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NMSP Exam II > Wolff: Crossword > Flashcards

Wolff: Crossword Flashcards

1
Q

often the dose-limiting adverse effect when colchicine is

administered for gout prophylaxis

A

GI distress

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2
Q

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

A

Anakinra

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3
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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4
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

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5
Q

calcitonin from this species has a longer half-life and greater potency than human calcitonin, available as intranasal spray and SC and IM solutions, generally safe…but not used much because other treatments are more efficacious

A

salmon

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6
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; July 2021 guidelines recommend using this after HCQ but before MTX in DMARD-naive patients with low RA disease activity

A

Sulfasalazine

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7
Q

absolute contraindication for treatment of RA with methotrexate, reason to choose hydroxychloroquine instead; sulfasalazine also appears safe

A

pregnancy

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8
Q

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

A

uricosuric

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9
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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10
Q

microscopic canals between the lacunae of ossified bone; 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

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11
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

celexicob

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12
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

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13
Q

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

A

rasburicase

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14
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

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15
Q

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

A

pegloticase

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16
Q

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

A

tocilizumab

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17
Q

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

A

TNF-alpha

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18
Q

SNRI that is being used to treat osteoarthritis with some success, but increased risk of constipation is an issue

A

duloxetine

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19
Q

important non-pharmacological component of rheumatoid

arthritis management

A

exercise

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20
Q

sx of malignancy that can be treated with bisphosphanates and furosemide

A

hypercalcemia

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21
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

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22
Q

refers to the use of methotrexate, hydroxychloroquine and

sulfasalazine together to treat rheumatoid arthritis

A

triple therapy

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23
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

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24
Q

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

A

osteonecrosis

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25
Q

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

A

hydroxychloroquine

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26
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

polyglutamination

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27
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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28
Q

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

A

elderly

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29
Q

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

A

febuxostat

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30
Q

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

A

zolendron acid

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31
Q

methotrexate, hydroxychloroquine and sulfasalazine are

examples of this type of DMARD

A

traditional (non-biologic)

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32
Q 
class of drugs widely used for the treatment of pain and
inflammation, but significant cardiovascular/respiratory/renal/GI contraindications and can cause hypersensitivity skin reactions
A

NSAIDs

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33
Q

refers to the response that can occur in people when foreign peptides or proteins are injected, also common when there is a sulfur group in the drug

A

hypersensitivity

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34
Q

calcium-receptor sensitizer, acts to lower PTH secretion in

chronic kidney disease

A

cinacalcet

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35
Q

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

A

infliximab

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36
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

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37
Q

JAK3 antagonist now classified as a targeted synthetic DMARD, novel in that it is orally active, its class had become an early choice once csDMARD therapy had failed but recent safety alert was published after a large clinical trial revealed that it also increased the risk for heart attacks and strokes

A

tofacitinib

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38
Q

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

A

uricacid

39
Q

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

A

prednisone

40
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

RANK-L

41
Q

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

A

fluorinated

42
Q

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

A

probenecid

43
Q

along with chondroitin, widely used in hope of treating

osteoarthritis but little evidence of benefit beyond placebo effect

A

glucosamine

44
Q

route of administration required whenever administering

peptides, antibodies or fusion proteins

A

parenteral

45
Q

route for administration of calcitonin-salmon

A

intranasal

46
Q

accumulates outside of the cell 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

A

adenosine

47
Q

never do this with biologic DMARDs

A

combine them

48
Q

dietary supplements for adolescents, postmenopausal women and elderly to treat mild hypocalcemia

A

calcium salts

49
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

50
Q

used to treat gout in patients who cannot take NSAIDs; relieves inflammation from gout if administered within 12-24 hrs of symptom onset by blocking the tubulin polymerization (microtubule formation) needed by leukocytes for migration and phagocytosis

A

colchicine

51
Q

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

A

SJS

52
Q

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

A

teriparatide

53
Q

drug class associated with atypical bone fractures

A

bisphosphanates

54
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

55
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

56
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

57
Q

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

A

etanercept

58
Q

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

A

calcitriol

59
Q

a classic NSAID with COX1 selectivity, remains a drug of

choice for treating acute gouty arthritis

A

indomethacin

60
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

61
Q

NSAID ingredient of topical gel that is perhaps the most

effective topical pain remedy for osteoarthritis

A

diclofenac

62
Q

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

A

androgen deprivation

63
Q

disrupts pyrimidine synthesis, a later choice traditional/ conventional synthetic DMARD due to greater prevalence of more serious adverse effects

A

leflunomide

64
Q

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

A

retina

65
Q

uricosuric agent acting similar to probenecid, both require GFR > 60 ml/min and only works for under-excreters

A

sulfinpyrazone

66
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

67
Q

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

A

raloxifene

68
Q

mammalian enzyme that converts uric acid to allantoin,

mutated/nonfunctional in humans

A

uricase

69
Q

_____ urate forms negatively birefringent needle-shaped crystals that can precipitate in and around joints, ear helices, soft tissues, etc., and can impale neutrophils during phagocytosis

A

monosodium

70
Q

how do you treat gout prophylactically?

A

low dose colchicine OR NSAIDs

71
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

72
Q

unlike for cancer chemotherapy with isolated rounds of high dose methotrexate requiring leucovorin rescue, RA is treated with a lose dose at this interval

A

weekly

73
Q

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

A

nephropathy

74
Q

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

A

recurrent

75
Q

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

A

uric acid

76
Q

abruptly doing this with exogenous glucocorticoids can be deadly

A

stopping

77
Q

very effective pain relievers that unfortunately have a high risk of misuse, so generally not used for pain of osteoarthritis

A

opioids

78
Q

emerging class of DMARDs with agents such as tofacitinib

A

targeted specific

79
Q

risk of developing this cancer is decreased in women receiving raloxifene as treatment for osteoporosis

A

breast

80
Q

not altered by use of NSAIDs or glucocorticoids in RA

A

disease progression

81
Q

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

A

vitamin D

82
Q

intense and historically feared during an acute gout attack

A

pain

83
Q

vitamin D generated in skin by sunlight

A

cholecalciferol

84
Q

likely chemical identity of vitamin D added to foods

A

ergocalciferol

85
Q

manner in which teriparatide must be administered to achieve net bone growth rather than resorption

A

pulsed

86
Q

methotrexate, hydroxycholorquine, sulfasalazine, and leflunomide are of this (“traditional”) DMARD class

A

conventional synthetic

87
Q

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

A

gout

88
Q

generally not recommended in 2021 RA treatment guidelines if patient has been in remission for >6 months and DMARDs are tolerated

A

tapering

89
Q

syndrome that includes hypercalcemia and hyperuricemia

A

tumor lysis syndrome

90
Q

kinase blocked by tofacitinib and some newer agents in class, effective but now concerns about increased risk for serious cardiovascular events

A

JAK3

91
Q

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

A

calcitonin

92
Q

classic class of DMARDs now seldom used due to toxicity

A

gold salts

93
Q

long associated with gout, word not in notes, but represented by images in old drawings on intro slide; reduced by recommended lifestyle changes

A

gluttony

94
Q

antimalarial that is also a traditional DMARD used alone or in combination, promoted by July 2021 guidelines to first-choice of DMARD if previously untreated and low disease activity, alters antigen presentation by disrupting lysosomal pH, >2 months of treatment can be needed to see evidence of benefit

A

hydroxycholorquine

NMSP Exam II (17 decks)

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