rheumatoid arthritis

Question 1

first line of tx for rheumatoid arthritis?

Answer 1

NSAID–reduce inflammation and pain: does not alter progression of RA

Question 2

Glucocorticoid effects on rheumatoid arthritis; adverse effect

Answer 2

reduce inflammation and cause dramatic improvement of symptoms in RA, but DOES NOT alter progression RA —but CANNOT be long term use

Question 3

DMARDs effects on rheumatoid arthritis; adverse effects?

Answer 3

reduce inflammation, improve symptoms, and slow bone growth., and reduce joint damage

Its a slow onset of action (6 weeks/6months)–thats why need NSAID for immediate effect

Question 4

what is the 1st line DMARDS to tx Rheumatoid arthritis?

Answer 4

Methortrexate

Question 5

which agent is indicated for both symptomatic improvement and retardation of structural joint damage

Answer 5

Leflunomide

Question 6

what are the anti-malarial agents that have anti-inflammatory action

Answer 6

Chloroquine, hydroxychloroquine

Question 7

what are the synthetic DMARDS agents

Answer 7

Methotrexate, Leflunomide, Chloroquine, hydroxychloroquine

Question 8

Which DMARD is the cytokine receptor fusion protein

Answer 8

Etanercept

Question 9

which DMARD is the anti0TNF chimeric monoclonal amtibody

Answer 9

Infliximab

Question 10

which one is the IL-1 inhibitor for DMARD

Answer 10

Anakinra

Question 11

what are the DMARD biological agents

Answer 11

Etanercept, Infliximab, Anakinra

Question 12

what are the stages to Rheumatoid arthritis

Answer 12

Initiation: nonspecific inflammation: little to no symptoms

Amplification: Tcell-activation–>responding to antigent

Chronic inflammation with tissue injury

Question 13

What has to occur during headache to be considered a’migrane’ along with other criteria?

Answer 13

Nausea, and/or vomiting, photophobia, phonophobia

Question 14

What are the drugs used for preventive therapy of migrane? which one is the treat of choice?

Answer 14

Propranolol, metoproplol (beta antagonists tx of choice!), Amitriptyline, divalproex(valporic acid), topiramate

Question 15

what do you have to be cautious about during tx of Acute migrate attack when using non-specific pain medication?

Answer 15

AVODI oversuse: limit drug tx to 2-3 days. Analgesic drug can “transform” migraine into more severe chronic disorder

Question 16

Which antiemetics are used during acute migrane attacks? how are the used?

Answer 16

metoclopramide, chlorpromazine, prochlorperazine: used as adjuncts for nausea and vomiting

Question 17

What drugs are used for the Migrane-specific therapy?

Answer 17

Ergotamine, Dihydroergotamine, sumatriptan, zolmitriptan, the “triptans”

Question 18

Ergotamine effects; adverse effects

Answer 18

Cause vasoconstriction from alpha-adrenergic, and 5HT receptors

-complex drug “dirty drug”, due to vasoconstrictor effect, it could increase vascular effects (cautious w/ cardiovascular disease)

Question 19

Sumatriptan and zolmitriptan effects

Answer 19

inhibit activation of trigeminal afferent nociceptors. SELECTIVE 5HT activity–>cranial/dural vasoconstriction

Controls migrane attack

Question 20

what is the ultimate tx for migranes

Answer 20

SLEEP!!!

Question 21

advantages of the Triptans over Ergot?

Answer 21

it has seletive pharmacology and pharmakinetics, therefore LESSS side effects. Established efficacy and safety records

Question 22

Triptans contraindication?

Answer 22

Ischmic Heart disease, hypertension, cerebrovascular disease

Question 23

what drugs are used during Acute migrane attack?

Answer 23

NSAIDs, Antiemetics: metoclopramide, chlorprmazine, prochlorperazine, the triptans: sumatriptan, zolmitriptan, etc, Ergot alkaloids: Ergotamine, dihydroergotamine and deriv