wolff Flashcards by Fiu B

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

Triple Therapy

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

Uricase

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

Glucosamine

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increases the risk for developing gout

Hyperuricemia

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

Febuxostat

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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

Allopurinol

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

Tofacitinib

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

Genetic

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never do this with biologic DMARDs

Combine them

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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

Alendronate

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important non-pharmacological component of rheumatoid arthritis management

Exercise

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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

Tocilizumab

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

Folate

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

Vitamin D

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

Fluorinated

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

Abatacept

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

Uricosuric

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

Raloxifene

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

Nephropathy

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

Diclofenac

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intense and historically feared during acute gout attack

Pain

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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

Etanercept

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

Sulfinpyrazone

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

Calcium salts

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

Bilateral

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

Salmon

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

Live vaccines

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

Androgen deprivation

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

Cortical

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

Polyglutamation

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

Leflunomide

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

Calcitriol

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

Rasburicase

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

GI distress

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

Naproxen

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

Duloxetine

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

Denosumab

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

Probenecid

abruptly doing this with exogenous glucocorticoids can be deadly

Stopping

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

Methotrexate

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

Recurrent

this of malignancy can be treated with bisphosphonates or furosemide

Hypercalcemia

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

RANKL

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

PTH

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

Teriparatide

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

Acetaminophen

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

Citrulline

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

Adalimumab

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

Overproducer

not altered by use of NSAIDs or glucocorticoids in RA

Disease progression

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

Osteonecrosis

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

Infliximab

parenteral route for administration of calcitonin-salmon

Intranasal

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

Traditional

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

Uric acid

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

Cinacalcet

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

Elderly

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

Hydroxychloroquine

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

Sulfasalazine

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

Indomethacin

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

Calcitonin

drug class associated with atypical bone fractures

Bisphosphonates

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

Prednisone

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

Rituximab

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

Underexcreter

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

Opportunistic

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

Gout

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

Hypersensitivity

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

NSAIDs

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

Anakinra

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

Zoledronic acid

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

Stephens Johnson

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

TNF alpha

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

Canaliculi

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

Prophylaxis

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

Pegloticase

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

Opioids

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

Parenteral

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

Purines

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

DMARD

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

Retina

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

Celecoxib

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

Loading dose

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

Colchicine

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

Adenosine

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

Pregnancy

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

Tophi