Rheumatology Pharm II

Question 1

TNF a

Answer 1

pro-inflammatory cytokine in synovium of those with RA

Question 2

MOA TNF a blockers

Answer 2

prevent binding TNF alpha to the R

causes down regulation of macrophages and T cells

Question 3

what type of drug is etanercept

Answer 3

recombinant fusion protein

Question 4

biologic DMARD response time

Answer 4

faster

1-2 weeks

Question 5

What biologics are used with MTX for RA

Answer 5

inflizimab and golimumab

Question 6

adverse effects DMARD biologics

Answer 6

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%

Question 7

biologic DMARD and pregnancy

Answer 7

relatively safe up to 30 weeks

category B

Question 8

Abatacept MOA

Answer 8

binds CD on T cells preventing activation

Question 9

what biologic has no assoc with TB

Answer 9

abatacept

tiruximab

Question 10

MOA rituximab

Answer 10

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

Question 11

Increases risk of bacterial fungal and viral infections

Answer 11

rituximab

Question 12

MOA tocilizumab

Answer 12

inhibits signaling IL6 R

Question 13

adverse effects tocilizumab

Answer 13

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

Question 14

NSAID and pregnancy

Answer 14

not used in third trimester

Question 15

what NSAID not effective for anklyosing spondylitis

Answer 15

aspirin

Question 16

adverse effects corticosteroids

Answer 16

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

Question 17

what can prevent corticoid induced osteoporosis

Answer 17

bisphosphonates or PTH hormone Tx

Question 18

what drugs increase risk of gout

Answer 18

thiazides, immunosuppressants
cyclosporing
impair urate excretion

Question 19

goals Tx for gout

Answer 19

dec Sx of acute attack and dec recurrent attacks

lower serum urate levels

Question 20

significant problem in Tx of gout

Answer 20

non compliance by patients

Question 21

first line for acute gout

Answer 21

NSAID because inhibit urate crystal phagocytosis

Question 22

most common NSAID used in gout

Answer 22

naproxen, indomethacin and sulindac

Question 23

what NSAID has dec GI effects

Answer 23

celecoxib

Question 24

what NSAID not given to patient with uric acid stones

Answer 24

oxaprozin because increase uric acid excretion in urine

Question 25

Aspirin use in gout

Answer 25

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

Question 26

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

Answer 26

cochicine

Question 27

what must you rule out before corticosteroid injection for gout

Answer 27

septic arthritis

Question 28

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

Answer 28

no don't stop | just don't start a Tx then

Question 29

non Rx measures to prevent attacks

Answer 29

weight loss and diet modification

Question 30

only potent uricosuric agent in US

Answer 30

probenecid

Question 31

what are the available xanthine oxidase inhbiitors

Answer 31

allopurinol and febuxostat

Question 32

why are xanthine oxidase inhibitors considered better

Answer 32

good regardless if over production urate or dec excretion

Question 33

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

Answer 33

pegloticase

Question 34

MOA colchicine

Answer 34

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

Question 35

second line therapy acute gout

Answer 35

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

Question 36

adverse effets colchicine

Answer 36

diarrhea, nausea, vomiting, abdominal pain | hepatic necrosis, acute renal failure, DIC, seizures, CI in patients with advanced renal or hepatic impairment

Question 37

acute overdose Sx of colchicine

Answer 37

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

Question 38

colchicine dosing

Answer 38

not repeated within 14 days to avoid toxicity

Question 39

MOA allopurinol

Answer 39

competetive antagonist to xanthine oxidase | irreversibly binds

Question 40

clinical use allopurinol

Answer 40

gout between attacks

Question 41

adverse effects allopurinol

Answer 41

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

Question 42

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

Answer 42

need to reduce the mercaptopurine and azathiprine

Question 43

allopurinol inhibits metabolism of what other gout drug

Answer 43

probenecid

Question 44

MOA probenecid

Answer 44

reduce reabsorption uric acid

Question 45

clinical uses probenecid

Answer 45

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

Question 46

adverse effects probenecid

Answer 46

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

Question 47

newer version allopurinol

Answer 47

febuxostat

Question 48

concurrent use with azathiprine or 6 mercaptopurine

Answer 48

febuxostat

Question 49

given IV dosing every 2 weeks to reduce urate levels

Answer 49

pegloticase

Question 50

What drug is CI in patients wtih G6PD deficiency

Answer 50

pegloticase because hemolytic anemia