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NMSP Exam III*** > wolff > Flashcards

wolff Flashcards

1
Q

refers to the use of methotrexate, hydroxychloroquine, and sulfasalazine together to treat rheumatoid arthritis

A

Triple Therapy

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2
Q

mammalian enzyme that converts uric acid to allantoin, mutated/nonfunctional in humans

A

Uricase

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3
Q

along with chondroitin, widely used in hope of treating osteoarthritis but little evidence of benefit beyond placebo effect

A

Glucosamine

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4
Q

increases the risk for developing gout

A

Hyperuricemia

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5
Q

expensive non-purine/noncompetitive xanthine oxidase inhibitor useful for reducing urate levels in those with allopurinol intolerance

A

Febuxostat

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6
Q

competitive xanthine oxidase inhibitor that lowers serum urate levels, preferred/standard-of-care therapy for treatment of recurrent gout if low GFR or past urate stone or urate overproduction

A

Allopurinol

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7
Q

a JAK3 antagonist used as a biologic DMARD, novel in that it is orally active

A

Tofacitinib

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8
Q

abundant evidence shows people can have this type of predisposition for gout

A

Genetic

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9
Q

never do this with biologic DMARDs

A

Combine them

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10
Q

prototypical bisphosphonate drug class of first choice for treating osteoporosis in both women and men, its incorporation into bone inhibits the number and activity of osteoclasts

A

Alendronate

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11
Q

important non-pharmacological component of rheumatoid arthritis management

A

Exercise

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12
Q

biologic DMARD, generally a later choice, that is humanized antihuman IL-6 receptor antibody; among its effects is to decrease the acute-phase response of liver

A

Tocilizumab

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13
Q

supplementation of this is recommended for people prescribed methotrexate and/or sulfasalazine for the treatment of rheumatoid arthritis

A

Folate

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14
Q

ensuring adequate intake of this is a means of decreasing risk for osteoporosis

A

Vitamin D

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15
Q

dexamethasone, betamethasone, and triamcinolone are among _________ prednisolones, which have much greater potency and/or half-life than natural hydrocortisone

A

Fluorinated

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16
Q

biologic DMARD, generally not initial choice, a fusion protein blocks T cell CD80/86 co-stimulatory signal needed for activation

A

Abatacept

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17
Q

drugs that lower serum urate levels by increasing the fractional excretion by the kidneys

A

Uricosuric

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18
Q

SERM with agonist effects on bone but not breast or uterus that is used to treat osteoporosis

A

Raloxifene

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19
Q

gouty form of this is due to precipitation of uric acid in tubules if acute and, if chronic, interstitial accumulation of monosodium urate

A

Nephropathy

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20
Q

NSAID ingredient of topical gel that is perhaps the most effective topical pain remedy for osteoarthritis

A

Diclofenac

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21
Q

intense and historically feared during acute gout attack

A

Pain

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22
Q

fusion protein made from Fc portion of IgG and two TNF receptors, a biologic DMARD administered 2x/wk by sc injection; also used for psoriasis

A

Etanercept

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23
Q

uricosuric agent acting similar to probenecid, both require GFR > 60 ml/min

A

Sulfinpyrazone

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24
Q

dietary supplements for adolescents, postmenopausal women, and elderly to treat mild hypocalcemia (e.g., to facilitate bone growth or limit bone loss)

A

Calcium salts

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25
Q

word applying to pain in joints that suggests a systemic disease such as rheumatoid arthritis

A

Bilateral

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26
Q

calcitonin from this species has a longer half-life and greater potency than human calcitonin

A

Salmon

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27
Q

should not be administered to rheumatoid arthritis patients due to the risk of infection

A

Live vaccines

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28
Q

type of therapy for prostate cancer that increases patient risk for developing osteoporosis

A

Androgen deprivation

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29
Q

type of bone that is broken in the atypical femoral fractures (i.e., shaft) seen with bisphosphonate treatment

A

Cortical

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30
Q

happens to methotrexate, appears to be responsible for its low-dose ability to treat rheumatoid arthritis and reason its beneficial effects persist for some time after drug discontinuation

A

Polyglutamation

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31
Q

disrupts pyrimidine synthesis, a second-choice traditional DMARD due to greater prevalence of more serious adverse effects

A

Leflunomide

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32
Q

refers to 1,25 dihydroxy vitamin D, a hormone of calcium homeostasis that increase Ca2+ absorption from gut and resorption in kidney

A

Calcitriol

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33
Q

nonpegylated recombinant uricase administered for prevention of acute uric acid nephropathy due to tumor lysis syndrome

A

Rasburicase

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34
Q

often the dose-limiting adverse effect when colchicine is administered for gout prophylaxis

A

GI distress

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35
Q

non-aspirin NSAID with long half-life that can be useful for treating inflammation and/or pain of arthritis, a recommended drug of choice when benefits still outweigh concurrent cardiovascular risks

A

Naproxen

36
Q

SNRI that is being used to treat osteoarthritis with some success, but increased risk for constipation is problematic

A

Duloxetine

37
Q

osteoporosis monoclonal antibody therapy that binds RANKL to lower its bone microenvironment levels relative to OPG, and thereby decrease formation and function of osteoclasts

A

Denosumab

38
Q

blocks urate reabsorption by URAT1 transporter in proximal tubule to increase fractional excretion of filtered urate in urine

A

Probenecid

39
Q

abruptly doing this with exogenous glucocorticoids can be deadly

A

Stopping

40
Q

most effective and fastest acting of the traditional DMARDs, monitor for myelosuppression but generally well tolerated at low doses, often added to biologic DMARDs

A

Methotrexate

41
Q

refers to gout needing a management plan that lowers plasma urate levels

A

Recurrent

42
Q

this of malignancy can be treated with bisphosphonates or furosemide

A

Hypercalcemia

43
Q

refers to receptor activator of nuclear factor kappaB ligand, its ratio to OPG in the bone microenvironment governs the formation/activation of osteoclasts

A

RANKL

44
Q

hormone that acts to increase free Ca2+ levels in the plasma, does this increasing bone breakdown, promoting reabsorption of Ca2+ in kidney, and promoting generation of calcitriol

A

PTH

45
Q

1,34 PTH, only agent that forms bone but must be administered in PULSED manner… otherwise leads to bone resorption

A

Teriparatide

46
Q

noteworthy because it suppresses fever and pain but not inflammation, presumably in part by inhibiting prostaglandin synthesis in the CNS; no longer recommended as first-line therapy for osteoarthritis pain, used as adjunct for pain relief in RA

A

Acetaminophen

47
Q

autoantibodies present in a majority of RA patients target arginine residues in proteins that have been converted to a cyclic form of this

A

Citrulline

48
Q

antiTNF-biologic DMARD, this is humanized monoclonal antibody administered subcutaneously every 2 weeks; also used for psoriatic arthritis, ankylosing spondylitis, Crohn’s disease; top selling drug in the world

A

Adalimumab

49
Q

refers to person with hyperuricemia due to excess synthesis, excess dietary intake, and/or excess cell turnover (e.g., tumor lysis syndrome)

A

Overproducer

50
Q

not altered by use of NSAIDs or glucocorticoids in RA

A

Disease progression

51
Q

can occur in people using bisphosphonates (or denosumab), jaw is common site where it can be triggered by dental work

A

Osteonecrosis

52
Q

chimeric (human and mouse) monoclonal antibody directed against TNFalpha that can be administered IV every 6 weeks as a biologic DMARD

A

Infliximab

53
Q

parenteral route for administration of calcitonin-salmon

A

Intranasal

54
Q

methotrexate, hydroxychloroquine, and sulfasalazine are examples of this type of DMARD

A

Traditional

55
Q

poorly soluble end product of purine metabolism in humans, cause of kidney stones

A

Uric acid

56
Q

calcium-receptor sensitizer, acts to lower PTH secretion in chronic kidney disease

A

Cinacalcet

57
Q

patient population at greater risk for serious adverse effects of NSAIDs… and risk of osteoarthritis

A

Elderly

58
Q

antimalarial that is also a traditional DMARD used alone or in combination, alters antigen presentation by disrupting lysosomal pH

A

Hydroxychloroquine

59
Q

agent used as a traditional DMARD alone or in combination and also to treat IBD, GI side effects are a common reason for discontinuing

A

Sulfasalazine

60
Q

a classic NSAID with COX1 selectivity, remains a drug of choice for treating acute gouty arthritis

A

Indomethacin

61
Q

hormone that acts to lower free Ca2+ levels in the plasma, does this in part by suppressing bone breakdown

A

Calcitonin

62
Q

drug class associated with atypical bone fractures

A

Bisphosphonates

63
Q

glucocorticoid, prednisolone prodrug, short-term use is useful in therapy for rheumatoid arthritis until DMARD effects are seen

A

Prednisone

64
Q

targets CD20 antigen of B cells to cause a B cell ‘do-over,’ used to treat non-Hodgkin’s lymphoma and chronic lymphocytic leukemia, and can be effective in some antibody-dependent autoimmune diseases

A

Rituximab

65
Q

person with hyperuricemia due to lower than normal fractional excretion of urate or low GFR necessitating higher urate plasma concentrations to adequately filter/eliminate urate production per minute

A

Underexcreter

66
Q

general name referring to infections more commonly seen in patients using a biologic DMARD

A

Opportunistic

67
Q

associated with high serum urate levels (and gluttony), exquisitely painful with big toe being a frequent site

A

Gout

68
Q

refers to a response that can occur in people when foreign peptides or proteins are injected

A

Hypersensitivity

69
Q

class of drugs widely used for the pain and inflammation, but significant cardiovascular/respiratory/renal/GI contraindications can cause hypersensitivity skin reactions

A

NSAIDs

70
Q

late choice biologic DMARD due to limited efficacy, it is a recombinant version of endogenous human IL-1 receptor antagonist

A

Anakinra

71
Q

bisphosphonate administered by IV injection once per year; also associated with high incidence of osteonecrosis of jaw

A

Zoledronic acid

72
Q

allopurinol is among the widely used drugs that can cause this potentially fatal syndrome of epidermal necrolysis

A

Stephens Johnson

73
Q

blocking the effects of this inflammatory mediator is a common target when treating RA and various other autoimmune diseases

A

TNF alpha

74
Q

microscopic canals between the lacunae of ossified bones; large enough for bacteria but too small for white blood cells so healing with osteomyelitis requires either that efficacious antibiotics can reach bacteria or that infected bone is removed

A

Canaliculi

75
Q

for gout, low-dose colchicine or low-dose NSAIDs can be administered with this as a goal

A

Prophylaxis

76
Q

PEGylated version of recombinant mammalian uricase use to treat chronic gout in those refractory to conventional therapy

A

Pegloticase

77
Q

very effective pain relievers that unfortunately have a high risk of abuse and misuse, so not used for pain of osteoarthritis, etc.

A

Opioids

78
Q

route of administration required whenever administering peptides, antibodies, or fusion proteins

A

Parenteral

79
Q

part of dietary intake (e.g., in DNA, RNA) that is abundant in, for example, organ meats; also synthesized and salvaged as necessary

A

Purines

80
Q

patients with pain due to rheumatoid arthritis are often administered NSAIDs or glucocorticoids despite their lack of effect on disease progression while waiting for a drug from this broad class to begin exerting its effects

A

DMARD

81
Q

damage to this is a serious side effect of hydroxychloroquine, but little risk from low doses now used to treat RA

A

Retina

82
Q

COX-2 inhibitor that can be administered to treat pain and inflammation of rheumatoid arthritis if benefits > risks (e.g., if patient has ulcers, bleeding risk); only member of its class still marketed in US

A

Celecoxib

83
Q

needed to hasten the nevertheless slow-onset responses for DMARDs such as hydroxychloroquine and leflunomide because of their long half life

A

Loading dose

84
Q

relieves inflammation from gout if administered within 12-24 hours of symptom onset by blocking the tubulin polymerization (microtubule formation) needed by leukocytes for migration and phagocytosis

A

Colchicine

85
Q

accumulates outside of the cell as a consequence of AICAR accumulation inside cells due to the action of polyglutamated methotrexate; binds to purigenic GPCR on cell surface to exert anti-inflammatory response

A

Adenosine

86
Q

absolute contraindication for treatment of RA with methotrexate, reason to choose hydroxychloroquine instead

A

Pregnancy

87
Q

large aggregations of monosodium urate crystals surrounded by intense inflammatory reaction including large foreign-body giant cells; pathognomonic hallmark of gout

A

Tophi

NMSP Exam III*** (20 decks)

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