Unit 4 Flashcards
what is first line treatment for OA
Tylenol
Osteophyte formation is seen in what disorder
OA
What systems should be monitored when using NSAIDs in the elderly
GI, renal, cardiac
Why is chronic NSAID use not advised over the age of 75
increased risk for GI bleed
Celocoxib - what is the class and MOA
COX2 specific NSAID, blocks prostaglandin synthesis
Why is Celocoxib a better option than Ibuprofen for pain
COX2 specific, pain relief with less GI side effects
What is the downside to using a COX 2 inhibitor over a traditional NSIAD
increased risk of cardiovascular toxicity
What patients may not have Celocoxib prescribed as a first line medication for inflammatory pain
those with a history of myocardial infarction, significant congestive heart failure, stroke, or chest pain related to heart disease
true or false: topical NSAIDs are just as effective as oral NSAIDs for OA pain
true
What cartilage matrix components may be considered as alternative therapy to help with treating OA
Chondroitin sulfate and hyaluronic acid
What adverese effects does MTX have on the liver and kidney
Can cause cirrhosis. Can cause acute kidney injury, azotemia, cystitis, proteinuria and hematuria
Why might liver enzymes be elevated on initiation of MTX
May cause transient increase in LFTs which usually resolves on its own
What BW should be ordered on MTX therapy
CBC with diff and platelettes, Cr and LFTs
Why might MTX be prescribed
RA, atopic dermatitis, chrons disease, SLE, oncology
Why should biologics and NSAIDs not be used together
increased risk of bone marrow supression and GI toxicity
Why is folic acid given with MTX
reduce risk of oral ulcers, leukopenia, anemia, and thrombocytopenia
What is Lesch-Nyhan sydrome and what can it cause
complete abscene of the enzyme HGPRT - leads to gout
what medications may cause gout and why
diueretic and ASA - causes decreased excretion of urate
what is pseudogout
same symptoms as gout but caused by calcium pyrophosphate dihydrate (CPPD) crystals instead of hyperurecemia
What is the MOA of Probenicid
inhibits tubular reabsorption of urate, increasing urinary excretion of urate
True or false: Probenicid is a good option for acute gout attacks
False
What is Probenicid used for
Gout management/prevention
What is the MOA of allopurinol
inhibit xanthine oxidase which is the enzyme that converts xanthine to uric acid
How long after a gout attack has started is colchicine no longer a preferred treatment
36 hours
what are the initial therapies for mild to moderate gout
NSAIDs, systemic corticosteroids, colchicine
what are the suggested combination therapies for gout if monotherapy is not effective
colchicine and NSAIDs
colchicine and oral corticosteroids
intra-articular steroid and (NSAID or colchicine or oral corticosteroid)
Why are NSAIDs and corticosteroids not combined for treatment of gout?
overlap in toxicities
When would you see synovial cell hyperplasia and endothelial cell activation
early stages of RA
how do cytokines cause catabolism of chondrocytes in RA
Cytokines drive the generation of reactive oxygen and nitrogen species
what characterizes juvenile RA
Onset of RA before age 16
In early RA, the synovium becomes more or less vascularized
more
what is pannus tissue and when is it seen
layer of roughened granulation tissue, seen in RA
what can cause Boutoniere and Swan Neck deformities
RA
true or false: risk of death related to cardiovascular disease is increased in patients with RA
True
what are DMARDS
disease modifying anti-rheumatic drugs
What medications may be prescibed with DMRADS to bridge until the DMRADS reach therapeutic levels
NSAIDs or low dose steroids
what is the most commonly prescribed DMRAD
MTX
what is the MOA of MTX
folic acid antagonist and antimitotic which supresses inflammatory leukocyte activity
What class if sulfalazine and why might is be prescribed
DMRAD - for RA
What class is hydroxychloroquine
DMRAD
What class if Leflumanide
DMRAD
What class is Etanercept
biologic
What class is infliximab
biologic
what class is adlimumab
biologic
how do biologics work
target specific cytokine or cellular targets that are part of the inflammatory process
True or false: MTX is often combined with biologic therapy
true
what is the most important differential diagnosis for gout
septic arthritis
What is most commonly prescribed for acute gout attacks
Indomethacin
What class is indomethacin
NSAID
What is second and third line for acute gout
2nd colchicine
3rd oral corticosteroids
Osteoporosis is an imbalance of ____
bone remodelling
what condition causes bone mineral loss
osteoporosis
what are the three main cells involved in bone remodelling
osteocytes, osteoblasts, osteocasts
what cytokine stimulates osteoclast destruction
OPG
What is the receptor for RANKL
RANK
what is osteoprogenin (OPG)
a “decoy” protein that binds to RANKL preventing it from stimulating RANK
what cell makes RANKL and OPG
osteoblasts
when RANKL predominated _____ are activated
osteoclasts
when OPG predominates ______ activity are decreased
osteoclast
True or false, when RANKL is higher than OPG, there will be bone building
false, there will be bone loss
Calcitonin (increases or decreases) osteoclast activity and PTH (increases or decreases) osteoclasts activity
decreases
increases
decreased vitamin ____ can cause decreased calcium
vitamin D
as estrogen levels decline, bone minerals are (increased or decreased) and why
decreased
decreased estrogen levels sensitize bones to PTH causing increased osteoclast activity
what are the 4 treatment options for osteoporosis
calcium supplements, bisphosphonates, selective estrogen receptor modulators, hormone modifiers
What is the treatment for acute exacerbations of osteoarthritis that does not respond to Tylenol or NSAIDs
glucocorticoid injection
What supplements may be helpful in osteoarthritis
glucosamine and chondroitin
