Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Therapeutics > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

gout is characterized by a serum uric acid

A

> 6.8 mg/dL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

which disease states can increase risk of gout (7)

A

T2DM, hyperlipidemia, obesity, renal insufficiency, HTN, organ transplant, CHF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

which foods increase risk of gout (5)

A

meat, seafood, beer, soft drinks, fructose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

which foods decrease gout risk (3)

A

coffee, dairy, vit C

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

which medications increase gout risk (4)

A

thiazides, loops, nicotinic acid, aspirin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

which medications lower gout risk (2)

A

losartan, fenofibrate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

which 4 things can precipitate a gout flare

A

alcohol or high purine ingestion, stress, meds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

3 drugs used for acute gout management

A

NSAIDs, colchicine, steroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

colchicine need dose adjustment for

A

renal & hepatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

AEs of colchicine

A

GI, hematologic, rhabdo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

strong CYP3A4 inhibitors that interact with colchicine?
how to adjust dose?

A

clarithromycin, itraconazole, ketoconazole, darunavir/ritonavir

1/2 the doses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

moderate 3A4 inhibitors that interact with colchicine?
how to adjust dose?

A

diltiazem, erythromycin, fluconazole, verapamil

single 1.2 dose for flares, prophy dose is 1/2 QD or QoD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

p-gp inhibitors that interact with colchicine
how to adjust dose?

A

cyclosporine, amiodarone, ranolazine

single 0.6 for flare, prophy dose 1/2 QD or QoD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

intraarticular steroid dose for large, medium, small joint?

A

lg- 40 mg
med- 30 mg
sm- 10 mg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

2 xanthine oxidase inhibitors used chronically for gout

A

allopurinol, febuxostat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

starting dose for allopurinol and how increase dose

A

start 50-100 mg QD and inc Q3-5W until achieve goal SUA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

AEs of allopurinol

A

rash, DRESS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

which medications can increase the risk of rash when taking allopurinol

A

amoxicillin, ampicillin, thiazides, ACEi

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what should you do if you get a rash from taking allopurinol

A

d/c the drug

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

aside from drugs causing rash, which medications have a DDI with allopurinol

A

warfarin, 6-MP, azathioprine, theophylline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

dose of febuxostat

A

40 mg to start and can increase to 80 mg QD if not at goal after 2 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

AEs of febuxostat

A

HA, arthralgias, abdominal pain, nausea, abnormal LFTs, flushing, dizziness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

BBW febuxostat

A

CV death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

DDI with febuxostat

A

concurrent 6-MP, azathioprine, theophylline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

uricosuric that inhibits reabsorption of uric acid used for chronic gout

A

probenecid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

dose of probenecid

A

250 mg bid x1week then can inc to 500 mg bid
max 2g/day increased in 500 mg increments Q4W

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

when should probenecid be avoided

A

Crcl <50, hx of nephrolithiasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

DDI with probenecid where it should be avoided

A

penicillin, methotrexate, carbapenems, salicylates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

uricase agent used for chronic gout refractory to other treatments

A

pegloticase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

dose of pegloticase

A

IV 8 mg Q2W over 2 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

BBW for pegloticase

A

infusion reactions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

what is recommended 1st line for UA lowering in chronic gout therapy

A

allopurinol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

goal serum urate level for gout treatment

A

<6 mg/dl

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

what is next step after allopurinol for chronic gout

A

switch to febuxostat, inc dose, add probenecid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

what is used when all options fail for chronic gout therapy

A

pegloticase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

monitoring for chronic UA lowering therapy for gout

A

reassess levels Q2-5W, increase intensity until goal is reached

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

when should prophylaxis be used for chronic gout therapy and for how long

A

when ULT is initiated and continue for 3-6 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

1st line for prophylaxis for chronic gout therapy

A

colchicine 0.6 mg QD or BID
or
low dose NSAIDs - naproxen 250 mg BID

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

when should gout prophylaxis therapy be continued

A

activity of symptoms, flare in last 3 mos, tophi present

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

gout flare therapy for mild-mod pain with 1-2 joints involved

A

monotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

gout flare therapy for severe pain with >2 joints involved

A

combo therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

3 options for gout flare therapy

A

colchicine 1.2 mg then 0.6 mg one hour later then start prophy dosing 12 hours later
full dose NSAID
steroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

when should colchicine not be used for gout flare therapy

A

on it prophylactically and had an acute regimen in the last 14 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

intraarticular steroids can be considered for gout flare therapy if

A

1-2 large joints involved

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

3 main steroid options for gout flare and dose

A

PO prednisone 0.5 mg/kg/day for 5-10 days
PO medrol
IM triamcinolone acetonide 60 mg then PO pred

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

combo therapy options for gout flare (4)

A

nsaid + colchicine
po steroid + colchicine
IA steroid + nsaid +/- colchicine
IA steroid + po steroid +/- colchicine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

risk factors for osteoarthritis

A

obesity, genetics, trauma/injury, anatomic factors, female, non-caucasian, age >40F or >50M

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

main patho mechanism of OA

A

cartilage breakdown causes change to bone and joint tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

affected joints for OA

A

hand, knee, hip

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

features of OA presentation

A

pain/stiff (AM, idleness), decreased range of motion, mono/oligoarticular, asymmetrical

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

1st line option for hand, knee, and hip OA

A

oral NSAIDs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

what can be used for knee OA only

A

topical NSAIDs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

what can be considered for knee and hip OA

A

IA steroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

APAP is used conditionally for OA and should be taken

A

650-100 mg PO Q4-6H
AROUND THE CLOCK NOT PRN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

3 main complications from PO nsaid use

A

gastropathy, CV events, nephrotoxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

how to approach PO NSAIDs in OA if they have bleed history?
>1 yr ago?
<1 yr ago?

A

> 1 yr— COX2 selective or non w/ PPI
<1 yr— COX2 selective w/ PPI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

nsaids should be avoided in patients at high risk for

A

CV events

58
Q

conditional option for OA with BBW for addiction, misuse, resp depression

A

tramadol

59
Q

conditional topical option for KNEE OA that depletes substance P?

how is it used? how long to work?

A

topical capsaicin
AAA 3-4x QD
2 weeks to work

60
Q

SNRI used conditionally for OA

A

duloxetine

61
Q

minimum injection interval for IA steroids in OA

A

minimum 3 mos

62
Q

how long for IA steroids to work for OA? how long to last?

A

onset 1-3 days
peak 1 week
works 1-2 mos

63
Q

OTC that is not recommended in OA

A

glucosamine

64
Q

nonpharm option for hand, knee, and hip OA

A

exercise, self-efficacy, self-management programs

65
Q

risk factors for RA

A

smoking, coffee, obesity, infections, autoantibodies

66
Q

____ positive is associated with a poorer prognosis for RA

A

ACPA

67
Q

affected joints in RA

A

hands, wrists, ankles, feet

68
Q

key articular presenting features of RA

A

warmth, swelling w/o pain, decreased range of functionality, morning stiffness, symmetrical

69
Q

extraarticular presentations of RA

A

fatigue, weakness, mood change

70
Q

what can be used for burst therapy or bridging in RA but is NOT recommended for maintenance use

A

glucocorticoids

71
Q

1st line for RA treatment?
if that is CI then?

A

methotrexate 1st
leflunomide or sulfasalazine if CI

72
Q

after 1st line RA therapy if not improved at 3 mos or at target at 6 mos then what??
if poor prognostic factors?
not poor?

A

poor prog- add bDMARD or consider JAKi
not poor prog- change to or add 2nd conventional dMARD

73
Q

if after phase II of RA therapy still not improving then

A

change the bDMARD or JAKi

74
Q

4 conventional DMARDS for RA

A

methotrexate, hydroxychloroquine, sulfasalazine, leflunomide

75
Q

methotrexate RA dose

A

10-25 mg PO SQ or IM WEEKLY

76
Q

AEs of methotrexate

A

NV, stomatitis, alopecia, BMS

77
Q

what can be coadministered with methotrexate to mitigate AEs

A

folic acid 1-5 mg QD

78
Q

csDMARD that works best for mild disease

A

hydroxychloroquine

79
Q

AEs of hydroxychloroquine

one requires what monitoring

A

vision changes, skin pigmentation

routine eye exam

80
Q

what can be given when taking leflunomide to block EHC and promote rapid elimination in event of serious AEs or toxicity

A

cholestyramine wash

81
Q

AEs of sulfasalazine

A

NVD, discoloration of bodily fluids, blood cell abnormalities

82
Q

what should be screened for when taking sulfasalazine and why

A

glucose-6-phosphate dehydrogenase deficiency
mitigate risk of hemolytic anemia

83
Q

5 TNFi that are bDMARDs for RA

A

adalimumab
etanercept
infliximab
golimumab
certolizumab pegol

84
Q

BBW for TNFi

A

malignancy, serious infection, TB

85
Q

IL-1 receptor inhibitor used for RA

A

anakinra

86
Q

AE of anakinra
should it be used? when?

A

ISR

not effective, may be good if concomitant gout

87
Q

2 IL-6 receptor inhibitors used for RA

A

tocilizumab, sarilumab

88
Q

AEs of tocilizumab and sarilumab

A

infusion rxn, infection risk, anemias, INC LIPIDS, inc liver enzymes, GI perforation

89
Q

BBW for tocilizumab, sarilumab

A

infection, TB, inf rxn

90
Q

tocilizumab, sarilumab have which AE so it should be avoided in

A

gi perforation—- avoid in IBD

91
Q

tocilizumab, sarilumab monitor for what (among others)

A

LIPIDS

92
Q

T cell costimulation modulator for RA

A

abatacept

93
Q

which RA med has a very delayed onset

A

abatacept

94
Q

abatacept may be avoided in patients with

A

COPD

95
Q

B cell modulator (acts at CD20) used for RA

A

rituximab

96
Q

BBW for rituximab

A

inf or cutaneous rxn, HBV, PML

97
Q

retreatment with rituximab is based on

A

resurgence of symptoms

98
Q

3 JAKi used for RA

A

tofacitinib, baracitinib, upadacitinib

99
Q

reduce dose of JAKi for

A

renal/hep insufficiency, combo with 3A4 inhibitors

100
Q

BBW for JAKI

A

serious infection, malignancy, MACE, thrombosis, mortality

101
Q

interventions for injection site rxn

A

cold compress, hydrocortisone cream, oral H2Ri or antihistamine

102
Q

interventions for infusion reactions

A

premedicate, decrease inf rate, fluids PRN

103
Q

who is most commonly affected by SLE

A

women of childbearing years, black or hispanic

104
Q

5 triggers of SLE

A

sunlight, stress, smoking, medications, viruses

105
Q

which 3 medications can trigger SLE

A

hydralazine, sulfa drugs, procainamide

106
Q

main 3 initial presentations for SLE

A

fever, arthralgias, rash

107
Q

3 serologic tests for lupus

A

ANAs
anti-dsDNA Ab
Anti-Sm Ab

108
Q

presentation of lupus nephritis

A

foamy urine, peripheral edema, concomitant HTN

109
Q

SLE manifestation with kidney inflammation due to complex deposition

A

lupus nephritis

110
Q

Ab in SLE where when positive you are in a hypercoaguable state

A

antiphospholipid + antibodies

111
Q

what can be used in SLE to treat rash

A

topical steroids

112
Q

used in SLE for acute or chronic pain and inflammation

A

NSAIDs

113
Q

medication used in all SLE patients unless CI

A

hydroxychloroquine

114
Q

is hydroxychloroquine safe in pregnancy

A

low risk- ok to use

115
Q

adjunctive SLE med for mod-sev initial presentation, organ/life threatening, poor response to HCQ/NSAIDs, or poor QoL without

A

glucocorticoids

116
Q

adjunctive med for SLE given in combo with standard therapy via IV infusion or SQ QM

A

belimumab

117
Q

4 criteria for belimumab use

A

non-active CNS
autoantibody +
musculoskeletal or cutaneous disease unresponsive to HCG/NSAID/steroid
LN III IV V

118
Q

AEs of belimumab

A

nausea, diarrhea, allergic rxn, infusion rxn, depression, suicidality, PML

119
Q

adjunctive med for SLE given in combo with standard therapy IV infusion Q4W

A

anifrolumab

120
Q

anifrolumab is not indicated in

A

LN or CNS disease

121
Q

when are immunosuppressants used in SLE

A

poor sx control refractory to HCQ/NSAIDs/steroids and indicated for organ threatening SLE (mainly LN)

122
Q

immunosuppressant used for SLE with concomitant RA or primary presentation of arthritis

A

methotrexate

123
Q

immunosuppressant used in SLE 2nd line after steroids for more moderate disease, safest in class for pregnancy

A

azathioprine

124
Q

when is mycophenolate used for SLE

A

proliferative (II-IV) LN
2nd line for membranous (V) LN

125
Q

AEs of mycophenolate

A

diarrhea, abdominal pain, anorexia, nausea

126
Q

immunosuppressant used in SLE for organ threatening cardiopulmonary, renal, or neuropsychiatric disease

A

cyclophosphamide

127
Q

AEs of cyclophosphamide

A

very toxic, permanent infertility

128
Q

immunosuppressant used in SLE for MEMBRANOUS (V) LN

A

cyclosporine

129
Q

immunosuppressant for SLE used for PROLIFERATIVE (V) LN

A

tacrolimus

130
Q

immunosuppressant for SLE used off-label for severe renal, hematologic, or neuropsych SLE refractory to other agents

A

rituximab

131
Q

immunosuppressant for SLE used as an adjunct to immunosuppressants in active LN

A

voclosporin

132
Q

1st line for all patients in SLE

A

hydroxychloroquine, steroids

133
Q

what are the best options for refractory/severe SLE when wanting steroid-sparing immunosuppression

A

methotrexate, mycophenolate

134
Q

1st line for mainly skin disease in SLE

A

topicals, hydroxychloroquine

135
Q

induction therapy for LN in SLE is

A

immunosuppressant (MMF,CYC) + a steroid

136
Q

if SLE patient has glomerular disease and persistent proteinuria +/- HTN give them

A

ACE or ARB

137
Q

if LDL >100 in SLE give

A

statin

138
Q

antiphospholipid Ab + with no event in SLE gets what?

A

preg- LDA +/- LMWH
not preg- LDA

139
Q

antiphospholipid syndrome gets what?

A

preg- LDA +/- LMWH
not preg- warfarin

140
Q

INR goal for warfarin for antiphospholipid syndrome

A

inr 3-4 arterial
inr 2-3 venous

141
Q

most important non-pharm measure for SLE

A

limit sun exposure, use sun protection

Therapeutics (28 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions