MUSCULOSKELETAL

Question 1

Which musculoskeletal drug is a decoy receptor for TNF alpha

Answer 1

etanercept

Question 2

Which NSAID is injectable?

Answer 2

ketorolac

Question 2

What do all of the bisphosphonates end in?

Answer 2

dronate

Question 3

With which disease is urate nephropathy associated? What drug can prevent?

Answer 3

tumor lysis syndrome in patients with leukemia etc, allopurinol

Question 4

What are 3 indications for bisphosphonates?

Answer 4

osteoporosis, hypercalcemia, Paget’s disease of bone

Question 4

What are the side effects of bisphosphonates?

Answer 4

osteonecrosis of the jaw and corrosive esophagitis

Question 5

What is the MOA of colchicine for gout?

Answer 5

Binds and stabilizes tubulin to inhibit polymerization and leukocyte chemotaxis (i.e. the gout crystals induce complement = chemotaxis (C5a), this drug prevents them from actually infiltrating the gouty tissue)

Question 6

What is the function of PGI2?

Answer 6

causes vasodilation and inhibits platelet aggregation

Question 7

When is it okay to give a kid aspirin?

Answer 7

If they have Kawasaki disease (Kawasaki arteritis) the risk of coronary aneurysm is greater than the risk for Reye’s syndrome?

Question 8

Which musculoskeletal drug can cause corrosive esophagitis?

Answer 8

Bisphosphonates (alendronate and other dronates)

Question 10

How exactly does aspirin inhibit COX 1 and 2?

Answer 10

via acetylation

Question 11

What 2 NSAIDs are indicated for acute gout?

Answer 11

naproxen and indomethacin

Question 12

What is the toxic metabolite of acetaminophen?

Answer 12

N-acetyl-para-benzoquinone imine

Question 13

What are 2 indications for celecoxib? With what underlying condition would you choose this over an NSAID?

Answer 13

Osteoarthritis and Rheumatoid arthritis; if they have gastritis or ulcer you would choose these over a traditional NSAID

Question 14

T/F: aspirin is an NSAID

Answer 14

TRUE

Question 14

Which musculoskeletal drug can cause osteonecrosis of the jaw?

Answer 14

Bisphosphonates (alendronate and other dronates)

Question 16

What is the effect of low, medium, and high dose aspirin?

Answer 16

low (under 300) is for decreasing platelet aggregation; medium is for antipyretic/analgesic (300-2400); high is anti-inflammatory (2400-4000)

Question 17

What happens when a person overdoses on acetaminophen? What is the antidote?

Answer 17

Hepatic necrosis due to toxic adducts; N-acetylcysteine

Question 18

Which cranial nerve may be negatively affected by aspirin?

Answer 18

CN VIII (causes tinnitus)

Question 18

What is the MOA of bisphosphonates?

Answer 18

They are pyrophosphate analogs and bind to hydroxyapatite in bone and inhibit osteoclast activity

Question 18

What are the options for acute Tx of gout?

Answer 18

NSAIDs (indomethacin, naproxen) and oral/intra-articular glucocorticoids

Question 19

What effect does aspirin have on breathing?

Answer 19

stimulates respiratory centers leading to hyperventilation and metabolic alkalosis

Question 20

Name to COX-2 selective inhibitors

Answer 20

celecoxib and rofecoxib

Question 21

Why would a patient being treated for leukemia or lymphoma be placed on allopurinol or febuxostat?

Answer 21

Prevent tumor lysis syndrome

Question 23

What effect does aspirin have on PT, PTT, and bleeding time?

Answer 23

only increases bleeding time (because decreases platetlet aggregation) but no effect on the others which indicate effects on clotting factors

Question 24

What effect do NSAIDs have on renin activity?

Answer 24

increased, this is due to loss of prostacyclin (PGI2) in the afferent arteriole, leads to increased renin and HTN

Question 25

Which drugs should not be given with allopurinol?

Answer 25

Salicylates as all depress uric acid secretion (I’m guessing this is why you don?t give aspirin for your NSAID of choice in acute gout??)

Question 26

What is the MOA of adalimumab and infliximab?

Answer 26

anti-TNF-alpha monoclonal antibody

Question 27

Which drugs are increased in concentration with co-administration of allopurinol?

Answer 27

6 mercaptopurine and azathioprine

Question 28

Which drug is a reversible inhibitor of COX only in the CNS?

Answer 28

acetaminophen

Question 30

Which aspect of the nephron does probenicid exert its effects?

Answer 30

Proximal tubule, prevents reabsorption of uric acid

Question 31

Which enzyme, inhibited by aspirin will only be inhibited in tissue that is actively inflammed?

Answer 31

COX-2 since that is the inducible one

Question 33

How is the effect of LTB4 different from LTC4, D4 and E4?

Answer 33

B4 is chemotactic for neutrophils and the others are all active on smooth muscle, mediating vaso/bronchoconstriction

Question 34

How is the MOA of etanercept different from that of adalimumab/infliximab?

Answer 34

Etanercept is a decoy receptor for TNF-alpha (a fusion protein of TNF alpha and IgG1 Fc) whereas the others are monoclonal abs against TNF-alpha

Question 35

Which drug inhibits the reabsorption of uric acid in the PCT?

Answer 35

probenicid

Question 36

How is the MOA of acetaminophen different from NSAIDs?

Answer 36

it acts CENTRALLY to inactivate COX, it is inactivated peripherally

Question 37

What are 3 major issues that arise with chronic aspirin usage?

Answer 37

acute renal failure, interstitial nephritis, and UGIB

Question 38

Name 4 chronic gout drugs

Answer 38

febuxostat, allopurinol, and probenicid

Question 39

What should you give a child with a viral infection and fever?

Answer 39

Acetaminophen, if you give aspirin there is risk for Reye’s syndrome

Question 40

What NSAID is used to close a PDA

Answer 40

indomethacin