

minocycline

isoniazid

methyldopa

chlorpromazine

114
Q

OA symptoms

A

joint stiffness <30 min in AM

bony enlargement

115
Q

MTX MOA

A

inhibit dihydrofolate reductase

116
Q

Tx of hyper-reflexia in MS

2

A

anticholinergic

TCA

117
Q

Denosumab counseling

A

rapid bone loss after D/C so add antiresorptive

118
Q

Calcitonin MOA

A

inhibit clasts bone resorption via GPCR by causing clasts to detach

119
Q

way to treat hyperuricemia

(2)

A

inhibit urate crystallization

increase urate excretion

120
Q

RA are NSAIDs prn or scheduled

A

prn for sypmtoms only

121
Q

MOA of anti-resorptive agents

A

suppress clasts

slow resorption

dec. fracture risk

122
Q

What is the most common arthritis?

A

Fibromyalgia

123
Q

IL6 antagonists

A

Tocilizumab

Sarilumab

124
Q

med potency for tx of cutaneous lupus

A

for trunk and arms

traimcinolone acetonide 0.1%

mometasone furoate 0.1%

125
Q

Pegloticase can you use w/ allopurinol or febuxostat

A

NO

126
Q

when to add/switch anti TNF

A

after 1-3 nonbiologics

127
Q

Belimumab

indication

MOA

A

active, autoantibody +, SLE not on standard therapy

bind to B lymphocyte stimular to prevent its binding to B cells

128
Q

can you use probenacid w/ allopurinol

A

yes

129
Q

cimizia RA indication

A

mod-severe

130
Q

drugs that cause Osteonecrosis of Jaw and sensitivity of femur to breakage

A

Denosumab

BPP

131
Q

TX hypo-refelxic bladder symptoms in MS

A

bethanechol

132
Q

Tox of allopurinol

(4)

A

adjust dose for renal impairment

rash (HLA-B*5801)

GI

serious intx w/ azathioprine or mercaptopurine

133
Q

Denosumab MOA

A

stops RANKL action to inhibit clasts

134
Q

LDL goal lupus nephritis

A

<100

135
Q

BPP given IV

A

ZIP

zoledronate

ibandroante

pamidroamte

136
Q

tx for intermittent joint pain in lupus

3

A

NSAIDs

Prednisone 10mg/day

  • +/- hydrochloroquine
  • +/- MTX

intraarticular corticosteroid injection

137
Q

Abaloparitide counseling

A

limited to 2 years

orthostatic hypotension

138
Q

Raloxifene role in therapy

A

to maintain gained bone after use of anabolic agent

139
Q

hydroxychloroquine Se

A

retinal toxicity

140
Q

DMD or BMD have total loss of dystrophin

A

DMD

141
Q

class 4 lupus nephritis

A

diffuse lupus nephritis

most biopsied form

hematuria

proteinuria

nephrotic syndrome

renal failure

HTN

inc. anti-nDNA

142
Q

TX OA inflammation and pain drug classes

A

Cox 1/2 inhibitors

glucocorticoids

143
Q

Ocrelizumab cause what Se

A

Hep B reactivation

144
Q

role of estrogen in OP

A

act on blasts to inhibit RANKL

increase OPG

145
Q

what is uricase

A

enzyme humans lack that converts uric acid to soluble products

146
Q

is triamcinolone good option as intraarticular steroid

A

probs not

147
Q

how long of a trial for non tnf biologic tx

A

6 months

148
Q

Fingolimod needs what for pretesting?

A

Optical coherence tomography

149
Q

risk factor for MS exacerbation

A

heat

stress

anemia

infection

sleep depriviation

150
Q

counseling point for baclofen

A

avoid abrupt withdrawal b/c cause seizures and hallucinaitons

151
Q

drugs that cause hypercalcemia

A

Teriparitide

Abaloparitide

152
Q

Acute Gout

mono vs polyarticular

which joints

pain?

reccurence?

A

monoarticular

peripheral joints

severe pain

75% reccur in 1-2 years after acute attack

153
Q

Febuxostat Tox

(6)

A

adjust when Crcl <30

GI

inc. liver enzymes

Rash

Arthralgia

all cause mortality

154
Q

Colchicine dose for prevention and tx

A

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
Q

What does mutation in dystrophin gene cause

A

loss of muscle

muscle wasting

156
Q

Teriparatide counseling

A

do not exceed 18-24 months of tx

157
Q

Bowel symptoms tX in MS

A

fiber

158
Q

what to not combine biologics with

A

biologics or toacitinib

159
Q

Rituximab indication in RA

A

severe active RA and failure on one or more TNFa inhibitors

160
Q

Capsaicin MOA

A

depletes substance P at local sensory nerve endings counterirritant stimulate cutaneous receptors to induce cold/warmth to distract from pain

161
Q

DEXA

what does it tell us

what does it calculate

Scores

A

density of bones

T score

-5 to +2

higher = higher density

162
Q

M vs F in gout

A

Men 2-3x more

no difference >65 yrs

163
Q

MS med potency TX

A

Dimethyl fumarate

Fingolimod

164
Q

drugs best for non-vertebral OP

A

terparatide

alendronate

165
Q

when is lupus most severe

A

children, men and those >50

166
Q

Allopurinol MOA

A

inhibit xanthine oxidase

inhibit uric acid synthesis

167
Q

FBM DX

A

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
Q

Colchicine MOA

A

binds intracellular tubulin and prevents polymerization into microtubules which are needed for cell division and migration so inflammatory cells can’t proliferate

169
Q

OA M vs F

A

early years M>F

late years F>M

170
Q

Amitriptyline, nortriptyline, and flexeril put in order of efficacy for FBM

A

all similar in efficacy and tolerabliity

171
Q

Cutaneous Lupus erthymatosus definition

A

Discoid lupus

only affects skin and causs rashes

172
Q

what happens in antiphopholipid syndrome

A

immune system makes antibodies that attack normal proteins in blood causing blood clots to form

173
Q

CrCl for BPP

A

Alendronate : < 35

ibandronate: <30

Risendronate: <30

Zolendroate: <30

174
Q

Raloxifen DD-intx

A

cholestryamine or colestipol inhibits absorption

175
Q

Risk Factors of FBM

(4)

A

Stress

Lack of Activity

Poor sleep pattern

migraine

176
Q

types of lupus

4

A

systemic lupus erythematosus

curaneous lupus erythematosus

drug-induced lupus

neonatal lupus

177
Q

Labs of Gout

serum uric acid

urinary uric acid

A

>8%

<800mg/24 hours of excretion

178
Q

when can you consider prevention of acute gout?

and how long?

A

>2-3 attacks/year

treat up to 6-12 months after UA <6%

179
Q

Duloxetine contraindications

(4)

A

MAOIs

CrCl <30

hepatic insufficiency

alcohol use

180
Q

Lupus

M vs W

A

women of reproductive age

181
Q

Cyclophosphamide

indication

MOA

SE

A

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
Q

Milnacipran MOA

A

SNRI

183
Q

OA defintion

A

loss of cartilage and hypertrophy of bone

184
Q

tizanidine counseling point

A

monitor for hypotension

185
Q

What criteria is required for a dx of severe OP

A

fracture with BMD score

186
Q

high potency steroid tx for cutaneous lupus

A

for scalp, hands, soles of feet

clobetasol propionate

halobetasol propionate 0.05%

187
Q

sypmtoms of MS

7

A

pain

fatigue

spasticity

cognitive

depression

sensory symptoms

bladder and bowel symptoms

188
Q

OA cymbalta indication

A

chonic musculoskeletal pain

chronic lower back pain

189
Q

Estrogen moa

A

suppress RNAKL

190
Q

serious SE of alemtuzumab

A

thyroid disease

191
Q

best OP combo

A

anti-resorptive and anabolic

denosumab and terparatide

192
Q

What MS TX cause PML

A

Dimethyl fumarate

Fingloimod

Natalizumab

Ocrelizumab

IP3 (7 decks)

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