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MSK > Pharm 35 Objectives > Flashcards

Pharm 35 Objectives Flashcards

1
Q

What is the building block for de novo steroid hormone synthesis?

A

Cholesterol

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2
Q

What are the four major safety concerns with statin medications?

A
  • Pregnancy
  • Liver Damage
  • Muscle Damage
  • Development of DM
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3
Q

Pt is a taking a statin and c/o muscle pain, you do a complete lab workup and there is no increase in creatine kinase what do you do?

A
  • Lower current statin dose or go to QD
  • Go to lower risk statins (Fluvastatin, pravastatin)
  • Add Co-enzyme Q10 and/or Vit D
  • D/c statin or use a non statin lipid lower agent
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4
Q

Bone mineral density loss + fracture risk is increased by what drugs?

A
  • Long term Glucocorticoids- prednisone
  • Antiestrogens (cancer tx), antiandrogens, and MPA (depo)
  • Carbamazepine, phenobarbital, phenytoin
  • Excessive thyroid supplement
  • Drug induced hyperprolactinemia (antipsychotic)
  • DM drugs: thiazolidinediones, SGLT-2
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5
Q

Fracture risk only is increased by what drugs?

A
  • PPI
  • Antiparkinsonian drugs
  • Insulin (hypoglycemic episodes)
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6
Q

What is the appropriate clinical use for quinine sulfate in the U.S?

A

Malaria

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7
Q

What are the risks associated with quinine sulfate when inappropriately used for leg cramps?

A
  • Hematological adverse events (thrombocytopenia, hemolytic uremic syndrome, thrombotic thrombocytopenia purpura)
  • Chronic renal impairment
  • Hypersensitivity rxn
  • QT prolongation
  • Cardiac arrhythmias
  • Torsade’s de pointes
  • Death
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8
Q

What are some possible tx for nocturnal leg cramps?

A
  • Potassium, magnesium, calcium
  • Stretching
  • Walking and jiggling by leg elevation
  • Hot shower w/ steam
  • Ice massage
  • Homeopathic quinine OTC
  • Tonic water
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9
Q

What drugs can contribute to nocturnal leg cramps?

A
  • Inhaled long acting beta agonist (LABA)
  • Potassium-sparing diuretics
  • Thiazide-like diuretics
  • Loop diuretics and statins (small increased risk)
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10
Q

What does DMARD stand for?

A

Disease-modifying antirheumatic drugs

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11
Q

What are the non-biologic, “small molecule” DMARDS (oral)?

A
  • Methotrexate
  • Leflunomide
  • Hydroxychloroquine
  • Sulfasalazine
  • Tofacitinib (Xeljanz)
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12
Q

What are the biological DMARDs (injection)/anti-TNF antibodies?

A
  • Adalimumab
  • Etanercept
  • Infliximab
    [A, E, I]
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13
Q

What are the anti-inflammatory/analgesics: COX inhibitor and or glucocorticoids

A
  • Rofecoxib and Celecoxib

- Methylprednisolone or Prednisolone.

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14
Q

What is the 1st line DMARD for RA, psoriasis, and JIA?

A

Methotrexate (once wkly)

- inhibit T-cells

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15
Q

What are the toxicities associated with Methotrexate?

A
  • Anemia/pancytopenia-check CBCs
  • Liver
  • GI
  • Kidney
  • Pulmonary
  • Alopecia
  • CNS
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16
Q

What supplement should a pt take when taking Methotrexate?

A

Folic acid (helps reduce hepatoxicity)

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17
Q

What is the rescue medication for Methotrexate tox?

A

Leucovorin

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18
Q

What is the MOA of Leflunomide?

A

Inhibits pyrimidine synthesis

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19
Q

What are the CI of Leflunomide?

A

Pregnancy: teratogenicity and embryolethality

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20
Q

Leflunomide is tx for RA and what else?

A

Relapsing-remitting MS

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21
Q

Hydroxychloroquine is tx for RA and what else?

A

SLE

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22
Q

What is required when a pt is on Hydroxychloroquine?

A

Regular eye exams are required

- risk for retinopathy

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23
Q

What is the tx regiment for a SLE flair?

A

Prednisone (short term) + hydroxychloroquine (long term)

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24
Q

What is the first line tx for SLE?

A

Avoiding exacerbating drugs and tobacco cessation

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25
Q

What is 2nd line tx for SLE if inadequate response to topical steroid or topical calcineurin inhibitors for discoid and subacute cutaneous lupus erythematosus?

A

Hydroxychloroquine (200-400 mg daily)

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26
Q

Sulfasalazine is tx for RA and what else?

A

Juvenile rheumatoid arthritis

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27
Q

What warning is given with Sulfasalazine?

A

Sulfa drug- warning in pt with sulfa allergies

- metabolized to 5-ASA

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28
Q

What pregnancy category is Sulfasalazine?

A
  • Cat. B

- Should increase folic acid intake to 2 mg per day

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29
Q

Tofacitinib is a DMARD and also considered an oral what?

A

Oral TNF-a-inhibitor

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30
Q

What are the BBWs of Tofacitinib?

A

Serious infection and malignancy

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31
Q

Adalimumab is the recombinant form of what?

A

Human anti-TNF-a-mAb

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32
Q

Etanercept is the recombinant form of what?

A

p75 TNF-receptor/IgG1 FC construct

linker

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33
Q

Infliximab is the recombinant form of what?

A

Chimeric anti-TNF-a mAb

mouse

34
Q

What are the BBWs for Adalimumab, Etanercept and Infliximab?

A

Serious infection and malignancy

35
Q

Adalimumab binds to what and prevents what?

A
  • Binds: TNF-a

- Prevents: TNF-a/TNF-r activation

36
Q

How often is Adalimumab injected?

A

Every other week

37
Q

What is the MOA of Etanercept?

A

Acts as a receptor for TNF, binds to TNFa and LTa

38
Q

How often is Etanercept injected?

A

Once weekly BUT sometimes given twice weekly

39
Q

What is the MOA of Infliximab?

A

Inactives TNFa, binds soluble and membrane TNF

40
Q

Infliximab is used for RA and what else?

A

Crohns

41
Q

Infliximab has been found to be more effective when combined with what?

A

Methotrexate

42
Q

How often is Infliximab administered?

A

Administered IV every 4-12 wks

43
Q

Why does cancer chemotherapy lead to a gout attack?

A

As cell dies they break down DNA and releases uric acid

44
Q

What should be administered before chemotherapy to prevent gout attacks?

A

Allopurinol should be administered before chemotherapy starts

45
Q

What is the tx for active gout (reduce inflammation)?

A
  • NSAIDS- indomethacin (1st line)
  • Prednisone
  • Colchicine
46
Q

What are the ASEs of colchicine?

A
  • GI distress (n/v, diarrhea-MC)
  • Rhabdomyolysis
  • Bone marrow suppression
  • Peripheral neuropathy
  • Kidney or liver problems
47
Q

What is the preventative tx for gout (prevent the buildup of uric acid)?

A
  • Allopurinol: XOI
  • Probenecid: a uricosuric agent
  • Pegloticase: recombinant form of uric acid oxidase
48
Q

What is the MOA of Allopurinol?

A
  • Inhibits xanthine oxidase
  • Best for uric acid overproducers
  • Reduced blood uric acid levels
  • Prevents new tophus formation
  • Decreases risk of nephropathy from deposition of urate crystals in kidney
49
Q

What is the ASEs of Allopurinol?

A
  • Cataracts (if used >3 yrs)

- Fatal hypersensitivity syndrome- if rash or fever develops —–> d/c immediately

50
Q

What is the MOA of Probenecid?

A

Inhibits uric acid reabsorption in renal tubules which increases excretion.

51
Q

What drugs are delayed in excretion when pt take Probenecid?

A

PCNs
Cephalosporins
Indomethacin

52
Q

What are the ASEs of Probenecid?

A
  • May increase deposition of urate in the kidney resulting in kidney damage.
  • Increase 2.5-3 L of fluid daily during the first few days of tx
53
Q

What is the MOA of Pegloticase?

A
  • Inhibits the conversion of plasma uric acid to urate crystals deposited in joints
54
Q

Pegloticase is CI in a pt with what?

A

G6PD

55
Q

What are the ASEs of Pegloticase

A
  • Hypersensitivity rxn – anaphylaxis 6.5%
  • Tx with antihistamine and glucocorticoid required
  • Infusion rxn in 26-41%
56
Q

What is the general role of NSAIDs and anti-inflammatory steroids for RA and gout?

A
  • Pain and inflammation management

- NSAIDs can be given with allopurinol and Probenecid to prevent gouty attacks

57
Q

What IV drugs are used for severe hypocalcemia (and potential use in hyperkalemia and cardiotox)?

A
  • Calcium chloride

- Calcium gluconate

58
Q

What is the ASE of Calcium chloride?

A

Tissue necrosis and sloughing

59
Q

Which is preferred Calcium chloride or

Calcium gluconate?

A
  • Calcium gluconate- d/t lower risk of tissue necrosis if extravasation.
60
Q

What are the CIs of IV calcium?

A
  • incompatible w/ phosphate (caution in “total parental nutrition (TPN)) and carbonate
  • Ventral fibrillation
  • Infusion rate faster than 10-20 minutes can lead to cardiac arrest
  • Pts w/ hypokalemia
  • Pts on digoxin
61
Q

What are the fastest-acting therapies for hypercalcemia, and the class and route of the most commonly employed and most effective antiresorptive therapy?

A
  • IV fluids w/ isotonic saline
  • IV bisphosphonates
  • IM Calcitonin (less effective than others but onset is a bit faster (6-12hrs) - alternative to bisphosphonates
62
Q

What are the indications for Bisphosphonates?

A
  • Osteoporosis: prevention or tx (weekly)- primary use.
  • Paget’s disease: high dose, often daily for 3 mos
  • Bony complications of cancer: require high dose
63
Q

What should be supplemented when taking Bisphosphonate for tx of osteoporosis?

A

Calcium and vitamin D

64
Q

What would you tell your pt to do when taking an oral bisphosphonate?

A
  • Take 1 hr before food with water only

- Sit upright a min of 30 minutes after taking

65
Q

How often is IV and oral bisphosphonates administered?

A

IV: q3 mos
PO: daily or wkly

66
Q

What is the severe ASE of IV bisphosphonates?

A

Osteonecrosis of the jaw

67
Q

What are a few warnings for all bisphosphonates?

A
  • Fracture of femur

- Heartburn, nausea, GI irritant

68
Q

What are the effects of hyperparathyroidism on bone mineral homeostasis?

A

Pts with continuous elevation of PTH results in major bone resorption (osteoclast activity) and hypercalcemia

69
Q

What are the effects of once-daily teriparatide injections on bone mineral homeostasis?

A
  • Pulse dose of teriparatide promotes bone formation (stimulation of osteoblastic activity)
  • Promotes renal retention of Ca and phosphate excretion.
70
Q

What are the physiological effects of vitamin-D on calcium metabolism?

A
  • Stimulated intestinal absorption of Ca2+ and PO4-
  • Promotes bone formation and resorption
  • Enhances renal retention of Ca2+
71
Q

What are the skeletal effects of vitamin-D deficiency?

A
  • Reduced calcium and phosphate availability
  • Reduced osteoblast fxn
  • Results in rickets or osteomalacia
72
Q

What is typically used for vitamin-D deficiency in patients with healthy kidneys?

A

Ergocalciferol (Rx) and cholecalciferol (OTC)

73
Q

What is typically used for vitamin-D deficiency in patients with kidney failure?

A

Paricalcitol (Rx) and Doxercalciferol (Rx)

74
Q

What is the Rx dose of Vitamin D?

A
  • 50,000 IU taken once weekly.

- D2 form-Ergocalciferol

75
Q

What is the OTC dose of Vitamin D?

A
  • Dose ranges from 400-800 IU taken once daily.

- Usually D3 form- Cholecalciferol

76
Q

A woman experiencing intolerable menopausal symptoms – which drug(s)?

A
  • Oral estradiol and oral progestin

- Oral conjugated equine estrogens + medroxyprogesterone acetate

77
Q

A woman at risk for osteoporosis who also wishes to prevent breast cancer, also – which drug(s)?

A

Raloxifene or Tamoxifen

78
Q

When is Denosumab an appropriate therapy for osteoporosis and hypercalcemia?

A

Pts w/ high risk of osteoporotic fracture who cannot take other drugs but $$$$$

79
Q

What is required when taking Denosumab?

A

Concurrent calcium and vitamin D supplementation

80
Q

What are the ASEs of Denosumab?

A
  • MSK pain, hypercholesterolemia, and some immunologic activities
  • CI w/ live vaccines
  • Increase risk for cystitis, cellulitis, other infections
  • Eczema, dermatitis, rashes
  • May increase risk for malignant cell growth

MSK (11 decks)

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