Wolff: Crossword Flashcards
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 recommended for people prescribed methotrexate and/or sulfasalazine for the treatment of rheumatoid arthritis
folate
needed to hasten the nevertheless slow-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, available as intranasal spray and SC and IM solutions, generally safe…but not used much because other treatments are more efficacious
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; July 2021 guidelines recommend using this after HCQ but before MTX in DMARD-naive patients with low RA disease activity
Sulfasalazine
absolute contraindication for treatment of RA with methotrexate, reason to choose hydroxychloroquine instead; sulfasalazine also appears safe
pregnancy
drugs that lower serum urate levels by increasing its fractional excretion by the kidneys
uricosuric
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 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
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
celexicob
part of dietary intake (e.g., in 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 (e.g., tumor lysis syndrome)
overproducer
PEGylated version of recombinant mammalian uricase use to treat chronic gout in those refractory to conventional therapy
pegloticase
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
tocilizumab
blocking the effects of this inflammatory mediator is a common target when treating RA and various other autoimmune diseases
TNF-alpha
SNRI that is being used to treat osteoarthritis with some success, but increased risk of constipation is an issue
duloxetine
important non-pharmacological component of rheumatoid
arthritis management
exercise
sx of malignancy that can be treated with bisphosphanates and furosemide
hypercalcemia
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
refers to the use of methotrexate, hydroxychloroquine and
sulfasalazine together to treat rheumatoid arthritis
triple therapy
autoantibodies present in a 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
antimalarial 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 rheumatoid arthritis and reason its beneficial effects persist for some time after drug discontinuation
polyglutamination
type of bone that is broken in the atypical femoral fractures (i.e., shaft) 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
zolendron acid
methotrexate, hydroxychloroquine and sulfasalazine are
examples of this type of DMARD
traditional (non-biologic)
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
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
calcium-receptor sensitizer, acts to lower PTH secretion in
chronic kidney disease
cinacalcet
chimeric (human and mouse) monoclonal antibody directed against TNFalpha that can be administered IV every 6 weeks as a biologic DMARD
infliximab
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
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
poorly soluble end product of purine metabolism in humans, cause of kidney stones
uricacid
glucocorticoid, prednisolone prodrug, short-term use is useful in therapy for rheumatoid arthritis 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
RANK-L
dexamethasone, betamethasone and triamcinolone are among the __ prednisolones, which have much great potency and/or half-life than natural hydrocortisone
fluorinated
blocks urate reabsorption by URAT1 transporter in proximal tubule to increase fractional excretion of filtered urate in urine
probenecid
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
route for administration of calcitonin-salmon
intranasal
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
never do this with biologic DMARDs
combine them
dietary supplements for adolescents, postmenopausal women and elderly to treat mild hypocalcemia
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
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
allopurinol is among the widely used drugs that can cause this potentially fatal syndrome of epidermal necrolysis
SJS
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
bisphosphanates
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
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 increase Ca2+ absorption from gut and
reabsorption in kidney
calcitriol
a classic NSAID with COX1 selectivity, 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
NSAID ingredient of topical gel that is perhaps the most
effective topical pain remedy for osteoarthritis
diclofenac
type of therapy for prostate cancer that increases patient risk for developing osteoporosis
androgen deprivation
disrupts pyrimidine synthesis, a later choice traditional/ conventional synthetic DMARD due to greater prevalence of more serious adverse effects
leflunomide
damage to this is a serious side effect of hydroxychloroquine, but little risk from low doses now used to treat RA
retina
uricosuric agent acting similar to probenecid, both require GFR > 60 ml/min and only works for under-excreters
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 or 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,
mutated/nonfunctional in humans
uricase
_____ 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
how do you treat gout prophylactically?
low dose colchicine OR NSAIDs
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
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
gouty form of this is due to uric acid precipitation in tubules if acute, and if chronic, interstitial accumulation of monosodium urate
nephropathy
refers to gout needing a management plan that lowers plasma urate levels
recurrent
poorly soluble end product of purine metabolism in humans, cause of kidney stones
uric acid
abruptly doing this with exogenous glucocorticoids can be deadly
stopping
very effective pain relievers that unfortunately have a high risk of misuse, so generally not used for pain of osteoarthritis
opioids
emerging class of DMARDs with agents such as tofacitinib
targeted specific
risk of developing this cancer is decreased in women receiving raloxifene as treatment for osteoporosis
breast
not altered by use of NSAIDs or glucocorticoids in RA
disease progression
ensuring adequate intake of this is a means of decreasing the risk for osteoporosis
vitamin D
intense and historically feared during an acute gout attack
pain
vitamin D generated in skin by sunlight
cholecalciferol
likely chemical identity of vitamin D added to foods
ergocalciferol
manner in which teriparatide must be administered to achieve net bone growth rather than resorption
pulsed
methotrexate, hydroxycholorquine, sulfasalazine, and leflunomide are of this (“traditional”) DMARD class
conventional synthetic
associated with high serum urate levels (and gluttony), exquisitely painful with big toe being a frequent site
gout
generally not recommended in 2021 RA treatment guidelines if patient has been in remission for >6 months and DMARDs are tolerated
tapering
syndrome that includes hypercalcemia and hyperuricemia
tumor lysis syndrome
kinase blocked by tofacitinib and some newer agents in class, effective but now concerns about increased risk for serious cardiovascular events
JAK3
hormone that acts to lower free Ca2+ levels in the plasma, does this in part by suppressing bone breakdown
calcitonin
classic class of DMARDs now seldom used due to toxicity
gold salts
long associated with gout, word not in notes, but represented by images in old drawings on intro slide; reduced by recommended lifestyle changes
gluttony
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
