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Skeletal Muscle > Rheumatoid and Osteoarthritis Lec P1,P2,P3 Sharpe > Flashcards

Rheumatoid and Osteoarthritis Lec P1,P2,P3 Sharpe Flashcards

1
Q

What are the main components in the Synovial Joint? (select all)

A. Synovial membrane

B. Spongy Bone

C. Marrow Cavity

D. Joint Cavity

E. Articular Cartilage

A

A,D,E

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2
Q

Synovial joints are also known as ___ joints.

A. Stationary

B. Dynamic

C. Static

D. Moveable

A

D

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3
Q

T/F The main functions of a synovial joint is motion and flexibility

A

T

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4
Q

What is the main function of Articular cartilage?

A. Reduces friction and absorbs shock

B. To form a calcified stationary structure

C. To allow for two bones to collide with eachother without the need for synovial fluid

D. None of the above

A

A

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5
Q

Which of the following cell-types is responsible for maintaining Articular Cartilage?

A. Hyaluronan

B. Collagen

C. Chondrocytes

D. Blood

A

C

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6
Q

Articular cartilage is made of 85% water. What is the other 15% consisting of? (select all)

A. Type-II collagen

B. Blood

C. Proteoglycans

D. Hyaluronan

E. Macrophages

A

A, C, D

All of these will change with age.

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7
Q

The synnovial membrane is normally __ to __ cell layers thick and produces ______

A. 1 to 3, Blood

B. 8 to 10, Synovial fluid

C. 1 to 3, Synovial Fluid

D. 8 to 10, Blood

A

C

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8
Q

All of the following are functions of synovial fluid EXCEPT:

A. Lubricates joints

B. Supplies nutrients to chondrocytes

C. Removes waste products

D. Transports blood to the knee

A

A, B, C

Cartilage is avascular and does not contain blood, niether does the synovial fluid.

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9
Q

What is the purpose of hyaluronate in synovial fluid?

A. Maintaining adequate temperature of synovial fluid

B. Lubrication

C. Nourishment of the chondrocytes

D. Destruction of waste

A

B

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10
Q

T/F Synovial fluid does not require movement of the joint in order to remove waste products.

A

F

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11
Q

Which of the following statments is true about Osteoarthritis? (Select all)

A. Begins with trauma or stress on cartilage

B. Begins as an autoimmune condition

C. Caused by age and cartilage damage (destruction) outpaces repair

D. Hyaluronic acid concentration in synovial fluid decreases as concentration of water increases.

E. Involves the synnovial membrane initially swelling and growing, leading to bone and cartilage erosion.

A

A, C, D

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12
Q

Which of these factors leads to abnormal stresses on the joint? (Select All)

A. Trauma and Obesity

B. Anatomic abnormalities

C. Loss of joint stability

D. Aging

E. Microfractures and bony remodeling (spurs)

A

A, B, C, E

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13
Q

Which of the following factors causes abnormal cartilage (select all)

A. Aging

B. Genetic and metabolic diseases

C. Inflammation

D. Immune system activity

E. Obesity

A

A, B, C, D

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14
Q

Which of the following are considered non-pharmacological treatments for osteoarthritis?

A. Weight loss/ diet

B. Exercise

C. Surgery

D. All of the above

A

D

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15
Q

All of the following areas are COMMONLY effected by osteoarthritis EXCEPT:

A. Knee

B. Hip

C. Spine

D. Hands (fingertips)

E. Bases of hands

A

E

Bases of the hands are mostly affected by Rheumatoid arthritis

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16
Q

What types of drugs can be used to aleviate Pain and/or Inflammation? (Select All)

A. Acetaminophen

B. NSAIDs

C. Vitamin E

D. Calcium

E. Narcotic Analgesics

A

A, B, E

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17
Q

When Arachidonic acid is metabolized by COX-1 what can be produced?

A. Prostaglandins

B. Thromboxanes

C. Prostaglandins and Thromboxanes

A

C

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18
Q

When Arachidonic acid is metabolized by COX-2 what can be produced?

A. Prostaglandins

B. Thromboxanes

C. Prostaglandins and Thromboxanes

A

A

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19
Q

Prostaglandins affect all of these EXCEPT:

A. Pain and Fever (increase)

B. Renal function (impairment)

C. Tissue repair and reproduction

D. Gastric functions (protection)

E. Platelet Aggregation

A

E

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20
Q

T/F Platelet aggregation is affected by thromboxanes

A

T

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21
Q

Which of the following statements regarding acetaminophen is true? (Select all)

A. Has strong anti-inflammatory properties

B. Has little if any anti-thrombotic activity

C. Is a good analgesic

D. Brand names include paracetamol and APAP

E. Is a COX-2 selective drug

A

B, C, D

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22
Q

All of the following are mechanisms of action of Acetaminophen EXCEPT:

A. COX inhibitor

B. Acts peripherally in the body

C. Acts centrally in the body

D. Pain reliever with little to no anti-inflammatory properties

A

B

Know mainly it is a CENTRAL cox inhibitor NOT peripheral

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23
Q

Which of the following statements regarding Acetaminophen is true?

A. Displays no nephrotoxicity

B. Displays no Hepatotoxicity

C. Lower incidence of side effects such as GI distress

D. Has an equal chance to cause Reye syndrom in comparison to Aspirin

A

C

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24
Q

What is the name of the metabolite that is produced from CYP450 enzymes when metabolizing acetaminophen?

A. NAPQI

B. Acetylcysteine

C. Glutathione (GSH)

D. Thiosulfate

A

A

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25
Q

What specific CYP450 enzymes are responsible for metabolizng APAP to NAPQI? (select all)

A. CYP3A4

B. CYP2D6

C. CYP2E1

D. CYP2E9

A

A, C

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26
Q

NAPQI is not dangerous as itself in the body. It becomes hepatotoxic to the liver if not enough ____ is present. When this happens it is metabolized by ____ instead, producing hepatotoxic metabolites.

A. Glutathione (GSH), UDP(Glucuronidation)

B. Hepatic SH Proteins, Glutathione (GSH)

C. Glucuronidation (UDP), Glutathione (GSH)

D. Glutathione (GSH), Glucuronidation (UDP)

E. Glutathione (GSH), Hepatic SH proteins

A

E

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27
Q

What is used to treat APAP overdose? (Select All)

A. Activated charcoal

B. Glutathione

C. Potassium

D. N-Acetylcysteine

A

A,D

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28
Q

NSAIDs produce an antipyretic effect by inhibiting the prostaglandin ____. This particular prostaglandin is present in the brain so inhibiting it is a ____ effect.

A. PGE2, Peripheral

B. PGI2, Peripheral

C. PGE2, Central

D. PGI2, Central

A

C

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29
Q

The antithrombotic effects of NSAIDs is done by the inhibition of ___ enzymes. The particular prostaglandin that is not being produced as a result is ___.

A. COX-1, PGE2

B. COX-1, Thromboxane (TxA2)

C. COX-2, Thromboxane (TxA2)

D. COX-2, PGE2

A

B

30
Q

Prostaglandins in the stomach are known to be gastroprotective. What is the function of prostaglandins in the stomach? (Select All)

A. Decrease gastric acid secretion

B. Increase bicarbonate secretion

C. Decrease mucous secretion

D. Increase gastric acid secretion

E. Increase mucous secretion

A

A, B, E

31
Q

T/F When you give a non-selective NSAID you will see an increased risk of ulceration in the GI tract due to blocking the production of prostaglandins

A

T

32
Q

NSAIDs are known to have an increased risk of bleeding. What in particular is being blocked and causing this increased risk of bleeding?

A. Thromboxane (TxA2)

B. PGI2

C. Prostacyclin

D. COX-2

A

A.

TxA2 thromboxane, causes platelet aggregation and clotting. If you block its production then you will have less aggregatin and clotting, leading to increase chances of bleeding.

33
Q

Blocking what particular COX enzyme will lead to possible chances of gastric ulceration?

A. COX-1

B. COX-2

C. COX-3

D. Blocking cox enzymes is not associated with gastric ulceration side effects.

A

A

34
Q

Renal toxicity is associated with long-term use of NSAIDs. How does renal toxicity happen when using NSAIDs?

A. Decreased blood flow to kidneys

B. Accumulated toxins in the blood

C. Necrosis of papillary

D. All of the above

A

D

The main one is decreased blood flow to the kidney.

35
Q

Why does using NSAIDs possibly cause induced bronchospasms in Asthma patients?

A. Decreased PG production from the COX pathway

B. Increased synthesis of leukotrienes via LOX enzymes.

C. NSAIDs may possibly bind to B2 receptors and block the bronchodilatory effects of epinephrine, leading to bronchospasms.

D. Blocking PGI2 production can cause bronchospasms.

A

B

By cutting off the COX pathway the arachidonic acid will go down the LOX pathway and produce leukotrienes. Leukotrienes are known to cause bronchospams.

36
Q

The mechanism of action of Aspirin is the ____ inhibition of COX enzymes.

A. Reversible

B. Irreversible

A

B

The reason the anti-thrombotic effect is prolonged when taking aspirin is because it’s irreversible inhibition makes it so thromboxane is produced much less in comparison to an NSAID that only temporarily inhibits thromboxane production (reversible)

37
Q

Which of the following statements regarding Reye’s syndrome is NOT true?

A. Includes Encephalopathy

B. Causes Liver damage/ dysfunction

C. Commonly caused by all NSAIDs

D. Can develop in children and young adults <20 yo

E. Can be caused when using aspirin during viral-associated fevers

A

C

38
Q

Which of the following drugs are Proprionic Acid NSAIDs?

A. Naproxen

B. Meloxicam

C. Nabumetone

D. Ibuprofen

E. Piroxicam

A

A, D

Nabumetone is not a proprionic acid NSAID but does resemble Naproxen in structure.

Also remember than Naproxen has a longer half-life than ibuprofen

39
Q

T/F One of the main factors that Enolic Acid NSAIDs, Acetic Acid NSAIDs and Proprionic Acid NSAIDs have in common is that they are all nonselective and reversible inhibitors of COX-1 and COX-2 enzymes.

A

T

40
Q

Which of the following drugs are Acetic Acid Derivatives? (select all)

A. Sulindac

B. Meloxicam

C. Etodolac

D. Diclofenac

E. Indomethacin

A

A, C, D, E

Remember that diclofenac (voltaren) is also available topically and can be used in patients that have joint pain that is more closer tot he surface of the skin so they don’t have to take it by mouth.

Remember that indomethacin is one of the strongest anti-inflammatory NSAIDs available and very potent

41
Q

Which of the following medications are Enolic Acid Derivatives? (Select All)

A. Indomethacin

B. Diclofenac

C. Piroxicam

D. Naproxen

E. Meloxican

A

C, E

Enolic acid derivatives end in Oxicam

42
Q

Other than the reversible inhibition of COX-1 and COX-2 enzymes what is the other effect of Enolic Acid derivatives (oxicams)?

A. Inhibits proteoglycanase and collagenase in cartilage

B. Can sometimes cause irreversible inhibition of COX-2 and COX-2 enzymes

C. Increase the natural production of hyaluronic acid within the joint

D. Reduce formation of bone spurs

A

A

These enzymes break down the collagen and peptides that maintain health of the joint but blocking them will help prolong the health of those joints since those enzymes will not be breaking down the joint as much.

Also the other answers were just random things i came up with

43
Q

T/F Meloxicam has more affinity for the COX-2 enzymes than Piroxicam does but is NOT considered to be COX-2 selective

A

T

44
Q

What is the mecahnism of action of Coxib-class NSAIDs?

A. Selective to COX-1 enzymes

B. Have a higher affinity of COX-1 enzymes but can also block COX-2

C. Have a higher affinity of COX-2 enzymes but can also block COX-1

D. Selective to COX-2 enzymes

A

D

45
Q

Why were selective COX-2 inhibitors (celecoxib) created?

A. In theory they were supposed to provide better cardioprotective effects than non-selective NSAIDS

B. In theory they were supposed to have less GI side effects (gastric ulceration) by not inhibiting COX-1 enzymes

C. In theory they were supposed to have more renal-protective effects than non-selective NSAIDs

D. In theory they were supposed to have less GI side effects (gastric ulceration) by not inhibiting COX-2 enzymes

A

B

46
Q

Based on the COX-2 selective mechanism of action of coxib medications, why do you expect there to be major cardiovascular concerns with these medications?

A. Blocking COX-2 will drive more Arachidonic acid into the COX-1 pathway, creating more thromboxane (+ clotting)

B. Blocking COX-2 will decrease prostacyclin production and lead to a decrease the vasodilatory effects

C. Vaso constriction and smooth muscle proliferation

D. All of the above

A
47
Q

All of the following statements about Rheumatoid arthritis are true EXCEPT:

A. It is an autoimmune disorder

B. Usually begins with some type of trauma to the cartilage

C. Predominantly a involves a Synovial (not cartilage) problem

D. Extra-articular involvement is possible (involves more than just joints)

E. Involvement is usually symmetrical

A

B

Arthritis beginning with trauma is usually osteoarthritis. Rheumatoid arthritis starts as an autoimmune disorder that begins with the synovium NOT the cartilage.

Extra-articular means it can involve more than just joints. in other words it can involve other organs as well.

48
Q

What other extra-articular involvement can patients present with due to rheumatoid arthritis? (Select All)

A. Cardiac problems (IHD, Mitral regurgitation etc.)

B. Rheumatoid nodules

C. Anemia (hemolytic)

D. Confusion, delerium

E. Renal impairment

A

A, B, C, E

49
Q

Which of the following statments about Osteoarthritis and Rheumatoid arthritis are true? (Select All)

A. Osteoarthritis usually affects the spine, knees, neck. distal fingers and hips more commonly.

B. Rheumatoid arthritis can be seen in the same areas as osteoarthritis but is more seen in the base of the hands and feet.

C. Osteoarthritis is more symmetrical and Rheumatoid arthritis is usually asymetrical (not seen in both limbs)

D. Rheumatoid arthritis is usually seen symmetrically while osteoarthritis may or may not be symmetrically

E. Osteoarthritis is more commonly seen in the feet and the base of the hands in comparison to Rheumatoid arthritis.

A

A, B, D

50
Q

Synovial fluid:

A. Is located in the joint space

B. Contains hyaluronan and lubrican

C. Provides nutrients for chondrocytes of articular cartilage and lubrication

D. All of the above

A

D

51
Q

Rheumatoid arthritis causes the inflammation and growth of the synovial membrane. This is known as the ___ and causes erosion of the bone and cartilage.

A. Pannus

B. Osteocyte

C. Calciform synovium

D. Osteophyte

A

A

52
Q

People with rheumatoid arthritis usually produce ___ and can indicate the prescence of rheumatoid arthritis.

A. Hyaluronic acid

B. Osteophytes

C. Rheumatoid factors

D. Mast Cells

A

C

53
Q

T/F The amount of rehumatoid factors present can determine the severity of the disease ( in other words more rheumatoid factors= more severe)

A

F

54
Q

T/F Osteoarthritis is a cartilage disease (initially) and involves the thinning of the cartilage due to trauma and use. Rheumatoid arthritis is an autoimmune disease that forms a pannus that grows and leads to an erosion of the cartilage and bone.

A

T

its important for the test that you know the difference in how they start.

55
Q

Based on the picture provided, what can be inferred about the pathophysiology of Rheumatoid arthritis? (select all)

A. B-Cells and T-cells are responsible for ultimately producing Interleukin and TNF-a and increase the autoimmune damage to the bones and tissue

B. In order to reduce the damage done by Rheumatoid arthritis we can give drugs that block IL, TNF-a and stabilize B and T cells so they do not activate the cascade pathway.

C. The IL and TNF-a that are produced by B-Cells and T-Cells are produced in order to prolong the life of the bone and cartilage

D. Medications that effectivly suppress the immune response will ultimately lead to the longevity of the bone and joint health

A

A, B, D

56
Q

All of the following are side effects will you see when suppressing the immune system in order to decrease the progresion of RA EXCEPT:

A. Increased risk of infection

B. Increased risk of cancer

C. Decreased removal of tumors

D. Increased activity of immune system

A

D

57
Q

Which of the following DMARDs is considered to be biologic? (Select All)

A. Methotrexate

B. Leflunomide

C. Abatacept

D. Rituximab

E. Inflixmab

A

C, D, E

58
Q

Which of the following are considered to be Non-biologic DMARDS? (Select All)

A. Anakinra (Kineret)

B. Methotrexate (Rheumatrex

C. Leflunomide (Arava)

D. Tofacitnib (XelJanz)

E. Hydroxylchloroquine (Plaquenil)

F. Sulfasalzine (Azulfidine)

A

B, C, E, F

59
Q

What is the mechanism of action of Methotrexate? (Select All)

A. Folate antimetabolite that inhibits DNA synthesis

B. Increases levels of adenosine, leading to anti-inflammation (low dose)

C. none of the above

D. Both A and B

A

D

However, in Rheumatoid Arthritis the main mechanism of action is the increased adenosine production to lower inflammation. Mostly because you get this effect at lower dosages when treating rheumatoid arthritis.

60
Q

How does leflunomide (Arava) treat Rheumatoid arthritis?

A. Repairs the synovial membrane to decrease inflammation

B. Inhibits pyrimidne synthesis, leading to anti-inflammatory and anti-proliferative qualities. (lowers B and T-cell proliferation)

C. Inhibits TNF-a directly

D. Inhibits IL-6 directly

A

B

Pyrimidine is needed in order to produce B-Cells and T-Cells. Leflunomide will stop pyrimidine synthesis and lead to decreased levels of B and T-cells in the body. This causes a decrease in autoimmune response and lowers the effects of rheumatoid arthritis.

61
Q

Which of the following statements regarding leflunomide (Arava) is true? (Select All)

A. Inhibits pyrimidine synthesis

B. It is a prodrug and requires liver enzymes to become an active metabolite

C. It is hepatotoxic even though it requires the liver to work

D. Pregnancy is fine while on this medication.

A

A, B, C

62
Q

If a patient wants to become pregnant after they have taken leflunomide (Arava) within the past __ years, they must first be placed on a regimen of _____.

A. 10, Cholestyramine

B. 2, N-acetylcysteine

C. 10. N-acetylcysteine

D. 2, Cholestyramine

A

D

63
Q

What is the probable mechanism of action of Hydroxychloroquine?

A. Suppression of T-Lymphocyte response

B. Decreased Leukocyte chemotaxis

C. Stabilization of lysosomal enzymes

D. All of the above

A

D

The main one appears to be decreased leukocyte chemotaxis. Know this one for sure.

64
Q

Hydroxycholorquine is known to have ___ toxicity.

A. Cardiovascular

B. Hepatic

C. Ocular

D. Renal

A

C

The way I remember this side effect is Hydroxycholorquine has the word “Chloro” in it like “Chlorine”. So it makes me think of Ocular toxicity since chlorine burns the eyes.

65
Q

What is the mechanism of action of Sulfasalazine (Azulfidine)?

A. Cleaved in colon into 5-ASA and Sulfapyradine

B. Inhibiting the cytokine secretion, decreasing the inflammatory immune response.

C. None of the above

D. A and B

A

D

According to Dr. Sharpe the main mechanism of action for treating Rheumatoid arthritis is not done by the 5-ASA and instead is done by the Sulfapyradine.

66
Q

T/F Sulfasalazine (Azulfidine) is contraindicated in patients with sulfur allergies

A

T

67
Q

What is the mecahnism of action of Abatacept?

A. Inhibits activation of T-Cells by blocking co-stimulation at CD80/86

B. Inhibits TNF-a

C. Inhibits pyrimidine synthesis

D. Creates sulfapyradine

A

A

68
Q

T/F Abatacept should NOT be combined with TNF-a antagonists in order to prevent serious infections.

A

T

69
Q

What is the mechanism of action of Rituximab?

A. Inhibits TNF-a

B. Binds to CD20 on B-Cells and causes their destruction

C. Binds to CD20 on T-Cells and causes their destruction

D. Inhibits pyrimidine synthesis

A

B

70
Q
A

Skeletal Muscle (7 decks)

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