Rheumatology, NSAIDs, Acetaminophen

Question 1

Rapidly converted to mycophenolic acid which inhibits inosine monophosphate dehydrogenase (an enzyme in the de novo pathway of guanosine triphosphate synthesis GTP)

Supresses both B and T lymphocyte activation

Answer 1

Mycophenolate mofetil

Ind: SLE, Transplants

Question 2

Mycophenolate toxicity

Answer 2

GI

Myelosupression (neutropenia)

Question 3

Alkylating agents

Answer 3

Cyclophosphamide

Cisplatin

Question 4

Antimetabolites

Answer 4

5-FU
Methotrexate
Gemcitabine
6-mercaptopurine

Question 5

Antitumor antibiotics

Answer 5

Bleomycin
Doxorubicin
Mitomycin

Question 6

Natural product

Answer 6

Etoposide
Paclitaxel
Vincristine

Question 7

Alklyating agents form reactive molecular species that alkylate

Answer 7

nucleophilic groups on DNA bases particulary N-7 position of guanine

Question 8

Nitrogen mustard alkylating agent that alkylates nucleophilic groups ob DNA bases particularly the N-7 position of guanine

Cross-linking of bases, abnormal base pairing, and DNA strand breakage

Used in SLE, leukemia, non-Hodgkin’s, breast, ovarian cancer and neuroblastoma

Answer 8

Cyclophosphamide

Question 9

Breakdown product of cyclophosphamide by CYP450

Needed for antitumor activity

Answer 9

Acrolein

Question 10

Cyclophosphamide toxicity

Answer 10

GI distress
Myelosupression
Alopecia

Hemorrhagic cystitis
Cardiac dysfunction
Pulmo toxicity
SIADH

Question 11

Adverse effect of cyclophosphamide from acrolein formation

Decreased by vigorous hydration and by use of mercaptoethane sulfonate (MESNA)

Answer 11

Hemorrhagic cystitis

Question 12

First ever targeted biological treatment for SLE

Fully humanized IgG1 gamma monoclonal antibody against soluble B lymphocyte stimulator

Answer 12

Belimumab

Question 13

Enter the cell and bind to cytosolic receptors that transport it into the nucleus

This complex alters genes expression by binding to GRE (response elements) and tissue specific responses are made possible by protein regulators

Answer 13

Glucocorticoids

Question 14

Glucocorticoid organ and tissue effect on metabolism

Answer 14

Stimulates gluconeogenesis
Blood glucose rise
Muscle protein catabolism
Increased insulin secretion
Lipolysis and lipogenesis stimulation with fat deposition

Question 15

Glucocorticoid catabolic effect

Answer 15

Muscle protein catabolism
Lymphoid tissue connective tissue fat and skin wasting
Osteoporosis

Question 16

Glucocorticoid immunosupressive effect

Answer 16

Inhibit cell mediated immunologic functions especially those dependent on lymphocytes

Question 17

Glucocorticoid anti-inflammatory effect

Answer 17

Supressant on inflammatory process
Increase neutrophil
Decrease lymphocyte, eosinophil, basophil, monocyte
Inhibition of leukocyte migration

Induced synthesis of inhibitor of phospholipase A2
Decreased mRNA for COX2
Decreased IL-2 and IL-3
Decreased platelet activating factor

Question 18

Other glucocorticoid effects

Answer 18

Normal renal excretion of water
CNS behavioral change
Stimulate gastric acid secretion
Decreased resistance to ulcer formation

Question 19

DMARDs that interfere with activity of T lymphocytes

Immunosupressant used for rheumatoid arthritis

Answer 19

DMARDs
Hydroxychloroquine
Chloroquine

Question 20

DMARD toxicity

Answer 20

Retinal toxicity
Rash
GI distress
Myopathy
Neuropathy

Question 21

Inhibitot of dihydroorotate dehydrogenase an enzyme involved in de novo pyrimidine synthesis

Used in RA

Answer 21

Leflunomide

Question 22

Cytotoxic to rapidly dividing immune cells due to inhibition of dihydrofolate reductase

Anticancer, rheumatoid disorders

Answer 22

Methotrexate

Question 23

Methotrexate toxicity

Answer 23

Nausea
Mucosal ulcera
Hematoxicity
Hepatotoxicity
Teratogenecity

Question 24

Inhibition of microtubule assembly decreases macrophage migration and phagocytosis

Chronic and acute gout
Familial Mediterranean Fever

Answer 24

Colchicine

Question 25

Colchicine toxicity

Answer 25

Diarrhea | Severe liver and kidney damage in overdose

Question 26

Aminosalicylate Contains 5-aminosalicylic acid (5-ASA generic Mesalamine) used as topical therapy for IBD and RA Inhibiting synthesis of prostaglandin and inflammatory leukotrienes, and interfering with the production of inflammatory cytokines 5 ASA + sulfapyridine

Answer 26

Sulfasalazine

Question 27

Sulfasalazine adverse effect

Answer 27

Sulfonamide toxicity due to absorption of sulfapyridine moiety

Question 28

Cytotoxic drug Prodrug of anticancer drug mercaptopurine, which interferes with purine nucleic acid metabolism used for rheumatic diseases and organ transplantation

Answer 28

Azathioprine

Question 29

Acetylation of COX-1 and COX-2 results in decreased prostaglandin synthesis Irreversible COX inhibition Analgesia Antipyretic Anti-inflammatory Anti-thrombotic Prevents colon cancer

Answer 29

Aspirin | Salicylate

Question 30

Reversible inhibition of COX-1 and COX-2 results in decreased prostaglandin synthesis Analgesia Antipyretic Anti-inflammatory Closure of Patent Ductus Arteriosus Interferes with aspirin’s antithrombotic action

Answer 30

Ibuprofen | Nonselective NSAIDs

Question 31

Selective, reversible inhibition of COX-2 results in decreased prostaglandin synthesis Analgesia Antipyretic Anti-inflammatory Hepatic metabolism Less risk of GI toxicity Greater risk of thrombosis

Answer 31

Celecoxib | COX-2

Question 32

Mechanism unknown Weak COX inhibitor Analgesia Antipyretic NOT ANTI-INFLAMMATORY Hepatic conjugation Hepatotoxicity in overdose more likely in chronic alcohol consumltion which induces CYP450

Answer 32

Acetaminophen

Question 33

Inhibition of renal reuptake of uric acid Chronic gout, prolongation of antimicrobial drug action Exacerbation of acute gout Inhibits renal tubular secretion of weak acids such as methotrexate

Answer 33

Probenecid | Sulfinpyrazone

Question 34

Active metabolite irreversibly inhibits xanthine oxidase and lowers production of uric acid Chronic gout, adjunct to cancer chemotherapy Activated by xanthine oxidase

Answer 34

Allopurinol

Question 35

Reversible inhibitor of xanthine oxidase

Answer 35

Febuxostat

Question 36

Biologic agents that inhibit the action of tumor necrosis factor - alpha Decreases formation of interleukins and adhesion molecules involved in leukocyte activation Used in RA, IBD, Ankylosing spondylitis,

Answer 36

Infliximab Adalimumab Etanercept

Question 37

Recombinant human interleukin-1 receptor antagonist

Answer 37

Anakinra