Rheumatology

Question 1

methotrexate may accelerate or enhance what development?

Answer 1

The formation of rheumatoid nodules.

Question 2

“gold drugs” may cause what renal disease?

Answer 2

glomerular disease

Question 3

Of DMARDs for RA, which 2 are considered “safer”?

Answer 3

Hydroxychloroquine, sulfasalazine

Question 4

Two toxicities of hydroxychloroquine

Answer 4

retinopathy, hyperpigmentation

Question 5

Two toxicities of sulfasalazine

Answer 5

myelosuppression, GI disturbance

Question 6

7 SE of MTX

Answer 6

Stomatitis
Myelosuppression
Hepatic fibrosis
Cirrhosis
Pulm involvement
Worsens rheum nodules
teratogenicity

Question 7

5 Se of leflunomide (for RA)

Answer 7

Hepatotoxicity, nausea, diarrhea, HTN, teratogenicity

Question 8

5 SE of cyclosporine (for RA)

Answer 8

Renal dysfunction
tremor
hirsutism
HTN
gum displasia

Question 9

4 issues with Gold medications (IM and oral for RA)

Answer 9

Myelosuppression
Renal –> proteinuria (glomerular disease)
Diarrhea (#1 for oral)
Rash (#1 for IM)

Question 10

3 SE of azathioprine (for RA)

Answer 10

Myelosuppression, hepatotoxiity, lymphoproliferative disorders

Question 11

Name 7 Non-biologic DMARDs for RA

Answer 11

Hydroxychloroquine
Sulfasalazine
MTX
Leflunomide
Cyclosporine
Gold (IM or oral)
Azathioprine

Question 12

Name 6 biologic DMARDs for RA

Answer 12

1. Anti tumor necrosis factor agents (TNF) - etanercept (enbrel), infliximab (remicade), adalimumab (humira)
2. Co-stimulation modulators - abatacept (Orencia)
3. Anti-B cell antibodies (rituximab)
4. Interleukin (IL)-1 receptor antagonist (anakinra (kineret)
5. IL-6 antagonist Tocilizumab (actemra)
6. Protein Kinase inhibitors - tofacitinib (xeljanz)

Question 13

Side effect of rituximab

Answer 13

Anti - b cell antibodies which depletes b cells and might cause progressive multifocal leukoencephalopathy

Question 14

Side effect of Anti TNF agents (enbrel, remicade, humira)

Answer 14

possible exacerbation of CHF, skin cancer, demyelinating disease, infection

Question 15

Which two drugs potentiate gout?

Answer 15

thiazides, ASA

Question 16

Name the treatment regimen for acute (3) vs chronic (3) gout

Answer 16

Acute

• Colchicine - inhibits phagocytosis of urate crystals
• NSAIDs - indocin
• Corticosteroids

Chronic

• Allopurinol - decrease synthesis of uric acid
• Febuxostat - same
• Probenecid - uricosuric increases the renal excretion of uric acid.

Question 17

Corticosteroid dose for poly or dermatomyositis

Answer 17

1mg/kg/day prednisone for 4-6 weeks, then taper

delayed initiation represents poorer prognosis.

Question 18

second line therapy for dermatomyositis or polymyositis:

Answer 18

Azathioprine or MTX

IVIG in severe refractory cases

Question 19

Name the three drugs approved by FDA for fibromyalgia

Answer 19

Pregabalin (lyrica)
Duloxetine (Cymbalta)
Milnacipran (Savella)