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34 Cards in this Set

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DMARDS (disease-modifying anti-rheumatic drugs)
1) gold
2) antimalarial agents
3) chelators
4) cytotoxic agents
gold alter fuuctions and morphology of?
macrophage
gold accumulate in macrophages in the?
inflamed synovium
plasma t 1/2 of gold?
7 days (increases weeks or months)
IM gold
1) Aurothioglucose (Solganal)
2) Gold sodium thiomalate (Myochrysine)
PO gold
Auranofin (Ridaura)
SE of gold
1) dermatitis (most common)
2) stomatitis
3) chrysiasis (bluish-gray pigmentation)
4) bone marrow depression
5) nephrotic syndrome
antimalarial agent?
Hydroxychloroquine (Plaquenil)
mechanism of Plaquenil?
to stabilize lysosomal membrane
SE of Plaquenil?
1) serious damage to retina
2) dermatitis
3) ototoxicity
4) neuromyopathy
Chelator?
D-penicillamine (Cuprimine)
D-penicillamine inhibit enzymes that are?
pyridoxal-dependent; increases pyridoxine requirement
mechanism of D-penicillamine?
may affect immune system
SE of D-penicillamine?
1) loss of taste perception
2) nephrotoxicity
3) myasthenia-like syndrome
4) rash
5) thrombocytopenia
6) leukopenia
cytotoxic agents?
1) Azathioprine (Imuran)
2) Methotrexate (Rheumatrex)
mecahnism of cytotoxic agents?
1) direct anti-infla effect
2) suppress or modify immune response
serious SE of cytotoxic agents?
1) bone marrow depression
2) sterility
3) carcinogenic
4) mutagenic
Why aggressive early tx of cytotoxic agents is beneficial?
becuase it can prevent major manifestations of RA before irreversible damage become prevalent
Which medication of DMARDS has the best benefit-to-risk ratio?
Methotrexane (Rheumatrex)
drugs used in therapy of acute gout attacks?
1) Colchicine
2) NSAIDS
drugs that increase urate excretion?
= uricosurics
1) Probenecid (Benemid)
2) Sulfinpyrazone (Anturane)
drug that decrease uric acid production?
Allopurinol (Zyloprim)
Colochicine?
Alkaloid of Colchicum autumnale
1) Autumn crocus
2) Meadow saffron
Colchicine binds to?
tubulin and disrupts mitotic spindles, causes depolymerization
SE of colchicine
(cells with high rates of division are affected)
1) N/V
2) abdominal pain
3) diarrhea
4) hemorrhagic gastroenteritis
5) vascular damage
6) renal toxicity
7) muscular depression
8) paralysis
Probenecid and Sulfinpyrazone block reabsorption of?
urate in the renal proximal tubule
Probenecid is the prototype inhibitor of?
organic anion secretion (used to increase t1/2 of PCN)
initiation of Probenecid and Sulfinpyrazone may precipitate?
an acute gout attach
(prophylactic use of colchicine or and NSAID can prevent the attack)
mechanism of Allopurinol (Zyloprim)
to inhibit XO (xanthine oxidase)
XO converts?
1) hypoxanthine to
2) xanthine to
3) uric acid
action of Allopurinol?
1) increase [ ] of the more water soluble hypoxanthine and xanthine
2) decrease [ ] of the less soluble uric acid
Allopurinol is generally used in?
severe chronic gout
Allopurinol is used in prevention of hyperuricemia in pts with?
leukemia and some other cancers undergoing chemo with cytotoxic agents
SE of Allopurinol?
1) skin rash
2) GI problems
3) rare - bone marrow depression
4) acute gout attack with initiation of therapy