Ra And Gout Tx

Front 1

What is the use of NSAIDs in arthritis?

Back 1

1. Adjuvant tx for breakthrough pain

Front 2

What is the MOA of DMARDs?

Back 2

1. Anti-inflammation

2. Immunomodulation

3. Not directly analgesic

Front 3

What is 1o tx for RA?

Back 3

1. Methotrexate

Front 4

What is the MOA of methotrexate?

Back 4

1. Reduction of adenosine degradation--- inhibition of cytokine production

2. Blocks dihydrofolate reductase

3. Inhibition of nucleotide methylation

Front 5

How often is methotrexate given?

Back 5

1. Once weekly

Front 6

What is the pregnancy rating of methotrexate and leflunomide?

Back 6

1. X

Front 7

What is the MOA of leflunomide?

Back 7

1. May decrease activated T cells

2. **Prodrug

Front 8

What are the adverse effects of leflunomide?

Back 8

1. Diarrhea

2. Liver toxicity

3. Increased BP

4. Increased cholesterol

Front 9

What can reduce the GI effects of methotrexate?

Back 9

1. Folic acid

Front 10

What should you avoid if you are taking methotrexate?

Back 10

1. Heavy alcohol drinking

Front 11

What is the effect of cholestyramine on leflunomide?

Back 11

1. Reduces reabsorption

Front 12

How is sulfasalazine metabolized?

Back 12

1. Sulfapyridine is absorbed--- active drug

2. 5-aminosalicylic acid--- no importance

Front 13

What is the sulfasalazine pregnancy rating?

Back 13

1. B, C

2. Better than alternatives

Front 14

What is the bioavailability in oral administration of sulfasalazine?

Back 14

1. 10%

Front 15

What is the use of chloroquine and hydroxychloroquine in RA?

Back 15

1. Antimalarials that have immunomodulatory and anti-inflammatory properties to tx RA

Front 16

What is the oral absorption of chloroquine and hydroxychloroquine?

Back 16

1. Rapid and complete

Front 17

What is combo DMARD tx?

Back 17

1. Methotrexate

2. Sulfasalazine

3. Hydroxychlroquine

Front 18

What is the role of glucocorticoids in RA?

Back 18

1. Low dose--- effective while DMARD tx becomes effective

2. Flare-ups--- 1-2 week course

3. Long-term--- low-dose prednisone to supplement DMARD

Front 19

What are the TNFa blockers?

Back 19

1. Etanercept

2. Infliximab

3. Aalimumab

Front 20

What is adalimumab?

Back 20

1. Fully humanized Ab against TNFa

Front 21

What is infliximab?

Back 21

1. Partially humanized Ab against TNFa

Front 22

What is Etanercept?

Back 22

1. Soluble receptor that binds TNFa

Front 23

What are TNFa blockers usually given with?

Back 23

1. Methotrexate

Front 24

What are the side effects of the TNFa blockers?

Back 24

1. Increased prevalence of bacterial infections

2. Activation of latent TB

Front 25

What is the MOA of abatacept?

Back 25

1. Interferes with T cell function

2. Extracellular domain of CTLA-4

3. Blocks CD80/86 on APCs

Front 26

What is the use of abatacept?

Back 26

1. RA that is refractory to anti-TNFa drugs

Front 27

What is the MOA of rituximab?

Back 27

1. Targets CD20 to reduce B lymphocyte levels

Front 28

What is the use of rituximab?

Back 28

1. RA that is refractory to anti-TNFa agents

Front 29

What is the MOA of tocilizumab?

Back 29

1. Monoclonal Ab against IL-6

Front 30

What drugs cannot be taken with other biologic agents?

Back 30

1. Tocilizumab

2. Tofacitinib

Front 31

What is the JAK inhibitor for RA?

Back 31

1. Tofacitinib

Front 32

What is the use of tofacitinib?

Back 32

1. Tx RA refractory to TNFa blockers

Front 33

What is the 1o drug for flare-up gout pain?

Back 33

1. NSAIDs

Front 34

What is the MOA of colchicine?

Back 34

1. Decreases neutrophil activation and chemotaxis towards sites of inflammation

Front 35

When should urate-lowering tx be used?

Back 35

1. In patients with >= 2 gout attacks/year

Front 36

What is the urate-lowering tx?

Back 36

1. Dietary, weight loss, smoking cessation, exercise

2. Urate-lowering drugs to rate <6 mg/dL

3. Allopurinol, febuxostat, probenedcid, pegloticase

Front 37

What is the MOA of xanthine oxidase inhibitors?

Back 37

1. Inhibit xanthine oxidase--- blocks uric acid produciton

Front 38

What is the 1o XOI?

Back 38

1. Allopurinol--- irreversible inhibitor

Front 39

How is allopurinol cleared?

Back 39

1. Kidney

Front 40

What is the use of febuxostat (XOI)?

Back 40

1. More potent than methotrexate

2. Well-tolerated in patients with allopurinol intolerance

Front 41

What is the uricosuric drug?

Back 41

1. Probenecid

Front 42

What is the MOA of probenecid?

Back 42

1. Blocks URAT1

2. Decreases reabsorption of uric acid in the proximal tubule

Front 43

What is the uricase drug?

Back 43

1. Pegloticase

Front 44

What are the side effects of pegloticase?

Back 44

1. **Anaphylaxis

Front 45

What is the tx escalation for gout?

Back 45

1. XOI--- allopurinol, then febuxostat

2. If serum level not achieved, add probenecid

3. If that doesn't work, add pegloticase