POMS DR36 Drug Review

C. The patient likely developed acute gout as a result of mobilization of the urate from joints and tissues. (that's why we always need prophylaxis for acute gout; has to be somthing not steroid)

A 44-year-old man is suffering from recurrent gouty arthritis. His serum uric acid level is elevated, and you prescribe allopurinol. Within 1 week of the allopurinol, he develops a painful episode that "feels like gout." Which of the following is the best explanation? A. The patient is resistant to the allopurinol and should be placed on another medication. B. The patient likely has an arthritis syndrome produced by allopurinol and should have an antinuclear antibody (ANA) drawn. C. The patient likely developed acute gout as a result of mobilization of the urate from joints and tissues. D. This likely represents a drug-drug interaction, and so the allopurinol should be discontinued.

B. Infliximab

A 55-year-old woman is being treated for RA. After 6 months, she notes night sweats, weight loss, chronic cough, and a cavitary lesion. Which of the following medications was most likely prescribed for the RA? A. Gold salts B. Infliximab C. Methotrexate D. Naproxen

B. Pegloticase synthetic uracase: breaks down uric acid not D: needs to be renal dosed not sulfinpyrazone: likes probenecid; cause skin allergy

A 61-year-old male patient has 5-6 painful gouty attacks every year despite being treated with febuxostat. He is highly allergic to probenecid . Which of the following would be the best course of treatment for this patient? A. NSAIDs at maximal doses B. Pegloticase C. Sulfinpyrazone D. Allopurinol

B. Allopurinol not E: probenecid will increase uric acid excretion allopurinol & febuxostat will lower the uric acid in blood

A patient with hyperuricemia is placed on an "antigout" drug. The post‐treatment sample shows a significant reduction in urine uric acid content. What drug most likely accounted for these findings? A. Acetaminophen B. Allopurinol C. Colchicine D. Indomethacin E. Probenecid

COX2 causes inflammation trash heart & cause sulfur allergy

COX isozosyme for prostanglandin synthesis

B. Gastrointestinal and cardiovascular

Celecoxib (Celebrex) is a COX‐2 inhibitor used to treat osteoarthritis. What "black‐box" warning is listed for celecoxib? A. Gastrointestinal and renal B. Gastrointestinal and cardiovascular C. Renal and hepatic D. Hepatic and cardiovascular E. Cardiovascular and neurologic

D. Skin rashes

Celecoxib is a sulfonamide and thus may cause: A. Renal insufficiency B. Increased menstrual pain C. Acute joint pain D. Skin rashes E. Diaphoresis

B. 3 months

How long following administration of a biologic agent do you need to wait to administer any live vaccines? A. 2 months B. 3 months C. 2 weeks D. 3 weeks

A. Binds to TNF-α and sequesters it from receptors

Infliximab does which of the following? A. Binds to TNF-α and sequesters it from receptors B. Is a TNF-α receptor agonist C. Is a TNF-α receptor antagonist D. Is a synovium-specific anti-inflammatory agent

celecoxib diclofenac IbP Naproxen (naproxen most heart protective)

NSAID most to least COX 2 selective

treat arthritis but limited long term use (toxicity)

NSAID, glucocorticoid, DMARDs effect

B. Analgesic but no anti‐inflammatory efficacy

Oral ibuprofen prescribed in lower doses (< 2,400mg/day) has: A. Both analgesic and anti‐inflammatory efficacy B. Analgesic but no anti‐inflammatory efficacy C. Anti‐inflammatory but no analgesic efficacy D. Neither analgesic nor anti‐inflammatory efficacy

A. Dihydrofolate reductase

The immunosuppressive effect of methotrexate is a result of its inhibition of which of these? A. Dihydrofolate reductase B. Leukocyte migration C. Microtubule function D. Phospholipase A2

C. Neutralizes circulating tumor necrosis factor (TNF‐α )

What is the entanercept mechanism? A. Inhibits eicosanoid synthesis by inhibiting phospholipase A2 B. Inhibits leukocyte migration by blocking microtubular formation C. Neutralizes circulating tumor necrosis factor (TNF‐α ) D. Selectively and effectively inhibits COX‐2 E. Stimulates collagen and mucopolysccharide synthesis in the joints

C. GI distress that is almost as bad as the acute gout discomfort

What is the main and most common reason for avoiding colchicine and prescribing another drug for the acute management of gout? A. Bone marrow suppression B. Bronchospasm C. GI distress that is almost as bad as the acute gout discomfort D. Hepatotoxicity

D. TNF inhibitors

What is the most common biologic class used as a treatment for RA? A. Selective costimulation modulators B. Interleukin (IL) ‐6 inhibitors C. IL‐1 antagonists D. TNF inhibitors

E. Probenecid

Which drug has the desired uric acid‐related effects reduced or eliminated by aspirin A. Acetaminophen B. Allopurinol C. Colchicine D. Indomethacin E. Probenecid

B. Adalimumab

Which of the following is a TNF inhibitor: A. Anakinra B. Adalimumab C. Abatacept D. Azathioprine

C. Meloxicam (Mobic)

Which of the following is a selective COX‐2 inhibitor and would be associated with fewer clinical GI symptoms and complications when treating rheumatoid disease? A. Piroxicam (Feldene) B. Diclofenac (Voltaren) C. Meloxicam (Mobic) D. Naproxen (Aleve)

C. DMARDs

Which of the following is used for slow bone damage in rheumatoid arthritis? A. NSAIDs B. Glucocorticoids C. DMARDs

D. Slow, stop, possibly reverse joint pathology in rheumatoid arthritis

Which statement most correctly summarizes how are methotrexate and hydroxychloroquine drugs differ from a typical NSAID? A. Activate the immune system to neutralize inflammatory mediators B. Are remarkably free from serious toxicities C. Provide much quicker relief of arthritis signs and symptoms D. Slow, stop, possibly reverse joint pathology in rheumatoid arthritis

A. Infections with typical and atypical organisms

Which type of adverse effect is the most common in patients receiving tumor necrosis factor (TNF)alpha inhibitors? A. Infections with typical and atypical organisms B. Rash C. Diarrhea D. Hypotension

E: COX2 kicks up IL17 & macrophage differentiation

what is inhbited by COX2 only? A. GI tract function B. Renal tract function C. Platelet function D. Macrophage differentiation E. Inflammation