Wolff: Crossword Flashcards by Maren Osterholt

often the dose-limiting adverse effect when colchicine is

administered for gout prophylaxis

GI distress

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

Anakinra

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

loading dose

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

salmon

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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

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

pregnancy

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

uricosuric

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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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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

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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

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

purines

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

rasburicase

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

overproducer

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

pegloticase

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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

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

TNF-alpha

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

duloxetine

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important non-pharmacological component of rheumatoid

arthritis management

exercise

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sx of malignancy that can be treated with bisphosphanates and furosemide

hypercalcemia

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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

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refers to the use of methotrexate, hydroxychloroquine and

sulfasalazine together to treat rheumatoid arthritis

triple therapy

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autoantibodies present in a majority of RA patients target

arginine residues in proteins that have been converted to a cyclic form of this

citrulline

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

osteonecrosis

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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

zolendronacid

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

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 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

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

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 second-choice traditional | 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

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