PAIN-OA NON BIOs

Question 1

What is difference btwn osteoarthritis and Rheumatoid?

Answer 1

OA- Articular cartilage loss large jts and hands.

RA- autoimmune, smaller jts, symmetric. INC CRP, ESR

Question 2

This severe condition is 2/2 this skin condition which is triggered by environment?

Answer 2

Psoriatic Arthritis: Aberrant immune response- Distal jt in fingers, wrist, feet. ASYMMETRIC

Question 3

What condition affects spine and SI jt that is autoimmune and inflammatory?

Answer 3

Ankylosing Spondylitis- onset young LABS- ESR, HLA-B27 (similar to IBD) NO RF

Question 4

This is common at base of great toe due under-excretion of uric acid?

Answer 4

Gout- sudden, foot, finger, knee, wrist, elbow.

Question 5

Which findings are DX in serology for RA?

Answer 5

1. Rheumatoid factor
2. anti-CCP (Anticyclic citrullinated peptide
   antibodies) . 3. TNF-a tumor necrosis factor

Question 6

Based off ACR criteria. What is defined improvement of therapy response?

Answer 6

1. > 20% improvement in tender joint count and
2. > 20% improvement in swollen joint count and
3. > 20% improvement in 3 of the following:
   Patient pain assessment
   Patient global assessment
   Physician global assessment
   Patient self-assessed disability
   Acute-phase reactant (ESR, CRP, etc.)

Question 7

What are RX and NON RX goal for Arthritis?

Answer 7

RX- DEC pain, improve jt motion, min. decline in fx.

NON-RX- Pt ed, self tx, wt loss, PT

Question 8

APAP, PO NSAIDs, inj. TramadoL is REC for which condition?

Answer 8

Osteoarthritis

Question 9

What common meds are not REC for OA?

Answer 9

Intraarticular, Opioids, Chondroitin sulfate, glucosamine, topical capsaicin

Question 10

This med is Q4-6hr, MAX 4g for OA with liver toxicity, and avoid ETOH >2/day?

Answer 10

APAP- mild to mod 1st line** OA

Question 11

This RX inhibits prostaglandin synthesis via COX 1-2?

Answer 11

NSAIDs

Question 12

If Mr. Bony has PMH of GIB, Renal dz, and platelet inhibition. What should be avoided?

Answer 12

NSAIDs and COX2. DI- wafarin, ARK -ACE, ARB, diuretics

Question 13

When should NSAID and COX-2 Inhib be used?

Answer 13

Severe pain and if APAP doesn’t help

Question 14

MAX 3200mg TID or QID is for what NSAID?

Answer 14

IBUPROREN

Question 15

This RX is effective but HIGH risk for bleeds, MAX 40mg ONLY 5 days. is for what NSAID?

Answer 15

KETOROLAC

Question 16

1250mg TID or QID is for what NSAID?

Answer 16

NAPROXEN

Question 17

What COX 2 inhib have dec risk of GIB but inc CVD events?

Answer 17

Celecoxib- MAX 200/day.

Meloxicam- 7.5-15mgQD

Question 18

What are non-acetylated salicylates?

Answer 18

Salsalte, Mg Salicylate, Choline Mg Trisalcity-
PROS- mod-severe pain.
LESS GIB- no platelet fx, less severe w/ warfarin CONS- GI, CKI

Question 19

What are agents for intraarticular glucocorticoids?

Answer 19

Methylprednisolone acetate

Triamcinolone acetate/acetonide Dexamethasone Betamethasone

Question 20

What are benefits of intraarticular for OA?

Answer 20

Adjunctibe only

Question 21

How is Hyaluronic acid used in therapy?

Answer 21

Injected, replaces depleted hyaluronan.
THis replace lubricant and shock absorption. Last up to 6mo.
CONS- inj site irritation, delayed onset, $$.
Hyalgan, Synvis, Suparx, Euflexxa- QWx3-5

Question 22

If Mr. Bony with OA has allergic rxn to NSAID what can be used?

Answer 22

Topical Diclofenac Sodium Gel (Voltaren)-Elderly**

Question 23

This topical dec Substance P?

Answer 23

Topical capsaicin- Cons- eye irritation

Question 24

Which RX used for all arthritis except OA, and is a immunosuppresant?

Answer 24

DMARDs- Dz modifying anti rheumatic Drugs.

Question 25

What are benefits of DMARDs in early TX?

Answer 25

DEc progression of DZ

Question 26

This DMARD non biologic dihydrofolate reductase inhibitor- inhibits DNA synthesis thereby- inhibiting immune function?

Answer 26

Methotrexate- 1st LINE

Question 27

How is Methotrexate used in PA and RA?

Answer 27

RA- low pulse therapy- 7.5-20mg

**PO WEEKLY PA- 10-30mg WEKLY

Question 28

What are CONS of METHOTRexate?

Answer 28

RENAL.

1. Alopecia, Myelosuppresion, NVD, Mouth ulcers, stomatis 2. Hepatotoxicity
2. DI- NSAIDS, TMX/STM bactrim
3. X-preg, liver dz, IMC
4. Replace **folic acid- dec heme, GI, and liver ADR

Question 29

What clinical monitor is needed for methotrexate?

Answer 29

CBC, SCR, LFT

Question 30

This non biologic DMARD MOA is unknown, slow onset, add-on early for RA, PA, AS?

Answer 30

Sulfasalaine

Question 31

What are monitoring and ADR of Sulfasalaine?

Answer 31

1. N/V/AN
2. Skin
3. Sulfa
4. Monitor CBC, SCR, LFT x3m, then QOM

Question 32

This add on DMARD inhibits production of RF and Acute phase reactants. Often used as an add on?

Answer 32

Hydroxychloroquine

Question 33

Why is testing for G6PD and eye exam important for this agent?

Answer 33

Hydroxychloroquine- MAY cause hemolysis and retinal damage.

GET Baseline labs and exam (5yrs)

Question 34

Purines (AG) and Pyrimidine (CTU) are part of DNA sequence. This agent inhibits pyrimidine synthesis and T-cell activity for PA and RA?

Answer 34

Leflunomide- altn for MTX. PO, 1-2 mo rapid onset.
1. Lab monitor
2. NO preg
3. ADR- D, alopecia, immunsuppresion, infx, hepatox.
OD TX- Cholestyramine or Charcoal

Question 35

Which Non biologic DMARD improve lymphocyte fx, reduces IgM, used limited 2/2 toxicity, and for aggressive RA, PA?

Answer 35

Pencillamine- ADR- allergy to penicillin, proteinuria.

Question 36

Azathiprine is used refractory for RA by?

Answer 36

Inhibits T-cell anti-inflam

Question 37

These two RA drugs for refractory RA inhibit T-lymphocytes or prevent cell replication?

Answer 37

Cyclosporin- T-lymph. MONITOR BP and Cyclophosphamide: T/B cell suppressed; severe Life threat systemic vasculitis

Question 38

Which drug is off label for Psoriasis w/ VC SE, and the drug inhibits guanosine synthesis, which in turn affect T/B cell?

Answer 38

Mycophenolate-
SE VC- CV, CNS, heme, hepatic,renal,
INFX