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Year2 MSK exam2 > Rheumatology Pharm II > Flashcards

Rheumatology Pharm II Flashcards

1
Q

TNF a

A

pro-inflammatory cytokine in synovium of those with RA

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2
Q

MOA TNF a blockers

A

prevent binding TNF alpha to the R

causes down regulation of macrophages and T cells

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3
Q

what type of drug is etanercept

A

recombinant fusion protein

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4
Q

biologic DMARD response time

A

faster

1-2 weeks

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5
Q

What biologics are used with MTX for RA

A

inflizimab and golimumab

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6
Q

adverse effects DMARD biologics

A

injection site reactions
infusion reactions with infliximab: fever, urticaria dyspnea, hypotension
cytopenias! CBC needed regularly
serious infections!!!
heart failure- not rec for those with CHF or EF<50%

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7
Q

biologic DMARD and pregnancy

A

relatively safe up to 30 weeks

category B

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8
Q

Abatacept MOA

A

binds CD on T cells preventing activation

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9
Q

what biologic has no assoc with TB

A

abatacept

tiruximab

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10
Q

MOA rituximab

A

depletes CD30 expressing B lymphocytes through cell mediated and C’ dependent cytotoxicity and stimulation apoptosis
inhibts secretion proinflammatory cytokines

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11
Q

Increases risk of bacterial fungal and viral infections

A

rituximab

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12
Q

MOA tocilizumab

A

inhibits signaling IL6 R

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13
Q

adverse effects tocilizumab

A

infusion reactions, HTN, neutropenia, elevated transaminases, dyslipidemia
GI perforation, infections HS and anaphylaxis have been reported

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14
Q

NSAID and pregnancy

A

not used in third trimester

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15
Q

what NSAID not effective for anklyosing spondylitis

A

aspirin

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16
Q

adverse effects corticosteroids

A

osteoporosis, weight gain, gluid retention, cataracts, glaucoma, poor wound healing, hyperglycemia, hypertension, adrenal suppression and increased risk of infectionbone loss

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17
Q

what can prevent corticoid induced osteoporosis

A

bisphosphonates or PTH hormone Tx

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18
Q

what drugs increase risk of gout

A

thiazides, immunosuppressants
cyclosporing
impair urate excretion

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19
Q

goals Tx for gout

A

dec Sx of acute attack and dec recurrent attacks

lower serum urate levels

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20
Q

significant problem in Tx of gout

A

non compliance by patients

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21
Q

first line for acute gout

A

NSAID because inhibit urate crystal phagocytosis

22
Q

most common NSAID used in gout

A

naproxen, indomethacin and sulindac

23
Q

what NSAID has dec GI effects

A

celecoxib

24
Q

what NSAID not given to patient with uric acid stones

A

oxaprozin because increase uric acid excretion in urine

25
Q

Aspirin use in gout

A

can inhibit urate excretion at low doses
increases risk of renal caliculi at highter doses
also can inhibit actions or uricosuric agents

26
Q

what is used for gout in patients with chornic kidney disease active peptic ulcer disease or hHx NSAID intolerance

A

cochicine

27
Q

what must you rule out before corticosteroid injection for gout

A

septic arthritis

28
Q

should you stop urate lowering therapy during acute attack since CI for Tx of acute attack

A

no don’t stop

just don’t start a Tx then

29
Q

non Rx measures to prevent attacks

A

weight loss and diet modification

30
Q

only potent uricosuric agent in US

A

probenecid

31
Q

what are the available xanthine oxidase inhbiitors

A

allopurinol and febuxostat

32
Q

why are xanthine oxidase inhibitors considered better

A

good regardless if over production urate or dec excretion

33
Q

what is used to Tx severe chronic gout refractory to conventional Tx

A

pegloticase

34
Q

MOA colchicine

A

binds tubulin and prevents polymerization
leads to inhibition of leukocyte migration and phagocytosis
antimitotic effects, arrests G1 by interfering with microtuble and spindles
renders cell membranes more rigid and decrease secretion of chemotactic factors from neutrophils

35
Q

second line therapy acute gout

A

colchicine within 12-24 hours of Sx onset!!!!!

36
Q

adverse effets colchicine

A

diarrhea, nausea, vomiting, abdominal pain

hepatic necrosis, acute renal failure, DIC, seizures, CI in patients with advanced renal or hepatic impairment

37
Q

acute overdose Sx of colchicine

A

burning throat pain, bloody diarrhea, shock , hematuria and oliguria, fatal ascending CNS depression

38
Q

colchicine dosing

A

not repeated within 14 days to avoid toxicity

39
Q

MOA allopurinol

A

competetive antagonist to xanthine oxidase

irreversibly binds

40
Q

clinical use allopurinol

A

gout between attacks

41
Q

adverse effects allopurinol

A

precipitate acute gouty arthritis
take with NSAID or colchicine for first few mo therapy
GI intolerance: nausea vomiting, diarrhea, allergic rash

42
Q

what is req if patient on 6 mercaptopurine or azathioprine with alloputinol

A

need to reduce the mercaptopurine and azathiprine

43
Q

allopurinol inhibits metabolism of what other gout drug

A

probenecid

44
Q

MOA probenecid

A

reduce reabsorption uric acid

45
Q

clinical uses probenecid

A

Tx hyperuricemia with gout when xanthine oxidase inhibitors CI or if tophi present!!!

46
Q

adverse effects probenecid

A

icnreased uric acid secretion( inc renal stone formation)
largue urine volume but be maintained to minimize renal stone formation
CI in those with renal stones
GI irritation and rash
ASA and salicylates may diminish effects

47
Q

newer version allopurinol

A

febuxostat

48
Q

concurrent use with azathiprine or 6 mercaptopurine

A

febuxostat

49
Q

given IV dosing every 2 weeks to reduce urate levels

A

pegloticase

50
Q

What drug is CI in patients wtih G6PD deficiency

A

pegloticase because hemolytic anemia

Year2 MSK exam2 (17 decks)

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