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
antimalarial that is also a traditional DMARD used alone or in combination, alters antigen presentation by disrupting lysosomal pH
hydroxychloroquine
26
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
polyglutamination
27
type of bone that is broken in the atypical femoral fractures (i.e., shaft) seen with bisphosphonate treatment
cortical
28
patient population at greater risk for serious adverse effects of NSAIDs and risk for osteoarthritis
elderly
29
expensive non-purine/noncompetitive xanthine oxidase inhibitor useful for reducing urate levels in those with allopurinol intolerance
febuxostat
30
bisphosphonate administered by IV injection once per year; also associated with highest incidence of osteonecrosis of jaw
zolendron acid
31
methotrexate, hydroxychloroquine and sulfasalazine are | examples of this type of DMARD
traditional (non-biologic)
32
``` 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 ```
NSAIDs
33
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
hypersensitivity
34
calcium-receptor sensitizer, acts to lower PTH secretion in | chronic kidney disease
cinacalcet
35
chimeric (human and mouse) monoclonal antibody directed against TNFalpha that can be administered IV every 6 weeks as a biologic DMARD
infliximab
36
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
37
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
tofacitinib
38
poorly soluble end product of purine metabolism in humans, cause of kidney stones
uricacid
39
glucocorticoid, prednisolone prodrug, short-term use is useful in therapy for rheumatoid arthritis until DMARD effects are seen
prednisone
40
refers to receptor activator of nuclear factor kappaB ligand, its ratio to OPG in the bone microenvironment governs the formation/activation of osteoclasts
RANK-L
41
dexamethasone, betamethasone and triamcinolone are among the __ prednisolones, which have much great potency and/or half-life than natural hydrocortisone
fluorinated
42
blocks urate reabsorption by URAT1 transporter in proximal tubule to increase fractional excretion of filtered urate in urine
probenecid
43
along with chondroitin, widely used in hope of treating | osteoarthritis but little evidence of benefit beyond placebo effect
glucosamine
44
route of administration required whenever administering | peptides, antibodies or fusion proteins
parenteral
45
route for administration of calcitonin-salmon
intranasal
46
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
adenosine
47
never do this with biologic DMARDs
combine them
48
dietary supplements for adolescents, postmenopausal women and elderly to treat mild hypocalcemia
calcium salts
49
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
50
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
colchicine
51
allopurinol is among the widely used drugs that can cause this potentially fatal syndrome of epidermal necrolysis
SJS
52
1-34 PTH, only agent that forms bone but must be administered in a PULSED manner... otherwise leads to bone resorption
teriparatide
53
drug class associated with atypical bone fractures
bisphosphanates
54
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
55
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
56
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
57
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
58
refers to 1,25 dihydroxy vitamin D, a hormone of calcium homeostasis that increase Ca2+ absorption from gut and reabsorption in kidney
calcitriol
59
a classic NSAID with COX1 selectivity, remains a drug of | choice for treating acute gouty arthritis
indomethacin
60
``` 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
61
NSAID ingredient of topical gel that is perhaps the most | effective topical pain remedy for osteoarthritis
diclofenac
62
type of therapy for prostate cancer that increases patient risk for developing osteoporosis
androgen deprivation
63
disrupts pyrimidine synthesis, a later choice traditional/ conventional synthetic DMARD due to greater prevalence of more serious adverse effects
leflunomide
64
damage to this is a serious side effect of hydroxychloroquine, but little risk from low doses now used to treat RA
retina
65
uricosuric agent acting similar to probenecid, both require GFR > 60 ml/min and only works for under-excreters
sulfinpyrazone
66
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
67
SERM with agonist effects on bone but not breast or uterus that is used to treat osteoporosis
raloxifene
68
mammalian enzyme that converts uric acid to allantoin, | mutated/nonfunctional in humans
uricase
69
_____ 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
monosodium
70
how do you treat gout prophylactically?
low dose colchicine OR NSAIDs
71
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
72
unlike for cancer chemotherapy with isolated rounds of high dose methotrexate requiring leucovorin rescue, RA is treated with a lose dose at this interval
weekly
73
gouty form of this is due to uric acid precipitation in tubules if acute, and if chronic, interstitial accumulation of monosodium urate
nephropathy
74
refers to gout needing a management plan that lowers plasma urate levels
recurrent
75
poorly soluble end product of purine metabolism in humans, cause of kidney stones
uric acid
76
abruptly doing this with exogenous glucocorticoids can be deadly
stopping
77
very effective pain relievers that unfortunately have a high risk of misuse, so generally not used for pain of osteoarthritis
opioids
78
emerging class of DMARDs with agents such as tofacitinib
targeted specific
79
risk of developing this cancer is decreased in women receiving raloxifene as treatment for osteoporosis
breast
80
not altered by use of NSAIDs or glucocorticoids in RA
disease progression
81
ensuring adequate intake of this is a means of decreasing the risk for osteoporosis
vitamin D
82
intense and historically feared during an acute gout attack
pain
83
vitamin D generated in skin by sunlight
cholecalciferol
84
likely chemical identity of vitamin D added to foods
ergocalciferol
85
manner in which teriparatide must be administered to achieve net bone growth rather than resorption
pulsed
86
methotrexate, hydroxycholorquine, sulfasalazine, and leflunomide are of this ("traditional") DMARD class
conventional synthetic
87
associated with high serum urate levels (and gluttony), exquisitely painful with big toe being a frequent site
gout
88
generally not recommended in 2021 RA treatment guidelines if patient has been in remission for >6 months and DMARDs are tolerated
tapering
89
syndrome that includes hypercalcemia and hyperuricemia
tumor lysis syndrome
90
kinase blocked by tofacitinib and some newer agents in class, effective but now concerns about increased risk for serious cardiovascular events
JAK3
91
hormone that acts to lower free Ca2+ levels in the plasma, does this in part by suppressing bone breakdown
calcitonin
92
classic class of DMARDs now seldom used due to toxicity
gold salts
93
long associated with gout, word not in notes, but represented by images in old drawings on intro slide; reduced by recommended lifestyle changes
gluttony
94
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
hydroxycholorquine