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315 Cards in this Set
- Front
- Back
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What determines the symptoms of epilepsy
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Site of electric discharge
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Epileptic seizures may cause convulsions if what part of the brain is involved
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Motor Cortex
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Visual, Auditory, or Olfactory hallucinations may occur if what part of the brain is involved
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Parietal or occipital cortex
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T or F: Although drug therapy is the most widely effective mode of treatment of epilepsy, it is NOT 100% effective in all pts
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True
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Why is drug therapy for is not 100% for all epileptic pts
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poor pt adherence and complicated by drug interactions
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In what % of epilepic pts can seizures be completely controlled
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50%
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T or F: epilepsy usually has no identifiable cause
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True
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The areas that are functionally abnormal in the brain, may be triggered by what environmental factors
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Blood gases, pH, electrolytes, or glucose availability
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What is idiopathic or primary epilepsy
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Has no specific anatomic cause
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Secondary epilepsy involves reversible disturbances such as
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tumors, head injury, hypoglycemia, meningeal infection, or rapid withdrawal of alcohol
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Simple partial seizure is caused by neurons exhibiting abnormal electtrical activity in how many locuses
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Single
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Does the electrical discharge spread to other parts of the brain in simple partial seizure
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No
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Does the patient lose consciousness in simple partial seizure
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No
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Where is abnormal activity exhibited in a pt with a simple partial seizure
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Single limb or muscle group that is controlled by the region of the brain experiencing the problem
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What symptoms does the pt exhibit in a complex partial seizure
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Complex sensory hallucinations, mental distortion, loss of consciousness, motor dysfunction
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Motor dysfunctions involving what areas are present in pt w/ complex partial seizure
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chewing movements, diarrhea, urination
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What are the subtypes of partial seizures
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Simple partial and complex partial
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Do generalized seizures spread
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Yes
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Where do generalized seizures spread to
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throughout both hemispheres
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Are generalized seizures convulsive
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May be convulsive or noncunvulsive
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Does the patient lose consciousness in generalized seizures
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Yes, usually immediately
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What is the most commonly encountered and the most dramatic form of epilepsy
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Tonic-clonic (grand mal)
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Describe the presentation of tonic-clonic seizure
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Loss of consciousness, followed by tonic (continuous contraction) and then clonic (rapid contraction and relaxation). This is followed by period of confusion and exhaustion
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Describe the loss of consciuosness exhibitied by someone having an Absence (petit mal) seizure
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brief, abrupt, and self-limiting loss of consciousness
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Pts in what age group usually experience absence seizures
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3-5 y/o
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T of F: Absence seizures last until puberty
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True
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What facial signs does pt exhibit in an absence seizure
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Stare, rapid eye-blinking which lasts 3-5 seconds
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Describe Myoclonic seizures
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short episodes of muscle contractions that may reoccur for several minutes
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Who experiences febrile seizures
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Young children (3mos - 5yrs)
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Describe febrile seizures
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Seizure with illness accompanied by high fever. Generalized tonic-clonic convulsions, rarely require meds
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What seizures are rapidly recurring
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Status epilepticus
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What are subtypes of generalized seizures
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Tonic clonic (Grand mal)
Absence (Petit mal) Myoclonic Febrile Status Epilepticus |
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List three mechanisms employed by antiepileptic drugs
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Blockade of volage gated channels
Enhancement of inhibitory GABAergic impulses Interference with excitatory glutamate transmission |
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What is a major consideration in the selection of an anti-epileptic drug
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Toxicity
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Why is monotherapy instituted with a single agent until seizures are controlled or toxic signs occur
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B/c pts on monotherapy show better compliance and fewer side effects
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What happens when seizures are not controlled with one drug
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monotherapy with an alternative antiepileptic drug is administered before a combo of drugs is tried
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T or F: when therapy with one drug is ineffective, a second drug may be added to the therapeutic regimen
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True
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Can therapy be terminated abruptly for tonic clonic seizures
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No, because seizures may result
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What is the drug of choice for initial tx of tonic-clonic and partial seizures
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Phenytoin
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What is the mechanism of action of Phenytoin
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It blocks voltage gated sodium channels
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At higher concentrations, phenytoin can block what type of voltage dependent channels
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Calcium (this interferes with release of monoaminergic neurotransmitters)
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Is Phenytoin a generalized CNS depressant like the barbiturates
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No
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Does phenytoin produce some degree of drowsiness and lethargy
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Yes
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Is phenytoin effective for absence seizures
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No
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T or F: Absence seizures may worsen if treated with Phenytoin
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True
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Chronic administration of Phenytoin is through what route
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Oral
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In status epilepticus, Phenytoin is given through what route
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IV, in the form of Fosphenytoin
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What parts of the CNS system are depressed with Phenytoin and side effects can this cause
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Cerebellum and vestibular system --> Nystagmus and ataxia
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What side effect may be elicited by Phenytoin in Children, that slowly regresses after termination of therapy
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Gingival Hyperplasia
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What type of anemia occurs as a result of Phenytoin tx and why
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Megaloblastic, b/c the drug interferes with reaction for which vitamin B12 is a cofactor
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What happens to the facial features in children taking Phenytoin
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Coarsening
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Phenytoin causes inhibition of insulin secretion which in turn has what effect on ADH
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Inhibition
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What teratogenic syndrome does Phenytoin cause
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Fetal hydantoin syndrome
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Fetal hydantoin syndrome includes what abnormalities
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Cleft lip, cleft palate, and congenital heart disease
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T or F: Almost half of untreated epileptic women have an increased seizure freequency during pregnancy which can lead to anoxic episodes, which yield a higher incidence of congenital birth defects
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True
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What is the mechanism of action of Carbamazepine
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Blocks sodium channels
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Carbamazepine is highly effective for what types of seizures and is often the drug of choice
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Partial
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What drug has been used to treat trigeminal neuralgia and in manic depressive pts
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Carbamazepine
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Chronic administration of carbamazepine can cause what types of side effects
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Stupor, coma, respiratory depression
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What type of blood dyscrasias can carbamazepine cause
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Leukopenia, aplastic anemia, serious liver toxicity
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What tests should be routinely performed on someone taking Carbamazepine
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Blood and liver function tests
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Mechanism of action of phenobarbital
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Unknown
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T or F: Doses required for antiepileptic action are higher than those that cause pronounced CNS depression
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False, doses are lower
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What seizures is Phenobarbital used for
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Simple partial
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Is phenobarbital effective in treating complex partial seizures
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No
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Phenobarbital is used to treat recurrent ______ seizures, esp in pts who do not respond to diazepam plus phenytoin
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Tonic-clonic
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What drug can be used as a mild sedative to relieve anxiety
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Phenobarbital
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What drugs are superior to Phenobarbital in relieving anxiety
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Benzodiazepines
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Adverse side effect of phenobarbital
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Sedation
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what anti-epileptic drug is structurally related to phenobarbital
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Primidone
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Primidone is often used with what 2 drugs, allowing smaller doses
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Carbamazepine and phenytoin
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What drug is most effective against myoclonic seizures
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Valproic Acid
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T or F: Valproic acid is a 2nd line drug of myoclonic seizures due to its hepatotoxic potential
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True
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What adverse side effects can Valproic acid have on blood
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Thrombocytopenia + inhibition of platelet aggregation --> increased bleeding time
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What is the first drug of choice in absence seizures
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Ethosuximide
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Which benzodiazepine is used for chronic treatment of status epilepticus
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Clonazepam
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What 2 benzodiazpines are used for acute tx of status epilepticus and are effective in interrupting the repetitive seizures of
status epilepticus |
Diazepam and lorazepam
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Does diazepam or lorazepam have a longer duration of treatment
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Lorazepam
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What side effects do all benzodiazepams have
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sedative effects: drowsiness, somnolence, and fatigue
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What drug is reserved for use in refractory epilepsies, esp Lennox-Gestault
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Felbamate
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What property of Gabapentin minimize the potential for drug interactions
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it does NOT bind to plasma proteins and is excreted unchanged through the kidneys
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What drug has been shown to alleviate diabetic neuropathic and posherpatic pain
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Gabapentin
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Oligohidrosis has been reported in children taking this antiepileptic Rx
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Zonisamide
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What should children on Zonisamide be monitored for
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Increased body temp and decreased sweating
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What blood test provides a measure of how well treatment has normalized blood glucose in Type 1 diabetics
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HbA1C
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T or F: In contrast to pts with Type 1 diabetes, those with type 2 are often obese
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True
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T or F: Weight reduction, exercise, and dietary modification increases insulin resistance
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False: decreases
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Which cells decline in function as type 2 diabetes progresses, increasing the need for insulin tx
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Beta cells
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What has a stronger effect on insulin secretion by the pancreas, IV glucose or oral glucose
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Oral
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What is more widely used, human or beef/pork insulin
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Human
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How is human insulin produced
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Recombinant DNA tech using special strains of E. Coli or yeast
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Does all human insulin have the same pharmacokinetic properties
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No
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What 3 human insulins have a faster onset and a shorter duration of action than regular insulin because they do not aggregate or form complexes
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Lispro, Aspart, and glulisine
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What 2 human insulins are long-acting and show prolonged, flat levels of the hormone following a single injection
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Insulin glargine and insulin detimir
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In hyperglycemic emergency, regular insulin is injected through what route
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IV
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Why has continuous subcutaneous insulin infusion become popular
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because it does not require multiple injections
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Most common and serious adverse reactions to insulin overdose
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hypoglycemia
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T or F: Long term diabetics often do not produce adequate amounts of counterregulatory hormones (glucagon, epi, cortisol, and GH)
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True
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T or F: It is important that any change in insulin tx be made cautiously w/ strict attention paid to the dose
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True
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What type of insulin is regular insulin
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Rapid onset, short-acting
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What type of insulin is safely used in pregnancy
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Regular insulin
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What types of insulin fall under category of rapid onset, ultrashort-acting
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lispro, aspart, glulisine
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When is Lispro usually administered
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15 min prior to a meal
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When is glulisine usually administered
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either 15 minutes before a meal or within 20 minutes after starting a meal
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Which glucose analogs are administered to mimic the prandial release of insulin and are not usually used alone, but along w/ a
longer-acting insulin |
Aspart, Lispro, Glulisine
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Which glucose analog is preferred for external insulin pumps because it does not form hexamers
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Lispro
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What type of insulin is Lente
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Intermediate acting
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What is the onset of action and peak effect of Lente insulin in relation to regular insulin
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slower, but sustained for a longer period
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What are the 2 intermediate acting insulins
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Lente and NPH
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What are 3 names of prolonged acting insulin
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Ultralente "extended zinc insulin"
Insuilin glargine Insulin detimir |
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What property is unique of insulin glargine
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Has no peak, producing flat, prolonged, hypoglycemic effect
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What is the injection frequency in standard tx of insulin
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Injection twice daily
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Mean blood glucose and HgbA1c in standard tx of insulin
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225-275 mg/dL, 8-9% of total Hgb
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What is the injection frequency in intensive treatment of insulin
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3+ daily
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Mean blood glucose and HgbA1c in intensive treatment of insulin
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150 mg/dL, 7% of total Hgb
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T or F: Frequency of hypoglycemic episodes, coma, and seizures due to excessive insulin is particularly high with intensive treatment regimens
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True
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T or F: Pts on intensive therapy show a 60% reduction in long-term complications of diabetes - retinopathy, nephropathy, and neuropathy
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True
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T or F: Oral hypoglycemic agents are useful in treatment of patients w/ Type 2 diabetes, but cannot be managed by diet alone
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True
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What pts are most likely to respond well to oral hypoglycemic agents
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Those who develop diabetes after age 40 and has had it <5 yrs.
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T or F: Pts w/ long standing diabetes may require a combination of hypoglycemic drugs
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True
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Should oral hypoglycemic agents be given to pts w/ Type 1 diabetes
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No
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What class of drugs is classified as Insulin secretagogue b/c they promote release of insulin from the Beta cells of the pancreas
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Sulfonylureas
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Name 1st generation sulfonylureas
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Tolbutamine
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Name 2nd generation sulfonylureas
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glyburide
glipizide glimepiride |
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What is the mechanism of action of sulfonylureas
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reduction of serum glucagon and increasing binding of insulin to target tissues and receptors
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Which sulfanylurea drug has the shortest duration of action
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Tolbutamide
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How long do second-generation sulfanylurea agents last
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24 hrs
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What are some adverse effects of sulfonylureas
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Propensity to cause weight gain and hypoglycemia
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What class of drugs can traverse the placenta and deplete insulin from the fetal pancreas
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Sulfonylureas
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Pregnant women with type 2 diabetes should be treated with what
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Insulin
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Describe the onset and the duration of action of Meglitinide analogs
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Rapid onset, short duration of action
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What class of hypoglycemic agents are categorized as postprandial glucose regulators
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Meglitinides
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T or F: the incidence of hypoglycemia tends to be lower in sulfonylureas than meglitinides
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False, higher
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T or F: Weight gain is less of a problem with meglitinides than with sulfonylureas
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True
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What class of hypoglycemic analogs should be used with caution in pts with hepatic impairment
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Meglitinides
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What two classes of oral hypoglycemic drugs improve insulin action by improving target-cell response to insulin
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Biguanides and Thiazolidinediones
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What drug is the only currently available biguanide
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Metformin
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What 3 drugs are classed as an insulin sensitizer
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Metformin, Pioglitazone, and Rosiglitazone
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Does metformin require insulin for its action
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Yes
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Does metformin promote insulin secretion
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No
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Does metformin increase the risk of hyperinsulinemia and therefore the risk of hypoglycemia as much as sulfonylurea agents do
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No
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What is the mechanism of action of Metformin
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It inhibits hepatic gluconeogenesis
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T or F: Excess glucose produced by the liver is the major source of high blood sugar in Type 2 diabetes
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True
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Aside from being a hypoglycemic agent, Metformin has the ability to modestly reduce what?
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Hyperlipidemia (LDL and VLDL dec, HDL inc) and CV mortality
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What drug is considered to be the drug of choice for newly diagnosed Type 2 diabetics
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Metformin
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What rare, but potentially fatal side effect may occur with Metformin
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Lactic acidosis
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Diabetics being treated with what meds should not be given metformin because of an increased risk of developing lactic acidosis
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Heart failure meds
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In addition to the treatment of Type 2 diabetes, what drugs are effective in the treatment of polycystic ovary disease
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Metformin, TZDs
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Another name for Thiazolidinediones (TZDs)
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Glitazones
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What 2 drugs belong to the class of TZDs aka Glitazones
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Pioglitazone and Rosiglitazone
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What is the mechanism of action of TZDs
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Increse insulin sensitivity in adipose tissue, liver, and skeletal muscle
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T or F: Pioglitazone and Rosiglitazone increase HDL levels
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True
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What drug should be added in Type 2 diabetics who do not achieve glycemic control w/ a combo of glyburide and metformin in order to improve glycemic control and lower HgbA1c
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Rosiglitazone
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Pts on TZDs should have what tests done initially and then every 2 months for a year and periodically thereafter
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Liver enzymes due to hepatotoxicity
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Why does weight increase in those pts taking TZDs
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they increase subcutaneous fat and/or fluid retention
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T or F: TZDs can worsen heart failure
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True
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What 2 drugs belong to the alpha-Glucosdase inhibitors
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Acarbose and miglitol
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What is the mechanism of action of alpha-Glucosdase inhibitors
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Delay digestion of carbs, thereby dec glucose absorption
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What 2 drugs work by inhibiting membrane-bound alpha-glucosidase in the intestinal brush border
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Acarbose and miglitol
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As a monotherapy, do alpha-Glucosdase inhibitors cause hypoglycemia
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No
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What sugar is inhibited by alpha-Glucosidase
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Sucrose
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Patients with IBS should not take what drugs due to their adverse effects of flatulence, diarrhea, and abd cramping
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Acarbose and miglitol
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The effect of oral glucose resulting in a higher secretion of insulin than IV glucose is referred to as:
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Incretin effect
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What drug has a 50% polypetide sequence homologous to GLIP-1
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Exenatide
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Through what route is exenatide administered
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Parenterally
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What is the drawback to Exenatide
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Short duration of action, requiring frequent injections
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All of NSAIDS act by inhibiting the synthesis of what
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prostaglandins
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Prostaglandins are sometimes referred to as:
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Eicosanoids
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Do prostaglandins act locally or diffusely on the tissues
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Locally
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What is the primary precursor of prostaglandins and is present as a component of the phospholipids of cell membranes
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Arachidonic acid
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Free arachidonic acid is released from tissue phospholipids by the action of this molecule
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Phospholipase A2
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Name the 2 pathways involved in the synthesis of eicosanoids
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cyclooxygenase and lipoxygenase
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Prostaglandins and thromboxanes are synthesized via what pathway
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Cyclooxygenase
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What are the names of 2 related isoforms of the cyclooxygenase enzymes
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COX-1 and COX-2
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What enzyme is responsible for the physiologic production of prostanoids
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COX-1
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What enzyme causes production of prostanoids that occurs in site of disease and inflammation
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COX-2
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What enzyme is described as "housekeeping enzyme"
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COX-1
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What enzyme regulates normal cellular processes such as gastric cytoprotection, vascular homeostasis, platelet aggregation, and
kidney function |
COX-1
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Lipoxygenases act on arachidonic acid to form what
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Leukotrienes
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T or F: release of TXA2 (thromboxane A2) from platelets triggers the recruitment of new platelets for aggregation
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True
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T or F: Prostaglandins are chemical mediators that are released in allergic and inflammatory processes
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True
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NSAIDS differ in what properties
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antipyretic, analgesic, and anti-inflmmatory activities
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NSAIDS act primarily by inhibiting what enzyme that catalyzes the first step in prostanoid biosynthesis
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Cyclooxygenase
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Long-term tx with COX-2 specific inhibitors and nonspecific NSAIDS have been associated with increased risk of what?
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MIs and Strokes
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What drug is the prototype of traditional NSAIDS
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Aspirin
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T or F: About 15% of pts show intolerance to ASA and may benefit from other NSAIDS
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True
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Name 3 reasons why some newer NSAIDS may be superior to ASA
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Greater anti-inflammatory activity
Less gastric irritation Can be taken less frequently |
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What NSAID is unique in that it irreversibly acetylates and thus inactivates cyclooxygenase
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Aspirin
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Are all NSAIDS eqully potent in their actions
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no
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What drug is useful as an analgesic and antipyretic, but weak as an anti-inflammatory agent
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Acetaminophen
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What chemical is thought to sensitize nerve endings to the action of bradykinin, histamine, and other chemical mediators
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Prostaglandin E2 (PGE2)
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T or F: By increasing PGE2 synthesis, ASA and other NSAIDS repress the sensation of pain
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False: by decreasing
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T or F: Salicylates are used mainly for pain of low to moderate intensity arising from the viscera
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False: arising from integumental structures
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What's superior for management of pain in which inflammation is involved, NSAIDS or opioids
|
NSAIDS
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What occurs when the set-point of the anterior hypothalamic thermoregulatory center is elevated
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Fever
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Pyrogen released from white cells synthesize what chemical
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PGE2
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What NSAID resets the "thermostat" toward normal, but has no effect on normal body temperature
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ASA
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Higher doses of ASA result in what respiratory effect
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Hyperventillation and respiratory alkalosis
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Toxic doses of ASA result in what respiratory effect
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Respiratory paralysis and respiraotry acidosis
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What drug increases gastric acid secretion and diminished mucus protection which may cause epigastric distress, ulceration, and/or hemorrhage
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ASA
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How many ml of blood may be lost in the feces/day at ordinary ASA doses
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3-8 ml
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Are buffered and enteric-coated preparations of ASA helpful against GI problems
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Marginally
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Does TXA2 increase or decrease platelet aggregation
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Increase
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T or F: Low doses (60-80 mg/day) of ASA can irreversibly inhibit TXA2 (thromboxane) production in platelets which persists for the lifetime of the platelet, 3-7 days
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True
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Can platelet synthesize new enzymes, why?
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No, b/c they lack nuclei
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Can platelet synthesize new enzymes, why?
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No, b/c they lack nuclei
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How does ASA prolong bleeding time
|
it decreases TXA2, decreasing platelet aggregation (first step in thrombus formation)
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What prostaglandins are responsible for maintaining renal blood flow
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PGE2 and PGI2
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What drugs prevent the synthesis of PGE2 and PGI2
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Cyclooxygenase inhibitors
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T or F: NSAIDS may cause retention of Na and H2O and may cause edema
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True
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T or F: All NSAIDS can cause Interstitial nephritis
|
False, All EXCEPT Aspirin
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What drug facilitates closure of Patent ductus arteriosus
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ASA
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T or F: Low doses of ASA are used prophylactically to decrease incidence of TIA and unstable angina
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True
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Chronic use of what drug has been shown to decrease incidence of colorectal CA
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ASA
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Is rectal absorption of salicylates fast and reliable
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No, it's slow and unreliable
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When is rectal administration of salicylates warranted
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To vomiting children
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Salicylates exhibit analgesic activity at high or low doses
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Low
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Salicylates exhibit anti-inflammatory activity in high or low doses
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High
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What dosage of ASA has been shown to reduce incidence of recurrent MIs and reduce the mortality in post-MI pts
|
Low (160 mg every other day)
|
|
|
What dose of ASA has been beneficial in the prevention of 1st MI
|
160-325 mg/day
|
|
|
What drug is an organic acid and is secreted into the urine, affecting uric acid excretion
|
ASA
|
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Is uric acid secretion increased or decreased at low doses of ASA
|
Decreased
|
|
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How should ASA be taken in order to diminish GI disturbances
|
w/ food and large volumes of fluid
|
|
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ASA should not be taken for at least how long prior to surgery
|
One week
|
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T or F: when salicylates are administered, anticoagulants may have to be given in reduced dosage
|
True
|
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T or F: in toxic doses, salicyltes cause respiratory depression and a combination of uncompensated respiratory and metabolic acidosis
|
True
|
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Large doses of salicylates uncouple oxidative phosphorylation and the energy normally used for the production of ATP is dissipated as heat, this explains what effect caused by toxic doses of salicylates
|
Hyperthermia
|
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ASA given during viral infx has been associated with increased incidence of ____ syndrome, which is a fulminating hepatitis w/
cerebral edema |
Reye
|
|
|
Reye syndrome is especially encountered in whom
|
Children
|
|
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Children should be given what medication to reduce fever
|
Acetaminophen
|
|
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Mild Salicylate intoxication is called what
|
Salicylism
|
|
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What are characteristics of mild salicylate intoxication
|
Nausea
Vomiting Marked hyperventilation Headache Tinnitus |
|
|
What are characteristics of severe salicylate intoxication
|
All of those w/ mild plus followed by:
restlessness delirium hallucinations convulsions coma respiratory and metabotlic acidosis death from respiratory failure |
|
|
T or F: decreasing the urinary pH enhances the elimination of salicylates
|
False, Increasing pH
|
|
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T or F: in seriuos cases of salicylate intoxication, IV fluids and hemodialysis or peritoneal dialysis is required
|
True
|
|
|
what drugs are propionic acid derivatives
|
Ibuprofen
Ketoprofen Naproxen |
|
|
T or F: propionic acid derivatives have less intense GI effects than ASA
|
True
|
|
|
What drug belongs to the acetic acid derivatives
|
Indomethacin "Indocin"
|
|
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Despite its potency as an anti-inflammatory agent, the toxicity of Indomethacin "Indocin" limits its use to ____ and ____
|
acute gouty arthritis and osteoarthritis of the hip
|
|
|
What drug can be administered IM
|
Ketorolac "Toradol"
|
|
|
Does Diflunisal "Dolobid" have antipyretic properties
|
No
|
|
|
What drug is not metabolized to salicylate and cannot cause salicylate intoxication
|
Diflunisal "Dolobid"
|
|
|
Do traditional NSAIDS inhibit COX-1, COX-2, or both
|
both
|
|
|
Do COX-2 selective NSAIDS have a significant effect on platelets
|
No
|
|
|
What drug is sig more selective for inhibition of COX-2 than COX-1
|
Celecoxib "Celebrex"
|
|
|
Does celecoxib "Celebrex" inhibit platelet aggregation and increase bleeding time
|
No
|
|
|
T or F: the incidence of gastruduodenal ulcers in pts taking celecoxib was less than in pts taking naproxen or ibuprofen
|
True
|
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|
Celecoxib is contraindicated in pts who are allergic to what class of drugs
|
Sulfonamides
|
|
|
T or F: If there is a h/o sulfonamide drug allergy, instead of using celecoxib, use a nonselective NSAID along w/ a proton pump inhibitor
|
True
|
|
|
Does acetaminophen have anti-inflammatory activity
|
No
|
|
|
What are the 2 main properties of acetominophen
|
Antipyretic and analgesic
|
|
|
What is the mechanism of action of acetaminophen
|
It inhibits prostaglandin synthesis in the CNS
|
|
|
Does acetaminophen have an effect on cyclooxygenase in peripheral tissues
|
Very small (accounts for its weak anti-inflammatory activity)
|
|
|
Does acetaminophen affect platelet function
|
No
|
|
|
What is the DOC for children w/ viral infections or chickenpox
|
Acetaminophen
|
|
|
Can acetaminophen be used in pts w/ gout
|
Yes
|
|
|
A portion of acetaminophen is hydroxylated to form _____ , potentially dangerous metabolite that reacts with sulfhydryl groups
|
N-acetylbenzoiminoquinone
|
|
|
With normal therapeutic doses, does acetaminophen have any sig adverse effects
|
No
|
|
|
With large doses of acetaminophen, N-acetylbenzoiminoquinone reacts w/ sulfhydryl groups of hepatic proteins, resulting in what potentially life-threatening condition
|
Hepatic necrosis
|
|
|
What drug can reverse acetaminophen toxicity
|
N-acetylcysteine
|
|
|
What group of drugs have the potential to reduce or prevent joint damage
|
DMARDs
|
|
|
T or F: DMARDS have a long onset of action, sometimes taking 3-4 months
|
True
|
|
|
T or F: No one DMARD is efficacious and safe in every patient and trials of several different drugs may be necessary
|
True
|
|
|
Most experts begin DMARD therapy with what drugs
|
Methotrexate or hydroxychloroquine
|
|
|
Are combination tx of DMARDS safe and efficacious
|
YES
|
|
|
In most combo tx, what DMARD is combined w/ one of the other DMARDs
|
Methotrexate
|
|
|
Methotrexate exhibits what property, accounting for its effectiveness in arthritis
|
immunosuppressant
|
|
|
How often is methotrexate taken for arthritis
|
Once/week
|
|
|
Chronic administration of methotrexate may result in what side effect
|
Cytopenias, particularly decreased WBC count
|
|
|
What drug is an immunomodulatory agent and causes cell arrest of lymphocytes
|
Leflunomide "Arava"
|
|
|
Leflunomide "Arava" has been approved for treatment of what disease
|
Rheumatoid arthritis
|
|
|
T or F: Leflunomide reduces pain and inflammation in RA and appears to slow the progression of structural damage
|
True
|
|
|
Can leflunomide be used as an alternative to methotrexate or as an additional drug in combo tx?
|
Yes
|
|
|
What drugs are classified as DMARDS
|
Methotrexate
Leflunomide Chloroquine Hydroxychloroquine D-penicillamine Gold Salts -Auranofin "Ridaura" |
|
|
What DMARDS are used in the treatment of Malaria
|
Chloroquine and Hydroxychloroquine "Plaquenil"
|
|
|
What DMARDS ahve been shown to slow progresion of erosive bone lesions
|
Chloroquine and hydroxychloroquine "Plaquenil"
|
|
|
What DMARD has serious side effects
|
D-Penicillamine
|
|
|
These DMARDS are taken up by macrophages and suppress phagocytosis and lysosomal enzyme activity
|
Gold salts - Auranofin "Ridaura"
|
|
|
T or F: Gold slts are being used less and less by rheumatologists b/c of the need for meticulous monitoring for serious toxicity
|
True
|
|
|
Name 2 pro-inflammatory cytokines involved in the pathogenesis of RA
|
IL-1b and TNF-alpha
|
|
|
When secreted by synovial macrophages, IL-1b and TNF-alpha stimulate synovial cells to proliferate and synthesize ____ therby
degrading cartilage and stimulating bone resorption |
Collagenase
|
|
|
What 3 drugs decrease the activity of TNF
|
Etanercept "Enbrel"
Infliximab Adalimumab |
|
|
T or F: the combo of etanercept and methotrexate is more effective than methotrexate or etanercept alone in retarding disease
process in RA |
True
|
|
|
T or F: Many experts propose that an anti-TNF drug plus methotrexate be considered as standard therapy for patients w/ RA and psoriatic arthritis
|
True
|
|
|
What anti-TNF drug has been approved for Crohn disease
|
Infliximab "Remicade"
|
|
|
This anti-TNF drug is used in pts w/ inadequte response to 1+ DMARD
|
Adalimumab "Humira"
|
|
|
Elevated levels of ____ in the synovial fluid are involved in the pathologic pain and joint destruction in RA
|
TNF
|
|
|
This drug is an IL-1 receptor antagonist
|
Anakinra "Kineret"
|
|
|
This drug interferes with uric acid synthesis
|
Allopurinol
|
|
|
These 2 drugs increases uric acid excretion
|
Probenecid or Sulfinpyrazone
|
|
|
This drug inhibits leukocyte entry into the affected joint in Gout
|
Colchicine
|
|
|
Name drugs that can treat Gout
|
Allopurinol
Probenecid Sulfinpyrazone Colchicine NSAIDS |
|
|
What can trigger acute gouty attacks
|
Excessive ETOH consumption
Diet rich in purines Kidney disease |
|
|
What NSAID is contraindicated in gout
|
ASA
|
|
|
Chronic gout should be treated with uricosuric drugs that increase the excretion of uric acid and this drug, which is selective
inhibitor of the terminal steps in the biosynthesis of uric acid |
Allopurinol
|
|
|
Does Colchicine prevent the progression of gout to acute gouty arthritis
|
No
|
|
|
This gout drug disrupts the mobility of granulocytes, thus decreasing their migration into the affected area
|
Colchicine
|
|
|
The anti-inflmamtory activity of this drug is specific for gout, alleviating the pain of acute gout within 12 hrs
|
Colchicine
|
|
|
This drug has largely replaced colchicine in the treatment of acute gouty attacks
|
Indomethacin
|
|
|
This drug is currently used for prophylaxis of recurrent gouty attacks
|
Colchicine
|
|
|
Adverse side effects of colchicine
|
Nausea, vomiting, abdominal pain
|
|
|
What drug is NEVER given during a gouty attack because it makes it worsse
|
Allopurinol "Zyloprim"
|
|
|
This drug inhibits the last 2 steps of uric acid biosynthesis that are catalyzed by xanthine oxidase
|
Allopurinol "Zyloprim"
|
|
|
This drug is effective in the treatment of primary hyperuricemia of gout and hyperuricemia secondary to other conditions, after
ChemoRx or in renal disease |
Allopurinol "Zyloprim"
|
|
|
What drugs are administered in acute gouty attacks
|
Colchicine and NSAIDS
|
|
|
These 2 drugs are uricosuric agents that promote renal clearance of uric acid by inhibiting urate reabsorption
|
Probenecid and sulfinpyrazone
|
|
|
What drug is a synthetic analog of the hormone amylin is used to decrease glucose in Type I and II diabetics
|
Symlin
|
|
|
What does insulin due to glycogenesis, lipogenesis, glycogenolysis, gluconeogenesis
|
Accelerates glycogenesis
Increases lipogenesis Decreases glycogenolysis Slows gluconeogenesis |
|
|
The rationale for treatment of diabetics stems from two landmark trials namely
|
DCCT and the UKPDS
|
|
|
What are the 2 quesions The United Kingdom Prospective Diabetes Study (UKPDS) Group addressed in its blood glucose control study
|
Would improved glycemic control in patients with type 2 diabetes prevent clinical complications?
Would treatment with a sulfonylurea, insulin, or metformin have specific advantages or disadvantages? |
|
|
The results of the UKPDS study showed that for every % point decrease in HgbA1c, what also decreased
|
35% in microvascular disease
25% in diabetes related deaths 18% in myocardial infarction |
|
|
What are the ADA recommendations for adults in their control of glucose
|
A1C - <7.0%*
Preprandial plasma glucos - 90-130 mg/dL Peak postprandial plasma -glucose <180 mg/dL |
|
|
2 injection regimen is best for what type of diabetes
|
Type 2 and early Type 1
|
|
|
T or F: Clinical trial results show inhaled insulin to be at least as effective as injected insulin in controlling blood glucose
levels |
True
|
|
|
What is the name of the reusable dry powder inhaler that has been designed for systemic insulin absorption
|
Exubera
|
