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Pharm Exam 5 > Unit XIV Bone & Joint (Chapters 59 & 61) > Flashcards

Unit XIV Bone & Joint (Chapters 59 & 61) Flashcards

1
Q

Treatment goals for Rheumatoid Arthritis (4)?

A

Relieving symptoms (Pain, inflammation, stiffness)
Maintaining joint function and ROM
Minimize systemic involvement
Delay disease progression

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2
Q

Non-drug therapies for Rheumatoid Arthritis?

A 
Physical therapy (massage, warm baths, and applying heat to affected areas)
Proper rest and exercise to decrease joint stiffness and improve function (NOT TO EXCESS)
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3
Q

Drug Classes for treatment of Rheumatoid Arthritis (3)?

A

NSAIDS
Glucocorticoids
Disease-modifying antirheumatic drugs (DMARDS)

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4
Q

Role of NSAIDS in the treatment of RA?

A

Quick relief of joint pain/inflammation

Used until DMARDS on board (then withdrawn)
DON’T delay disease progression

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5
Q

Role of Glucocorticoids in treatment of RA?

A

Quick relief of joint pain/inflammation, particularly used for flares & with DMARDS until they take effect

CAN delay disease progression
Can not be used long term because of toxicity/adverse effects

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6
Q

Role of Disease-modifying antirheumatic drugs (DMARDS) in treatment of RA?

A

Reduce joint destruction and slow progression

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7
Q

MOA of DMARDS?

A

Interfere with immune and inflammatory responses

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8
Q

3 types of DMARDS?

A

Conventional (traditional)
Biologic
Targeted

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9
Q

MOA of Conventional (traditional) DMARDS?

A

Extensive effects on the immune system

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10
Q

MOA of Biologic DMARDS?

A

Work on cytokines

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11
Q

MOA of Targeted DMARDS?

A

Block specific pathways inside cells of the immune system

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12
Q

Do all NSAIDS work the same in every patient?

A

All have antirheumatic effects but some may respond differently to others

Try multiple to see which is best for the patient

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13
Q

Black Box warning for NSAIDS (3)?

A

Thrombotic events
GI Ulceration
Bleeding

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14
Q

Which NSAID should be used when there is a high risk for GI Ulceration and low risk from thrombosis?

A

Celebrex

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15
Q

What is the NSAID dose range when employed for RA (higher or lower than ‘regular’ use)?

A

Higher

ASA can be 5.2 g/day

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16
Q

Delivery systems for glucocorticoids for treatment of RA (2) and when each is used?

A

1) Oral formulations with generalized symptoms (low-grade fever and other systemic effects)
2) Intra-articular injections when limited to specific joints to give relief with limited systemic adverse effects

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17
Q

Can NSAIDS and Glucocorticoids be used together?

A

No–discontinue NSAIDS when using glucocorticoids r/t increased GI bleeding.

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18
Q

Which type of DMARDs is the least expensive?

A

Conventional

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19
Q

List examples of Conventional DMARDs (2)

A

Methotrexate

Hydroxychloroquine (Plaquenil)

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20
Q

What is the first-line Conventional DMARD for use of RA treatment?

A

Methotrexate

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21
Q

Which DMARD works faster than other DMARDs?

A

Methotrexate

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22
Q

How long does it take for the effects of Methotrexate to take effect?

A

3-6 weeks

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23
Q

What must always be prescribed with Methotrexate?

A

Folic Acid

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24
Q

Adverse Effects of Methotrexate (4)?

A

Hepatic fibrosis
Bone Marrow Suppression
GI Ulceration
Pneumonitis (general inflammation of lung tissue)

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25
Q

Monitoring parameters with Methotrexate?

A

LFTs

CBC

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26
Q

What dose of Folic Acid must be given in conjunction with Methotrexate?

A

5mg/week

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27
Q

What is the role of Folic Acid when given in conjunction with Methotrexate?

A

Reduces GI & Hepatic Toxicity

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28
Q

Contraindications of Methotrexate (5)?

A 
Pregnancy
Breastfeeding
Blood Dyscrasias
Immunodeficiency
Liver Disease
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29
Q

Drug interactions with Methotrexate (3)?

A

Alcohol
LIVE VACCINES
Inactivated vaccines require revaccination 3 months after therapy is stopped)

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30
Q

What vaccines should be given prior to starting treatment with Methotrexate (5)?

A 
Pneumonia
Flu
Hep B
HPV
Herpes Zoster
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31
Q

Black Box warning with Methotrexate (4)?

A

Toxicity of bone marrow, liver, lung, and kidney
Skin reactions
Hemorrhagic Enteritis
GI perforation

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32
Q

What drug is typically combined with Hydroxychloroquine (Plaquenil) in the treatment of RA?

A

Methotrexate

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33
Q

How long does it take for Hydroxychloroquine to take effect after the start of treatment for RA?

A

3-6 months

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34
Q

What is the most significant adverse effect risk with Hydroxychloroquine?

A 
Retinal Damage (producing irreversible blindness)
Loss of vision is directly related to dosage, low doses only for long term use)
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35
Q

Adverse effects of Hydroxychloroquine (7)?

A

Retinal damage/vision loss
Cardiomyopathy
Varying degrees of AV heart block
BBB
Can prolong QT interval (increases risk for ventricular dysrhythmias)
Hypoglycemia
GI distress (taking with food or milk helps)

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36
Q

Monitoring parameters with Hydroxychloriquine

(1)?

A

Ophthalmologic exam before beginning therapy and at least every 6 months

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37
Q

Examples of Biologic DMARDs?

A

Etanercept (Enbrel)

Adalimumab (Humira)

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38
Q

Drug class of Biologic DMARDs?

A

Tumor Necrosis Factor Inhibitors

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39
Q

Monitoring parameters for Methotrexate?

A

LFTs (due to potential liver damage)
CBC and platelets (due to immunosuppressant
effects)

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40
Q

Long or short half-life with Hydroxychloriquie?

A

Extremely long 1/2 life of 40 days

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41
Q

MOA of Biologic DMARDs?

A

Specific immunosuppressant meds that target different parameters on the inflammatory cascade.

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42
Q

What is the delivery system of most biologic DMARDs?

A

Injection or Infusion

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43
Q

Black Box Warning with Etanercept (Enbrel)

A

Increased risk for serious systemic infections (TB and HBV) and sepsis

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44
Q

Drug Interactions with Etanercept (Enbrel)

A

Other immunosuppressant drugs

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45
Q

Adverse Effects Etanercept (Enbrel)

A

Significant immune suppression

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46
Q

Monitoring Parameters with Etanercept (Enbrel)

A

CBC
Platelets
*to monitor for significant infection

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47
Q

Patient education related to Etanercept (Enbrel)

A

TB tests
Stay away from sick people (constantly immunosuppressed)
NO LIVE VACCINES (inactivated only)

48
Q

Can Adalimumab (Humira) be used in combination with methotrexate and/or other DMARDs?

A

YES, often is

49
Q

Adverse Effects of Adalimumab (Humira)?

A

Significant immune suppression

50
Q

Monitoring Perameters with Adalimumab (Humira)

A

CBC

Platelets

51
Q

Patient Eduation related to Adalimumab (Humira)

A

TB tests, stay away from sick people (constantly immunosuppressed)
NO LIVE VACCINES (inactivated only)

52
Q

Example of Targeted DMARDs

A

Xeljanz

53
Q

What class of drugs are Targeted DMARDs?

A

Janus kinase Inhibitors (JAK)

54
Q

What is the delivery system of Targeted DMARDs?

A

Oral

55
Q

Indications for use for Xeljanz?

A

Those who cannot take methotrexate or who did not respond well to Methotrexate

56
Q

Adverse Effects of Xeljanz (4)?

A

Bone Marrow Supression
Bradycardia (with prolonged PR intervals)
Hyperlipidemia
Increased occurrence of malignancies

57
Q

Patient education regarding Xeljanz?

A

TB Tests
Stay away from sick people (constantly immunosuppressed)
NO LIVE vaccines (only inactivated)

58
Q

Black Box warning for Xeljanz?

A

Development of potentially fatal infections (TB in particular)

59
Q

Drug Interactions with Xeljanz (3)?

A

CYP inhibitors
Other biologic DMARDs (DO NOT combine)
Other immunosuppressant agents (DO NOT combine)

60
Q

What do osteoCLASTS do?

A

Reabsorb (break down) old bone

61
Q

What do osetoBLASTS do?

A

Deposit new bone and increase bone mass

62
Q

Where does absorption of Ca take place?

A

Small intestine

63
Q

How is Ca excreted?

A

Kidneys

64
Q

What vitamin increases Ca reabsorbtion?

A

Vitamin D

65
Q

What are common sources of Vitamin D?

A

Sun
Diet
Supplements

66
Q

What happens to Vitiam D requirements with age?

A

They increase

67
Q

What mineral is essential to maintain solid bone structure?

A

Calcium

68
Q

What is the function of Vitamin D in the role of Ca?

A

Vitamin D is necessary in order for Ca to absorb well.

69
Q

What are non-drug measures for preventing osteopenia/osteoperosis (3)?

A

Weight-bearing exercises
Adequate Dietary Ca
Supplemental Vit D/Ca when necessary

70
Q

What are first-line drugs for Osteoporosis?

A

Calcium Salts

71
Q

Examples of Ca Salts

A

Calcium Carbonate–Tums, Rolaids

Calcium Citrate–Citracal

72
Q

Adverse effects of Ca Salts?

A

Constipation

Diarrhea at high doses only

73
Q

Calcium Salt Drug Interactions (4)?

A

Glucocorticoids (decrease absorbtion of Ca)

Can decrease the effectiveness of some antibiotics (tetracyclines & quinolones)
Can decrease the effectiveness of Thyroid medications
Can decrease the effectiveness of some anti-seizure meds (Dilantin)
Bisphosphonates (reduced absorption)

Thiazides (HYPERcalcemia)
Loop Diuretics (HYPOcalcemia)
74
Q

Can Calcium Salts be taken in conjunction with other medicines?

A

Ca salts should not be taken within 1 hour of other medicines (2 hours is better)

75
Q

Ca Salt food interactions?

A

Oxalic acid (spinach, rhubarb, swiss chard, beets). These decrease the absorption of Ca.

76
Q

Should Ca salts be taken with food or on an empty stomach?

A

Empty stomach

77
Q

Types of Ca Supplements/Ca Salts (2)?

A

Calcium Carbonate

Calcium Citrate

78
Q

Which is more widely used…Calcium Carbonate or Calcium Citrate?

A

Calcium Carbonate

79
Q

Which is generally easier to tolerate…Calcium Carbonate or Calcium Citrate?

A

Calcium Citrate

80
Q

Which is better absorbed…Calcium Carbonate or Calcium Citrate?

A

Calcium Citrate

81
Q

Which is better for people with tendencies toward GI upset or other medication problems…Calcium Carbonate or Calcium Citrate?

A

Calcium Citrate

82
Q

What class of drugs is the primary cornerstone treatment for osteoporosis in the US?

A

Bisphosphonates

83
Q

MOA of Bisphosphonates?

A

Help improve bone density by decreasing the effectiveness of osteoCLASTS.

84
Q

Examples of Bisphosphonates (4)

A

Fosamax
Boniva
Reclast
Actonel

85
Q

What drug class are Fosamax, Boniva, Reclast, Actonel?

A

Bisphosphonates

86
Q

What is the most widely used/FIRST LINE Bisphosphonate for the treatment of osteoporosis?

A

Alendronate (Fosamax)

87
Q

Alendronate (Fosamax) Indications for use (3)?

A

Osteoporosis in post menopausal women
Osteoporosis in men
Glucocorticoid induced osteoporosis

88
Q

Alendronate (Fosamax) Indications for use (3)?

A

Osteoporosis in postmenopausal women
Osteoporosis in men
Glucocorticoid induced osteoporosis

89
Q

How to decrease risk of esophagitis caused by Alendronate (Fosamax(?

A 
Take with full glass of water
Remain upright (seated or standing) for at least 30 min after taking it
90
Q

How to decrease the risk of esophagitis caused by Alendronate (Fosamax and Actonel)?

A 
Take with a full glass of water
Remain upright (seated or standing) for at least 30 min after taking it
91
Q

Alendronate (Fosamax) food interactions (3)?

A

DO NOT TAKE with:
Food
Coffee
Orange Juice

*Take on an empty stomach with water

92
Q

MOA of Alendronate (Fosamax)?

A

Inhibits bone reabsorption by decreasing the activity of osteoCLASTS

93
Q

MOA of Risedronate (Actonel)

A

Incorporates itself into the bone for you to 5 years to help strengthen bones

94
Q

Risedronate (Actonel) Indications for use?

A

Osteoporosis in postmenopausal women
Osteoporosis in men
Glucocorticoid induced osteoporosis

95
Q

Risedronate (Actonel) Adverse effects(3)?

A

Flu-like symptoms
GI
ESOPHAGITIS

96
Q

Ibandronate (Boniva) indications for use?

A

Prevention and treatment of post-menopausal osteoporosis

97
Q

Ibandronate (Boniva) formulations for administration (and frequency)?

A

PO-once a month
IV-once every 3 months
Depends on preference/tolerance

98
Q

Ibandronate (Boniva) Adverse Reactions?

A

PO-Mostly GI

IV-can cause renal insufficiency

99
Q

Should Ibandronate (Boniva) be taken on empty stomach or with food?

A

Empty stomach with water

100
Q

How long should patients remain upright after taking Ibandronate (Boniva)?

A

SIXTY minutes

vs. 30 minutes for Fosamax and Actonel

101
Q

Zoledronic Acid (Reclast) Indications for use?

A

Osteoporosis in postmenopausal women
Osteoporosis in men
Glucocorticoid induced osteoporosis

102
Q

How is Zoledronic Acid (Reclast) administered?

A

IV ONLY

Once a year or once every 2 years

103
Q

Zoledronic Acid (Reclast) Adverse effects

A 
Transient fever and flu-like symptoms
Kidney Damage (dose dependent)
104
Q

Use Zoledronic Acid (Reclast) with caution in what patients?

A

Renal Insufficiency

105
Q

Estrogen therapy for prevention of osteoporosis (discouraged by research)requires what two factors?

A

Intact Uterus

Progestin Administration

106
Q

Indication for use of Evista?

A

Prevention and treatment postmenopausal osteoporosis AND

REDUCE RISK for breast cancer

107
Q

Selective Estrogen Receptor Modulators (SERMS) are CONTRAINDICATED when…(3)?

A

Patients with estrogen dependent cancer
Pregnancy
Women of childbearing age

108
Q

Example of Selective Estrogen Receptor Modulators (SERMS)?

A

Raloxifene (Evista)

Tamoxifien

109
Q

What drug class is Teriparatide (Forteo)?

A

Man-made form of Parathyroid Hormone

110
Q

Teriparatide (Forteo) Indication for use?

A

Osteoporosis in postmenopausal women
Osteoporosis in men
Glucocorticoid induced osteoporosis

111
Q

MOA of Teriparatide (Forteo)?

A

Interferes with osteoCLASTS

Increases bone deposition by building more osetoBLASTS

112
Q

How is Teriparatide (Forteo) adminisered?

A

Auto inject pen

113
Q

Teriparatide (Forteo) Adverse Effects?

A

GI Effects

Transient bone pain/arthralgia

114
Q

What bone mineralization drugs can be used in infants/children?

A

Calcium and Vitamin D ONLY

115
Q

What bone mineralization drugs can be used in Pregnancy and breastfeeding?

A

Calcium and Vitamin D ONLY

116
Q

Administration of bone mineralization drugs in older adults (3)?

A

Estrogen (BEERS criteria)
Bisphosphonates (Increased risk of esophagitis)
Do not continue therapies beyond 5 years

Pharm Exam 5 (5 decks)

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