Osteoporosis, RA & Gout

Question 1

Uricemia due to excess synthesis, diet intake, or excess cell turnover

Answer 1

overproducer

Question 2

What activates NFkB?

Answer 2

RANKL

Question 3

What governs the formation & activation of osteoclasts?

Answer 3

RANKL

Question 4

Indication for DULOXETINE

Answer 4

SNRI used to tx OA

increased risk for constipation

Question 5

What are tophi?

Answer 5

large aggregations of monosodium urate crystals surrounded by intense inflammatory reaction

Question 6

What is a pathognomonic hallmark of gout?

Answer 6

tophi

Question 7

What is an absolute CI for tx of RA w/ MTX?

Answer 7

PREGNANCY

Question 8

MOA of uricosuric drugs

Answer 8

lower serum urate levels by increasing urate fractional excretion by kidneys

Question 9

MOA & use of prednisone

Answer 9

glucocorticoid

short term use in tx for RA until DMARD effects are seen

Question 10

Sxs of OA

Answer 10

localized pain, stiffness, tenderness, crepitus, bone spurs (joint mice)

Question 11

MOA & use of ANAKINRA

Answer 11

late choice biologic DMARD (limited efficacy)

recombo version of endogenous human IL-1 receptor antagonist

Question 12

AEs of SERMs (raloxifene)

Answer 12

DVT
PE
Stroke

Question 13

MOA & use of infliximab

Answer 13

biologic DMARD, monoclonal AB v TNFa

IV every 6 weeks

Question 14

MOA & use of tofacitinib

Answer 14

biologic DMARD, JAK3 antagonist

orally active

Question 15

MOA & use of tocilizumab

Answer 15

biologic DMARD, humanized anti IL-6 receptor AB

decrease acute phase response of liver in RA

Question 16

MOA of febuxostat

Answer 16

non purine, non competitive xanthine oxidase inhibitor

reduce urate levels in pts w/ allopurinol intolerance

Question 17

MOA & use of pegloticase

Answer 17

PEGylated version of recombo mammal uricase

tx chronic gout in those refractory to conventional tx

Question 18

What is NOT altered by use of NSAIDs or glucocorticoids in RA?

Answer 18

disease progression

Question 19

What should pts take if on MTX or sulfasalazine in tx of RA?

Answer 19

B9 (folate) supplement

Question 20

What hormone acts to increase free Ca2+ levels in plasma?

Answer 20

PTH

increases bone breakdown, promotes reabsorption of Ca2+ in kidney & promotes generation of calcitriol

Question 21

Indication & AEs of Ca2+ salts

Answer 21

diet supplement in teen & post meno Fs to facilitate bone growth or limit bone loss

AEs w/ constipation, lethargy, polyuria, kidney stones

Question 22

MOA & use of colchicine

Answer 22

blocks tubulin polymerization (& MT formation) in leukocytes which needed for migration & phagocytosis

tx acute gout in pts who cannot take NSAIDs & relieves inflammation w/ in 12-24hrs of sxs

Question 23

MOA & use of rasburicase

Answer 23

non peg recombo uricase

prevention of acute uric acid nephropathy due to tumor lysis syndrome

Question 24

MOA & use sulfinpyrazone

Answer 24

uricosuric agent

requires GFR>60, only works for under excreters of uric acid

Question 25

MOA & use of hydroxychloroquine

Answer 25

traditional DMARD that alters antigen presentation by disrupting lysosomal pH tx of RA

Question 26

Indication for cinacalcet

Answer 26

secondary hyperPTH caused by CKD

Question 27

MOA & use of denosumab

Answer 27

monoclonal AB v RANKL to lower its bone microenviro levels relative to OPG (decreases formation & function of osteoclasts) tx of osteoporosis

Question 28

MOA & use of allopurinol

Answer 28

competitive xanthine oxidase inhibitor that lowers serum urate levels standard tx of recurrent gout if low GFR or past urate stone or urate overproduction

Question 29

MOA & use of leflunomide

Answer 29

disrupts pyrimidine synthesis 2nd choice traditional DMARD for RA

Question 30

MOA & use of raloxifene

Answer 30

SERM w/ agonist effects on bone tx of osteoporosis

Question 31

What type of tx for prostate cancer increases pt risk for developing osteoporosis?

Answer 31

androgen deprivation

Question 32

What type of bone is broken in atypical femoral fractures due to bisphosphonate tx?

Answer 32

cortical bone

Question 33

What autoABs in RA pts that target protein arginine residues?

Answer 33

cirtulline (anti CCP)

Question 34

MOA & use of indomethacin

Answer 34

NSAID w/ COX1 selectivity tx acute gouty arthritis

Question 35

MOA & use of abatacept

Answer 35

biologic DMARD that blocks T cell CD80/86 co stimulatory signal needed for activation tx of RA

Question 36

What is uric acid?

Answer 36

poorly soluble end product of purine metabolism cuase of kidney stones

Question 37

MOA & use of teriparatide

Answer 37

1-34 PTH only agent that FORMS bone via PULSED daily therapy tx of osteoporosis

Question 38

Major AE of hydroxychloroquine

Answer 38

retinal damage

Question 39

MOA & use methotrexate

Answer 39

traditional DMARD must monitor for myelosuppression, tx of RA

Question 40

AE of colchicine

Answer 40

GI distress

Question 41

How to tx hyperCa2+ of malignancy?

Answer 41

w/ bisphosphonates or furosemide

Question 42

MOA of cinacalcet

Answer 42

Ca2+ receptor sensitizer acts to lower PTH secretion

Question 43

What is triple tx for RA?

Answer 43

MTX Hydroxychloroquine Sulfasalazine

Question 44

MOA & use of alendronate

Answer 44

bisphosphonate, incorporates into bone to inhibit # & activity of osteoclasts 1st choice to tx osteoporosis in M & F

Question 45

MOA & use of sulfasalazine

Answer 45

traditional DMARD used for RA AEs of GI side effects

Question 46

MOA & use of adalimumab

Answer 46

antiTNF biologic DMARD tx psoriatic arthritis, ankylosing spondylitis

Question 47

MOA, use & major AE of zoledronic acid

Answer 47

bisphosphonate, IV injection 1x/year for tx of osteoporosis highest risk of ONJ

Question 48

MOA & use rituximab

Answer 48

targets CD20 on B cells tx RA

Question 49

MOA & use of probenecid

Answer 49

blocks urate reabsorption @ URAT1 transporter in kidney prox tubule increase excretion of urate in urine to tx gout

Question 50

Major AE of allopurinol

Answer 50

Stevens Johnson syndrome (fatal epidermal necrolysis) mc HLAB5801

Question 51

Major AE of oral bisphosphonates

Answer 51

esophagitis

Question 52

MOA of etanercept

Answer 52

biologic DMARD, sc injection 1-2x/week tx for psoriasis

Question 53

What is a common target to tx RA & other autoimmune dzs?

Answer 53

TNFa block