NSAIDS
(Ibuprofen, Naproxen, Celecoxib, Aspirin) - CORRECT ANSWER-What is the 1st line tx for arthritis?
Methotrexate - CORRECT ANSWER-DMARD
... [Show More] (non-biologic) of choice for RA?
methotrexate - CORRECT ANSWER-*MOA of what drug:*
Competitive folate analog, blocking dihydrofolate reductase preventing formation of THF, blocking purine biosynthesis - induces apoptosis of lymphocytes
Hepatic impairment, BM suppression, *pre-existing blood dyscrasias* - CORRECT ANSWER-CI for *Methotrexate*(Rheumatrex)
N/V, mucosal ulcers, dose-dependent *hepatotoxicity*, leukopenia, thrombocytopenia - CORRECT ANSWER-What is the SE of Methotrexate (Rheumatrex)?
folic acid - CORRECT ANSWER-What should you give Methotrexate with?
1. Appropriate use: must be under physician experienced
2. Fetal death/congenital abn
3. Renal insufficiency: impaired elimination
4. Myelosuppression, GI toxicity: if combo w/ NSAIDs
5. Pulm toxicity: any time
6. Lymphoma: at low-dose Tx
7. Tumor lysis syndrome: if pt has rapidly growing tumors
8. Fatal skin rxns: w/in days
9. Opportunistic infection
10. Soft tissue necrosis, osteo-necrosis: if w/
Radiotherapy - CORRECT ANSWER-What are the BBW for Methotrexate?
Methotrexate (Rheumatrex)
Sulfasalazine (Azulfidine)
Janus Kinase inhibitor (Xeljanz) - CORRECT ANSWER-What are the DMARD (NON-biologics)?
PO - CORRECT ANSWER-What is the route of admin of Sulfasalazine (Azulfidine)?
*UC, Crohn's disease, RA*, juvenile arthritis, ankylosing spondylitis - CORRECT ANSWER-CU of Sulfasalazine (Azulfidine)?
Decrease inflammatory response, inhibits prostaglandin synthesis - CORRECT ANSWER-MOA of Sulfasalazine (Azulfidine)
*oligospermia* - CORRECT ANSWER-main *SE* of *Sulfasalazine (Azulfidine)*
Abatacept (Orencia)
TNF- alpha blockers (Humira, Remicade, Enbrel) - CORRECT ANSWER-What are the DMARD *biologics*?
IV, SQ - CORRECT ANSWER-What is the ROA of Abatacept (Orencia)?
*Prevent T cell activation
- immunosuppressive* - CORRECT ANSWER-MOA of Abatacept (Orencia)
-Adalimumab (Humira)
-Infliximab (Remicade)
-Etanercept (Enbrel) - CORRECT ANSWER-What are the *TNF-alpha blockers*?
*Adalimumab (Humira)*
*Etanercept (Enbrel)* - CORRECT ANSWER-What TNF-alpha blocker(s) is given *SQ*?
*Infliximab (Remicade)* - CORRECT ANSWER-What TNF-alpha blocker(s) is given *IV*?
Recombinant human immunoglobulin G1 monoclonal Ab - *blocks TNF-alpha* (decrease inflammatory response) - CORRECT ANSWER-What is the MOA of the TNF-alpha blockers?
(Humira, Remicade, Enbrel)
**BBW: Serious risk for infection and lymphoma and other malignancies, some fatal reported in children and adolescents. - CORRECT ANSWER-What is BBW for Adalimumab (Humira)?
***BBW!!!! High risk for serious pulmonary, extrapulmonary tuberculosis, invasive fungal infections; some infections have been fatal
May cause Lymphoma and other malignancies, some fatal in children and adolescents treated with TNF blockers. - CORRECT ANSWER-What is the BBW for Infliximab (Remicade)?
BBW!!! Serious risk of infection + lymphoma and other malignancy,
fatal reported in children - CORRECT ANSWER-What is BBW for Etanercept (Enbrel)?
*Tofacitinib (Xeljanz)* - CORRECT ANSWER-What is the *Janus Kinase Inhibitor*?
PO - CORRECT ANSWER-what is the ROA of *Tofacitinib (Xeljanz)* - Janus Kinase Inhibitor?
Inhibit cytokine + growth factor JAK STAT (Janus kinase signal transducing and translation activator) signaling - CORRECT ANSWER-what is the *MOA* of *Tofacitinib (Xeljanz)* - Janus Kinase Inhibitor?
Serious risk of infection + lymphoma and other malignancy, increased in renal/other transplant pts - CORRECT ANSWER-What is the *BBW* of *Tofacitinib (Xeljanz)* - Janus Kinase Inhibitor?
Colchicine - CORRECT ANSWER-CU of what gout drug:
-Acute gout attack, give w/in 24 hrs
-*IF pt continues to have gouty attacks.. give this*
Colchicine - CORRECT ANSWER-Pt is taking OTC naproxen for Gout treatment, but is only getting minimal relief. What would be the best thing to prescribe this pt?
Colchicine - CORRECT ANSWER-MOA of what drug:
*Anti-inflammatory*, binds intracellular *tubulin + inhibits leukocyte migration* + phagocytosis, inhibits formation of LTB4
*Diarrhea* - CORRECT ANSWER-What is the big *SE of Colchicine* and it is the reason why it is only used acutely?
-Allopurinol (Aloprim)
-Febuxostat (Uloric)
-Pegloticase (Krstexxa)
-Probenecid (Benemid) - CORRECT ANSWER-What are the Antihyperuricemic drugs?
Allopurinol (Aloprim) - CORRECT ANSWER-*First line PROPHYLAXIS* for recurrent gout attacks (cost effective)?
-Allopurinol (Aloprim)
-Febuxostat (Uloric) - CORRECT ANSWER-What are the xanthine oxidase inhibitors?
serum uric acid - CORRECT ANSWER-What do you need to obtain w/in 6 mo of Tx of Allopurinol (Aloprim)?
Febuxostat (Uloric) - CORRECT ANSWER-If allergic to Allopurinol (Aloprim), what should you switch to?
Pegloticase (Krystexxa) - CORRECT ANSWER-What drug's CU:
When standard meds unable to lower uric acid (*REFRACTORY chronic gout*)
IV (q2wks) - CORRECT ANSWER-What is ROA for Pegloticase (Krystexxa)?
Breaks down excess circulating uric acid into allantoin - CORRECT ANSWER-MOA of Pegloticase (Krystexxa)?
BBWs!!!
-Appropriate use
-Anaphylaxis/infusion rxns
-*G6PD associated hemolysis* +
methemoglobinemia - CORRECT ANSWER-BBW for Pegloticase (Krystexxa)?
Probenecid (Benemid) - CORRECT ANSWER-MOA of what drug:
Inhibits reabsorption of uric acid in renal PCT, decreases urate pool + plasma concentration
Indomethacin - CORRECT ANSWER-NSAID of choice for gout
Acetaminophen
(Tylenol) - CORRECT ANSWER-*First line drug for mild OA*
Methylprednisolone Acetate - CORRECT ANSWER-What drug is *Injected* into the joint for pain/inflammation in OA pts?
Non-NSAID Analgesic (Tylenol) NSAIDs (Advil, Aleve, Diclofenac, Celebrex, Mobic), Glucocorticoids (Methylprednisolone Acetate) - CORRECT ANSWER-What are the classes used for osteoarthritis?
thiazide and loop diuretics - CORRECT ANSWER-What drugs can cause gout attacks?
Partial (focal) seizure - CORRECT ANSWER-Generalized or Partial seizure?
-Excessive electrical activity in *one* cerebral hemisphere.
-Affects only part of the body.
Simple Partial - CORRECT ANSWER-What type of Partial seizure:
Person may experience a range of strange or unusual sensations; *memory and awareness is preserved* during the seizure.
Complex Partial - CORRECT ANSWER-What type of Partial seizure:
1. Loss of awareness at seizure onset. Person seems dazed or confused and exhibits meaningless behaviors.
2. Typically originate in frontal or temporal lobes (e.g. Temporal lobe epilepsy)
3. *Loss of memory during seizure*
Myoclonic - CORRECT ANSWER-What type of generalized seizure?
Brief *shock-like muscle jerks* generalized or *restricted to part of one extremity*
Atonic - CORRECT ANSWER-What type of generalized seizure?
Sudden loss of muscle tone
Tonic clonic (grand mal) - CORRECT ANSWER-What type of generalized seizure?
Sudden *stiffening* of the body, arms, or legs followed by *rhythmic jerking movements* of the arms and legs
*Carbamazepine* (Tegretol) - CORRECT ANSWER-Primary TX for *Tonic-clonic* seizures
*Absence* (petit mal) seizure - CORRECT ANSWER-What type of generalized seizure?
Person appears to *"blank out" - "Daydreaming"*
*Ethosuximide* (Zarontin) - CORRECT ANSWER-What is the DOC for an *Absence seizure*?
*Cardiovascular risk w/ rapid infusion* - CORRECT ANSWER-What is the *BBW* for *phenytoin*?
a. Phenytoin (Dilantin)
b. Carbamazepine (Tegretol)
c. Topiramate (Topamax)
d. Lamotrigine (Lamictal)
e. Lancosamide (Vimpat) - CORRECT ANSWER-What are the *Na channel inhibitors* used to treat seizures?
*Gingival hyperplasia*, diplopia - CORRECT ANSWER-What is the important *SE* of *Phenytoin (Dilantin)*?
Levetiracetam (Keppra) - CORRECT ANSWER-MOA of what anti-seizure medication:
synaptic vesicle (SV2A) modulator - decrease neurotransmitter release
-Simple + complex partial seizure
-Generalized myoclonic seizure
-Generalized tonic-clonic seizure - CORRECT ANSWER-What are the CU of Levetiracetam (Keppra)?
Valproic acid (Depakene) - CORRECT ANSWER-DOC in pt w/ concomitant generalized tonic-clonic + absence seizure
diplopia - CORRECT ANSWER-Main SE of Carbamazepine (Tegretol)
*angioedema*, somnolence, edema, suicidal thoughts - CORRECT ANSWER-Main SE of Pregabalin (Lyrica)
*alopecia, tremor* [val has no hair bc he "tremmed" it off] - CORRECT ANSWER-SE of Valproic acid
Lamotrigine (Lamictal) - CORRECT ANSWER-Which anti-seizure medication has SEs that are *dose-dependent* such as diplopia, dizziness, & *steven-johnson syndrome*?
diplopia - CORRECT ANSWER-SE of ethosuximide
-Gabapentin (Neurontin)
-Pregabalin (Lyrica) - CORRECT ANSWER-Which two anti seizure medications can also be used for *neuropathic pain (DM)*, *post-herpetic neuralgia*?
*pruritis*, suicidal thoughts, edema - CORRECT ANSWER-SE of Gabapentin (Neurontin)
Carbemazepine
Phenytoin
Valproate - CORRECT ANSWER-*Conventional AED* for Simple/Complex Partial Seizure?
Carbemazepine
Phenytoin
Valproate - CORRECT ANSWER-*Conventional AED* for Complex Partial Seizure?
Ethosuximide
Valproate
Clonazepam - CORRECT ANSWER-*Conventional AED* for Absence Seizure (generalized)
Valproate
Clonazepam - CORRECT ANSWER-*Conventional AED* for Myoclonic seizures (generalized)?
Carbemazepine
Phenobarbital
Phenytoin
Primidone
Valproate - CORRECT ANSWER-*Conventional AED* for Tonic-clonic Seizures
Gabapentin
Lamotrigine
Levetiracetam
Topiramate
Lacosamide - CORRECT ANSWER-*New AED* for Simple/complex partial seizures
*Blocks* voltage-dependent *Na channels*; augment *GABA* activity; *antagonize glutamate* receptors, *inhibits carbonic anhydrase* - CORRECT ANSWER-Topiramate MOA?
*weight loss*, somnolence - CORRECT ANSWER-SE of Topiramate (Topamax)
Gabapentin
Lamotrigine
Levetiracetam
Topiramate
Lacosamide - CORRECT ANSWER-*New AED* for complex partial seizures
Lamotrigine - CORRECT ANSWER-*New AED* for Absence seizures (generalized)
Levetiracetam (Keppra) - CORRECT ANSWER-*New AED* for Myoclonic seizures (generalized)
Lamotrigine (Lamictal)
Levetriacetam (Keppra)
Topiramate - CORRECT ANSWER-*New AED* for Tonic-Clonic seizures (generalized)
NSAIDs - CORRECT ANSWER-1st line *NONSPECIFIC* tx for acute migraine HA
(*NASAL*) Triptans - CORRECT ANSWER-What *SPECIFIC TX* should be given for an ACUTE migraine HA if NSAIDS do not work?
-Topiramate (Topamax)
-Valproic Acid (Depakene) - CORRECT ANSWER-What are the antiepileptic agents that can be used for *PROPHYLAXIS* of *migraine HAs*?
-BBs (*Propranolol, Timolol*)
-CCB (*Verapamil*)
-TCAs (*Amitriptyline*)
-Anticonvulsants (*Topiramate, Valproic Acid*)
-Botulinum toxin A
-Butterbur - CORRECT ANSWER-What medications are used for the *prophylaxis* of *migraine HAs*
Other use: Seizures, anxiety, mania
Avoid: Liver dz - CORRECT ANSWER-What other comorbid conditions can Topiramate (Topamax) & Valproic acid (*Anticonvulsants*) treat other than *migraine HA prophylaxis*? What conditions should these be *avoided*?
Other use: HTN
Avoid: Asthma or depression - CORRECT ANSWER-What other comorbid conditions can *Propranolol & Timolol* (*BBs*) treat other than migraine HA prophylaxis? What conditions should these be *avoided*?
Other use: HTN/angina
Avoid: Depression - CORRECT ANSWER-What other comorbid conditions can *Verapamil* (CCBs) treat other than migraine HA prophylaxis? What conditions should this medication be *avoided*?
Other use: Depression
Avoid: Mania - CORRECT ANSWER-What other comorbid conditions can *Amitriptyline* (TCAs) treat other than migraine HA prophylaxis? What conditions should this medication be *avoided*?
*NSAIDs* (indomethaxin, ketolorac, naproxen), *Antiemetics*, *OTC agents* (ASA, ibuprofen, Naproxen) - CORRECT ANSWER-What are the *NON-SPECIFIC* treatments for *ACUTE episodes* of migraines?
1. *Triptans*
2. *Ergotamine*
3. *Dihydroergotamine* - CORRECT ANSWER-What medications are considered *SPECIFIC* for the tx of *ACUTE migraines*?
2 weeks - CORRECT ANSWER-How long should you wait after discontinuing MAOi before administering Triptans?
*pregnancy* (vasoconstriction) - CORRECT ANSWER-When should triptans be *cautioned*?
*CAD* and *PVD* - CORRECT ANSWER-When are triptans *CONTRAINDICATED*?
pts with CAD, PVD, sepsis, pregnancy - CORRECT ANSWER-What are *contraindications* of Ergotamine/Caffeine (Cafergot) & Dihydroergotamine?
triptans and ergotamines - CORRECT ANSWER-If a pt who has migraine HAs also has hx of CAD, what medications are CI?
BBW!!! *Peripheral ischemia* - CORRECT ANSWER-What is the BBW for Ergotamine/Caffeine (Cafergot) & Dihydroergotamine?
NSAIDS (triptans not indicated) - CORRECT ANSWER-What is 1st line med for *tension* type HA?
*ORAL* (not effective for prevention or for acute tx of cluster HA)
*Use SC/IN* - CORRECT ANSWER-What *ROA* of *Sumatriptan* is not effective in prevention of *Acute Cluster HA*?
-100% O2
-Sumatriptan SC/intranasal - CORRECT ANSWER-Pt is currently taking OTC NSAIDs. Pt develops an *Acute Cluster HA*, What would the next treatment therapy be?
*Verapamil* - CORRECT ANSWER-1st line tx for *Prophylaxis of cluster HA* & *Chronic cluster HA*?
NSAIDS - CORRECT ANSWER-Pt has angina/ CAD and has an acute HA, what do you give them?
Triptans - CORRECT ANSWER-MOA of what drugs:
Fast-acting, *serotonin 1B/1D receptor agonists*; constrict intracranial BVs, *suppress* release of *inflammatory neuropeptides*
BBW!!!
1. Life threatening pancreatitis
2. Hepatotoxicity: risk greater for children <2
3. Teratogenic: reports of spina bifida, orofacial - CORRECT ANSWER-What are the BBWs assoc with *Valproic acid*?
drowsiness, sedation - CORRECT ANSWER-What are SE of Clonazepine (Klonopin)?
C. Etanercept (Enbrel) - CORRECT ANSWER-Your patient has rheumatoid arthritis which has been controlled with an NSAID and methotrexate, however, during the past 8 months her hands indicate progressive destruction in the joints of several fingers. Treatment with another second line agent for RA was considered. Which of the following is a DMARD administered SC whose mechanism of action is to block TNF-alpha?
A. Sulfasalazine
B. Infliximab (Remicade)
C. Etanercept (Enbrel)
D. Tofacitinib (Xeljanz)
B. Febuxostat (Uloric) - CORRECT ANSWER-1. A 52 year old woman presented with intense pain, warmth, and redness in the first toe on her left foot. Examination of fluid withdrawn from the inflamed joint revealed crystals of uric acid. Over the next 7 months, the patient had 2 more attacks of acute gout. Her serum concentration of uric acid was elevated. The decision was made to put her on chronic drug therapy to try to prevent subsequent attacks. Which of the following drugs could be used to decrease this woman's rate of production of uric acid?
A. Pegloticase (Krystexxa)
B. Febuxostat (Uloric)
C. Colchicine
D. Probenecid
b. Ethosuximide (Zarontin) - CORRECT ANSWER-A 9 year old child is having learning difficulties at school. He has brief lapses of awareness with eyelid fluttering that occur every 5-10 min. Electroencephalogram (EEG) studies reveal brief 3 Hz spike and wave discharges appearing synchronously in all leads. Which drug would be effective in this child without the disadvantages of excessive sedation or tolerance development?
a. Clonazapam (Klonopin)
b. Ethosuximide (Zarontin)
c. Gabapentin (Neurontin)
d. Phenobarbital
a. Carbamazepine - CORRECT ANSWER-A young male patient suffers from a seizure disorder characterized by tonic rigidity of the extremities followed in 15-30 s of tremor progressing to massive jerking of the body. This clonic phase lasts for 1 or 2 min, leaving the patient in a stuporous state. Of the following drugs, which is most suitable for long term management of this patient?
a. Carbamazepine
b. Clonazepam
c. Ethosuximide
d. Tiagabine
Estazolam (ProSam), Flurazepam (Delmane), Quazepam (Doral), Temazepam (Restoril), triazolam (Halcion) - CORRECT ANSWER-*Benzos* used for Insomnia
Zolpidem (Ambien), Zaleplon (Sonata), Eszopiclone (Lunesta) - CORRECT ANSWER-*Benzo-Like* drugs for insomnia
Supress REM; Used as sedative, hypnotic and for seizures - CORRECT ANSWER-CU of Phenobarbital?
D. Zolpidem (Ambien) - CORRECT ANSWER-1. A 33-year-old woman has recently undergone a divorce. She reports that although she is exhausted, it usually takes her 2 or more hours to fall asleep at night. Which of the following drugs would help relieve her sleep disturbance while being least disruptive to REM sleep?
a. Triazolam (Halcion)
b. Phenobarbital (Nembutal)
c. Alprazolam (Xanax)
d. Zolpidem (Ambien)
1 - CORRECT ANSWER-How many tablets are recommended in the first dose of a triptan?
1 tablet, 2 hours later - CORRECT ANSWER-If patient is continuously having the migraine after 1 tablet of a triptan, when is the next appropriate dose?
2 - CORRECT ANSWER-What is the max amount of Triptan tablets in *24 hours?*
Etomidate or Versed
[both have minimal CV effects] - CORRECT ANSWER-Pt has Hx of CHF, which anesthetic could you use?
3 - CORRECT ANSWER-What is the max amount of Triptan tablets that you can take in *a week?*
Induction of anesthesia; hypnotic, *NO analgesic activity* (nothing for pain) - CORRECT ANSWER-What is the CU of *Etomidate (Amidate)*?
*Etomidate*
[Versed is a benzo; causes resp depression] - CORRECT ANSWER-What anesthetic drug has the *lowest incidence of respiratory depression* between *Etomidate and Versed*?
*Etomidate (Amidate)* - CORRECT ANSWER-What general anesthetic medication has *minimal CV & resp. depression SE*?
Propofol (Diprivan) - CORRECT ANSWER-What general anesthetic medication has *anti-emetic properties* (preferred OP anesthetic)?
IV - CORRECT ANSWER-What is the ROA of Propofol (Diprivan)?
Propofol (Diprivan) - CORRECT ANSWER-Which general anesthetic medication has SEs of *allergic rxn and pain on injection*, also *hiccups* & *twitching*?
Ketamine - CORRECT ANSWER-Which general anesthetic medication is the only one to have *analgesic effects*?
Ketamine - CORRECT ANSWER-Which general anesthetic medication has SE of *serious, excitatory & hallucinatory activity* (cry, hallucinate, scream, etc)?
Midazolam (Versed) - CORRE [Show Less]