RA and Gout

Question 1

Drugs used for initial treatment of RA

Answer 1

NSAIDs

need high doses- more SE- kidney + stomach

Question 2

Used to slow the progression of RA

Answer 2

DMARDs

Question 3

Type of NSAID used for RA

Answer 3

Celecoxib- COX2 inhibitor

Question 4

Methotrexate

MTX

Answer 4

#1 DMARD
small, daily doses for RA
large, cyclic doses for cancer

Question 5

MOA of Methotrexate (MTX)

Answer 5

inhibits dihydrofolate reductase, so dihydrofolate is not converted to tetrafolate
cells cannot make DNA

Question 6

SE of Methotrexate (MTX)

Answer 6

hepatotoxicity with long term use

Question 7

Hydroxychloroquine

Plaquenil

Answer 7

backup to MTX for initial RA treatment

Question 8

SE of Hydroxychloroquine

Answer 8

cinchonism

accommodation defects, corneal deposits, blurred vision, scotomas, night blindness

Question 9

Sulfasalazine MOA

Answer 9

prodrug- 5-ASA-SP broken up by gut bacteria
SP treats RA
ASA for Crohn’s / ulcerative colitits

Question 10

Sulfasalazine

Answer 10

backup to MTX for initial RA treatment

Question 11

SE of Sulfasalazine

Answer 11

nausea, vomiting, diarrhea

Question 12

Tofacitinib

Answer 12

used for severe RA when MTX has failed

Question 13

MOA of Tofacitinib

Answer 13

JAK inhibitor- stops inflammatory cytokine activity

Question 14

Infliximab and Adalimumab

Answer 14

for severe RA when MTX has failed

Question 15

MOA of Infliximab and Adalimumab

Answer 15

anti-TNF antibody drugs

Question 16

SE of Infliximab and Adalimumab and Tofacitinib

Answer 16

suppresses immune system so must test for TB before use

Question 17

Used for acute Gout attacks

Answer 17

NSAIDs

Question 18

Types of NSAIDs used for Gout

Answer 18

Indomethacin #1

naproxen

Question 19

Corticosteroids

Answer 19

for short term acute gout

Question 20

Colchicine MOA

Answer 20

binds to tubulin and blocks microtubular polymerization

treat gout attacks

Question 21

Allopurinol and Febuxostat MOA

Answer 21

inhibits xanthine oxidase- decreases uric acid production

Question 22

Drug interactions of Allopurinol

Answer 22

blocks metabolism of 6-mercaptopurine (cancer drug) which increases toxicity of 6-MP

Question 23

Probenecid MOA

Answer 23

inhibit proximal tubular reabsorption of uric acid- more uric acid excreted

Question 24

SE of Probenecid

Answer 24

renal stones

Question 25

Pegloticase MOA

Answer 25

is a urate oxidase enzyme- metabolizes uric acid into allantoin- easily excreted

Question 26

SE of Pegloticase

Answer 26

given IV over 2 hours

pretreat with antihistamines and corticosteroids to avoid histamine reaction