RA/gout tx

Question 1

What is the management of RA?

Answer 1

High dose NSAIDs (anti inflammatory)—>decrease pain and swelling
DMARDs—>slow disease progression (take a while to start working)

Question 2

What is the side effect for methotrexate when treating RA and cancer?

Answer 2

Treating RA—>liver damage

Cancer (high dose)—>myleosuppression

Question 3

What are the DMARDs?

Answer 3

Hydroxychloroquine
sulfasalazine/methotrexate/steroids
leflunomide/etanercept
infliximab/adalimumab
Anakinra

Question 4

Which 2 DMARDs would cause hemolytic anemia with G6PD deficiency?

Answer 4

Hydroxychloroquine and sulfasalazine

Question 5

Which DMARDs can cause cinchonism?

Answer 5

Hydroxychloroquine

Question 6

Which 3 DMARDs target TNF? and what infection should you be concerned about these drugs

Answer 6

Etanercept/infliximab/adalimumab—>TB

Question 7

What drug can you use for pt with Sjogrens syndrome?

Answer 7

Pilocarpine (M agonist)

Question 8

What drugs are used to treat acute gout?

Answer 8

NSAIDs or colchicine

Question 9

How does colchicine work and what other drugs have similar MOA? and where are they all bind to?

Answer 9

Inhibit microtubular polymerization
Drugs that work similarly:
Vincristine/vinblastine/paclitaxel (prevent disassembling)/griseofulvin (antifungal)
They all bind to tubulin

Question 10

What is the side effect of colchicine?

Answer 10

Myelosuppression

Question 11

What drugs are used for chronic gout? and what are their MOA?

Answer 11

Allopurinol and febuxostat—>inhibit xanthine oxidase—>decrease uric acid production

Question 12

Allopurinol and febuxostat cause the elevated level of?

Answer 12

Hypoxanthine

Question 13

What is the disease that is associated with HGPRT deficiency?

Answer 13

Lesch-Nyhan syndrome–>retardation and self mutilation

Question 14

What does rasburicase?

Answer 14

Urate oxidase—>prevent tumor lysis syndrome—>reduces serum uric acid

Question 15

When do we use allopurinol or rasburicase for tumor lysis syndrome?

Answer 15

Allopurinol—>use when uric acid level is normal before chemo
Rasburicase—>use when uric acid level is high before chemo

Question 16

What is the drug that works similar to rasburicase?

Answer 16

Pegloticase

Question 17

Which chronic gout drug that works in the kidney? and when shouldn’t we use it?

Answer 17

Probenecid—>inhibit proximal tubular reabsorption of urate
It is ineffective if GFR is very low

Question 18

What are the drug interactions with probenecid?

Answer 18

It inhibit secretion of weak acid drugs—>thus increase those drugs in the serum
e.g. antibiotics