wolff crosswards- OA, gout Flashcards
Hormone that acts to increase free Ca2+ levels in the plasma, does this increasing bone breakdown promoting reabsorption of Ca 2+ in kidney, and promoting generation of calcitriol
PTH
Often the dose-limiting adverse effect when colchicine is administered for gout prophylaxis
GI Distress
Late choice biologic DMARD due to limited efficacy, it is a recombinant version of endogenous human Il-1 receptor antagonist
Anakinra
Supplementation of this is recommendation for people prescribed methotrexate and/or sulfasalazine for the treatment of RA
Folate
Abruptly doing this with exogenous glucocorticoids can be deadly
Stopping
Needed to hasten the nevertheless sow-onset responses for DMARDs such as hydroxychloroquine and leflunomide because of their long half-life
Loading Dose
Calcitonin from this species has a longer half-life and greater potency than human calcitonin
Salmon
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
Absolute contraindication for treatment of RA with methotrexate, reason to choose hydroxychloroquine instead
Pregnancy
Drugs that lower serum urate levels by increasing its fractional excretion by the kidneys
Uricosuric
Very effective pain relievers, unfortunately have a high risk of abuse and misuse so not used for pain of osteoarthritis etc
Opioid
Biologic DMARD, generally not initial choice, a fusion protein blocks T- cell CD80/86 co stimulatory signal needed for activation
Abatacept
Microscopic canals between the lacunae of ossified bone; large enough for bacterial but too small for white blood cells so healing with osteomyelitis requires wither that efficacious abx can reach bacteria or that infected bone is removed
Canaliculi
COX-2 inhibitor that can be administered to treat pain and inflammation of RA if benefits>risks; only member of its class is still marketed in the US
Celecoxib
Intense and historically feared during acute gout attack
Pain
Part of dietary intake ( DNA, RNA) that is abundant in, for example organ meats, also synthesized and salvaged as necessary
Purines
Nonpegylated recombinant uricase administered for prevention of acute uric acid nephropathy due to tumor lysis syndrome
Rasburicase
Refers to person with hyperuricemia due to excess synthesis, excess dietary intake and/or excess cell turnover
Overproducer
PEGylated version of recombinant mammalian uricase uses to treat chronic gout in those refractory to conventional therapy
Pegloticase
Biologic DMARD, generally a later choice, that is humanized antihuman 1L-6 receptor antibody among its effects is to decrease the acute- phase response to liver
Tocilizumab
Should not be administered to RA patients due to the risk of infection
Live Vaccines
Blocking the effects of this inflammatory mediator is a common target when treating RA and various other autoimmune disease
TNF- Alpha
SNRI that is being used to treat osteoarthritis with some success but increased risk for constipation is problematic
Duloxetine
Important non-pharmacological component of RA management
Exercise
This of the malignancy can be treated with bisphosphonates or furosemide
Hypercalcemia
Non- Aspirin NSAID with long half-life that can be useful for treating inflammation and/or pain of arthritis a recommendation drug choice when benefits still outweigh concurrent cardiovascular risks
Naproxen
Refers to the use of methotrexate, hydroxychloroquine and sulfasalazine together to treat RA
Triple Therapy
Autoantibodies present in majority of RA patients target arginine residues in proteins that have been converted to a cyclic form of this
Citrulline
Can occur in people using bisphosphonates (or denosumab) jaw is a common site where it can be triggered by dental work = osteonecrosis
Osteonecrosis
Associated with high serum urate levels (and gluttony), exquisitely painful with big toe being a frequent site
Gout
Anti- malarial that is also a traditional DMARD used alone or in combination, alters antigen presentation by disrupting lysosomal pH
Hydroxychloroquine
Happens to methotrexate, appears to be responsible for its low-dose ability to treat RA and reasons its beneficial effects persist for some time after drug discontinuation
Polyglutamation
Type of bone that is broken in the atypical femoral fractures seen with bisphosphonate treatment
Cortical
Patient population at greater risk for serious adverse effects of NSAIDs…and risk for osteoarthritis
Elderly
Expensive non-purine/noncompetitive xanthine oxidase inhibitor useful for reducing urate levels in those with allopurinol intolerance
Febuxostat
Bisphosphonate administered by IV injection once per year; also associated with highest incidence of osteonecrosis of jaw
Zoledronic Acid
Not altered by use of NSAIDs or glucocorticoids in RA
Disease progression
Methotrexate, hydroxychloroquine and sulfasalazine are examples of this type of DMARD
Traditional
Class of drugs widely used for the treatment of pain and inflammation, but significant cardiovascular/respiratory/renal/GI contraindications and can cause hypersensitivity reactions skin reactions
NSAIDs
Refers to the response that can occur in people when foreign peptides or proteins are injected
Hypersensitivity
Calcium- receptor sensitizer, acts to lower PTH secretion in chronic kidney disease
Cinacalcet
Ensuring adequate intake of this is a means of decreasing risk for osteoporosis
Vitamin D
Chimeric ( human and mouse) monoclonal antibody directed against TNF- alpha that can be administered IV every 6 weeks as a biologic DMARD
Infliximab
Anti-TNF- biologic DMARD, this is humanized monoclonal antibody administered subq every 2 weeks; also used for psoriatic arthritis, ankylosing spondylitis Crohns disease ; top selling drug in the world ( Humera))
Adalimumab
JAK3 antagonist used as a biologic DMARD, novel in that it is orally active
Tofacitinib
Poorly soluble end product of purine, metabolism in humans, cause of kidney stones
Uric Acid
Glucocorticoids, prednisolone prodrug, short-term use is useful in therapy for RA until DMARD effects are seen
Prednisone
Refers to receptor activator of nuclear factor kappaB ligand, its ratio to OPG in the bone microenvironment governs the formation/activation of osteoclasts
RANKL
Dexamethasone, betamethasone and triamcinolone are among the______ prednisolones, which have much greater potency and/or half-time than natural hydrocortisone
Fluorinated
Blocks urate reabsorption by URAT1 transporter in proximal tubule to increase fractional excretion of filtered urate in urine
Probenacid
Along with chondroitin, widely used in hope of treating osteoarthritis but little evidence of benefit beyond placebo effect
Glucosamine
Route of administration required whenever administering peptides, antibodies, or fusion proteins
Parenteral
Parenteral route for administration of calcitonin- salmon
Intranasal
Accumulates outside of the cells as a consequence of AICAR accumulation inside cells due to the action of polyglutamated methotrexate; binds to purinergic GPCR on cell surface to exert anti-inflammatory response
Adenosine
Never do this with biologic DMARDs
Combine Them
Dietary supplements for adolescents, postmenopausal women and elderly to treat mild hypocalcemia ( to facilitate bone growth or limit bone loss)
Calcium Salts
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
Relieves inflammation from gout if administered w/in 12-24 hours of symptom onset by blocking the tubulin polymerization (microtubule formation) needed by leukocytes for migration and phagocytosis
Colchicine
Allopurinol is among the widely used drugs that can cause this potentially fatal syndrome of epidermal necrolysis
Stevens Johnsons Syndrome
1-34 PTH, only agent that forms bone but must be administered in a PULSED manner…otherwise leads to bone resorption
Teriparatide
Drug class associated with atypical bone fractures
Bisphosphonates
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
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
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
Word applying to pain in joints that suggests a systemic disease such as RA
Bilateral
Fusion protein made from Fc portion of IgG and two TNF receptors, a biologic DMARD administered 1-2x wk by sc injection also used for psoriasis
Etanercept
Refers to 1, 25 dihydroxy vitamin D, a hormone of calcium homeostasis that increases Ca2+ absorption from gut and reabsorption in kidney
Calcitriol
Gouty form of this is due to precipitation of uric acid in tubules if acute and, if chronic, interstitial accumulation of monosodium urate
Nephropathy
A classic NSAID with COX-1 selective, remains a drug of choice for treating acute gouty arthritis
Indomethacin
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
Increases the risk for developing gout
Hyperuricemia
NSAID ingredient of topical gel that is perhaps the most effective topical pain remedy for osteoarthritis
Diclofenac
Hormone that acts to lower free Ca2+ levels in the plasma, does this in part by suppressing bone breakdown
Calcitonin
Type of therapy for prostate cancer that increase patient risk for developing osteoporosis
Androgen Deprivation
Disrupts pyrimidine synthesis, a second-choice traditional DMARD due to greater prevalence of more serious adverse effects
Leflunomide
Damage to serious side effect of hydroxychloroquine, but little risk from low doses now used to treat RA
Retinal Damage
General name referring to infections more commonly seen in patients using a biologic DMARD
Opportunistic
Uricoduric agent acting similar to probenecid, both require GFR>60 ml/min
Sulfinpyrazone
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 of urate overproduction
Allopurinol
SERM with agonist effects on bone but not breast or uterus that is used to treat osteoporosis
Raloxifene
Mammalian enzyme that converts uric acid to allantoin, in mutated/nonfunctional in humans
Uricase
Refers to gout needing a management plan that lowers plasma urate levels
Recurrent
______ urate forms negatively birefringent needle- shaped crystals that can precipitate in and around joints, ear helices, soft tissue, etc, and can impale neutrophils during phagocytosis
Monosodium
Abundant evidence shows people can have this type of predisposition for gout
Genetic
For gout, low-dose colchicine or low-dose NSAIDs can be administered with this as a goal
Prophylaxis
Large aggregations of monosodium urate crystals surrounded by intense inflammatory reaction including large foreign- body giant cells; pathogonomic hallmark of gout
Tophi
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
Patients with pain due to RA 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
