Week 4 Exam: NR565 / NR 565 (Latest 2026 / 2027) Advanced Pharmacology Fundamentals | Questions & Answers | 100% Correct | Grade A - Chamberlain

Week 4 Exam: NR565 / NR 565 (Latest 2026 / 2027) Advanced Pharmacology Fundamentals | Questions & Answers | 100% Correct | Grade A - Chamberlain Question: Most common inflammatory form of arthritis Answer Gout Question: Characteristics: RA Answer Rapid onset 3:1 in women/men Age 35-50 years at onset Affects hands and feet local and systemic inflammation 60 mins morning joint stiffness Symmetric Elevated ESR Leukocytosis Systemic symptoms Question: RA symptoms Answer Pain Swelling Warmth Stiffness Question: Characteristics: Osteoarthritis Answer Slow onset (years) 1:1 in men/women Age 50 years at onset Affects hands, hips, knees Mild or local inflammation 30 min morning joint stiffness symmetric or asymmetric pattern ESR normal Mild leukocytosis No systemic symptoms Question: Symptoms: Osteoarthritis Answer Pain Bone enlargement Question: Treatment goals: RA Answer Relieve symptoms Maintain joint function and ROM Decrease systemic involvement Delay disease progression Question: Medications: RA Answer NSAIDS Glucocorticoids Conventional DMARDS Biologic DMARDS Question: Mechanism of action: Conventional DMARDs Answer Immunosuppressant Inhibits dihydrofolate reductase Inhibits lymphocyte proliferation Folate antagonist Question: Mechanism of action: Bioloic DMARDs Answer Inhibits JAK 1,2,3 = disruption of cytokine and growth factor signaling pathways Question: Mechanism of action: Targeted DMARDs Answer Binds to and inhibits tumor necrosis factor alpha = decreased inflammation and altered immune response Question: Medications: Conventional DMARDs Answer Methotrexate Sulfasalazine (azulfidine) Leflunomide (arava) Hydroxychloroquine (plaquenil) Question: Medications: Biologic DMARDs Answer Adalimumab (Humira) Certolizumab pegol (cimzia) Etanercept (Enbrel) Golimumab (Simponi) Question: Medications: Targeted DMARDs Answer Tofacitinib Baricitinib Question: DMARD prescribing considerations Answer Obtain baseline CBC w/WBC differential Assess for s/s of infection (TB/hepatitis) and malignancies R/O pregnancy Assess risk for immunocompetence (liver/renal status) Comprehensive H+P to establish baseline Screen for TB Question: Baseline diagnostic data: Conventional DMARDs Answer ALT, AST, serum creatinine Question: Baseline diagnostic data: Methotrexate Answer Chest x-ray, pulmonary + GI status Question: Baseline diagnostic data: Sulfasalazine Answer Chest x-ray, pulmonary + neurological status Baseline diagnostic data: Hydroxychloroquine Answer Ophthalmic exam, cardiac exam w/ ECG Baseline diagnostic data: Leflunomide Answer Chest x-ray, BP + pulmonary status Gout Answer Common type of inflammatory arthritis Increased uric acid levels in the blood Deposits in joints and surrounding tissues in the form of crystals Complications of untreated gout Erosion and irreversible joint damage, renal damage, and tophi ACP recommendations for Gout 1. Corticosteroids, NSAIDs, or colchicine for acute gout 2. Low-dose colchicine for acute gout 3. Avoid long-term urate-lowering therapy after 1st gout attack or in patients with infrequent attacks 4. Discuss benefits, harms, cost, and preferences before initiating urate-lowering therapy Medications for Gout: NSAIDs Naproxen Ibuprofen Dicolfenac Meloxicam Indomethacin Celcoxib Medications for Gout: Corticosteroids Intra-articular injection Use when NSAIDs are contraindicated Medications for Gout: Oral/systemic Colchicine *Use for acute treatment Medications for Gout: Chronic treatment Allopurinol (drug of choice in renal dysfunction) Febuxostat Mechanism of action: Cochicine Exact mechanism unknown Mechanism of action: Allopurinol and Febuxostat Inhibits xanthine oxidase Precautionary considerations: Colchicine Renal/hepatic impairment, biliary obstruction Elderly or debilitated patients Precautionary considerations: Allopurinol Caution in African-American, asian, or Hawaiian/Pacific Islander patients Caution in renal/hepatic impairment Precautionary considerations: Febuxostat Caution in severe hepatic impairment or CVD Side effects: Colchicine N/V/D Cramping Abd. pain Fatigue Headache Pharyngolaryngeal pain Side effects: Allopurinol Rash D/N Pruritus Urticaria Sonmolence Increased ALT/AST Eosinophilia Side effects: Febuxostat Increased LFTs Gout exacerbation Labs: Colchicine CrCL at baseline CBC for long-term use Labs: Allopurinol BUN, CrCL at baseline and periodically with renal infection or disease LFTs with hepatic disease Labs: Febuxostat LFTs at baseline Allopurinol hypersensitivity syndrome Severe, can be life threatening Rash, fever, liver dysfunction, renal dysfunction Stop allopurinol, seek medical attention Don't take antihistamines Adverse reactions: Colchicine Rhabdomyolysis Increased risk in patients who take statins Discuss potential risk of muscle injury Mechanism of action: Urate-lowering drugs/xanthine oxidase inhibitors Treat underlying cause of gout flare-ups Initial Febuxostat therapy Decrease production of uric acid = prevent gout attacks In the beginning, symptoms may flare Colchicine or NSAIDs are given for up to 6 months to prevent flares Uricosuric agents Probenecid Benzbromarone Sulfinpyrazone Lesinurad Probenecid Used for chronic gout Can exacerbate acute episodes Delay treatment until acute attack subsides Allopurinol and Warfarin Allopurinol may delay metabolism of warfarin Warfarin dose should be decreased when allopurinol is added Osteoporosis Decreased bone mineral density and bone mass Changes in quality or structure of bones Increased risk of osteoporotic fractures Osteoporosis treatment goals Slow or stop bone loss Prevent fractures Osteoporosis: Postmenopausal women Inadequate intake of dietary calcium Requires supplementation Osteoporosis: CPGs Men and PM women 50 should be considered for treatment if: Hip or vertebral fracture T-score of -2.5 or less @ femoral neck or spine Low bone mass Medication therapy: Osteoporosis Bisphosphonates Denosumab (RANKL inhibitor) Raloxifene Medications for osteoporosis: Bisphosphonates Alendronate Ibandronate Zoledronic acid Bisphosphonate treatment rank 1st line for PM women with prior hip or vertebral fracture DXA T-score of -2.5 or less Mechanism of action: Bisphosphonates Inhibits osteoclast activity = decreased bone resorption Mediations for osteoporosis: Denosumab (RANKL Inhibitor) Prolia Xgeva Denosumab (RANKL Inhibitor) treatment rank Alternative initial treatment for PM women with osteoporosis and increased risk of fractures Mechanism of action: Denosumab (RANKL Inhibitor) Binds to RANKL decreased osteoclast formation, maintenance and survival = decreased bone resorption Medications for osteoporosis: Estrogen agonist/antagonists Evista Raloxifene Estrogen agonist/antagonist treatment rank Treatment and prevention of osteoporosis in PM women who have contraindications to bisphosphonates and denosumab Mechanism of action: Estrogen agonist/antagonists Selectively binds to estrogen receptors = estrogenic/ anti-estrogenic effects Patient education: Bisphosphonates Wake with full glass of water Remain upright for 30-60 mins (risk of esophagitis) Food prevents absorption Don't eat for 30-60 mins after taking medication Patient education: Denosumab Take 1000mg of Ca++ and 400iu of Vit. D daily Increased immunosuppression Good dental hygeine Increased risk of fracture when medication is d/c Patient education: Reloxifene Adequate intake of Ca++ and Vit. D D/C 72 hours before prolonged immobilization Increased risk of DVT, PE, and thrombotic stroke *Black box warning: venous thromboembolic events in PM women with history of or increased risk of CHD Therapeutic goals: Bisphosphonates Prevent and treat osteoporosis Increase bone density and prevent bone loss Therapeutic goals: Denosumab Prevent fracture Increase bone density Prevent bone injury in patients with metastatic bone lesions Hypercalcemia of malignancy maintain Ca++ levels Therapeutic goals: Raloxifene Prevention and treatment of PM osteoporosis Decrease risk of invasive breast cancer in PM women with osteoporosis or those at increased risk for beast ca Baseline data: Bisphosphonates Axial DXA + height Serum ca++ and vit. d Creatinine level/renal function Pregnancy test Baseline data: Denosumab DXA + height Oral exam Baseline ca++ and vit. d Pregnancy test Baseline data: Raloxifene DXA + height Baseline ca++ and vit. d Mammogram Pregnancy test Monitoring: Bisphosphonates DXA every 1-2 years until stable Periodic ca++, vit. d and creatinine Monitoring: Denosumab DXA every 1-2 years until stable Check height annually Monitor for increased back pain-spinal x-ray to check for vertebral fracture Check ca++, creatinine, magnesium within first 2 weeks Monitoring: Raloxifene DXA every 1-2 years until stable Check height annually Monitor for increased back pain-spinal x-ray to check for vertebral fracture Check weight periodically Yearly mammograms High-risk patients: Bisphosphonates Esophageal/swallowing disorders Creatinine 30-35ml/min Correct decreased ca++ and vit. d before initiating therapy IV form contraindicated in ARF or CrCL 35ml/min High-risk patients: Denosumab Patients with immunodeficiencies Correct ca++ before initiating therapy Caution in decreased ca++, renal function, PTH/thyroid surgery, or malabsorption syndromes High-risk patients: Raloxifene Pregnancy History of venous thrombotic events pharm treatment for osteoarthritis. NSAIDS – inhibit COX1 (aspirin, ibuprofen) COX2-(celexicob) non pharm treatment for osteoarthritis heat, yoga, accupuncture · Complications of untreated gout Can cause erosion and irreversible joint damage, renal damage, tophi treatment of acute gout flare w colchicine Low dose colchicine for acute gout. Colchicine: 1.2 mg intitally, followed by 0.6 mg after 1 hr, maximum 1.8mg total dose colchicine adverse effects diarrhea, nausea, vomiting, cramps, abd, pain, fatigue, HA, pharyngolaryngeal pain colchicine and statin should be avoided - muscle injury/rhabdo colchicine pt education low sperm count, avoid in pregnancy, avoid grapefruit, increased side effects 65yo, don't take with statin long term tx of gout allopurinol allopurinol can cause rash, Stephen Jhonson's syndrome allopurinol drug interactions aspirin, warfarin antibiotics, ACEI NSAIDS/colchicine should be administered with febuxostat NSAIDS BB warning risk for heart attack or stroke, (HTN), GI bleeding NSAIDS MOA Reversibly inhibit COX-1 & COX-2 Block prostaglandin synthesis. NSAIDS drug interactions anticoagulants, glucocorticoids, alcohol, other NSAIDs What baseline diagnostics are needed for all DMARDs HBV and TB screen, lipid panel, ALT/AST Therapeutic response of methotrexate for OA folate antagonist, inhibits DNA synthesis and cellular replication, acts faster than all other DMARDS (3-6 wks) methotrexate first choice Dmard, except in pregnancy Osteoporosis-Alendronate-Patient education · take w water sitting/standing upright 30 MIN/ DONOT TAKE W FOOD OR EAT FOR 30MIN o Ibandronate - supplement that interferes w apsorption aluminum, magnesium, iron, calcium, antacids Rheumatoid Arthritis - treatment during pregnancy NSAIDS, corticosteroids, some DMARDS, hydroxychloroquine What is a DMARD Disease Modifying Anti Rheumatic Agent DMARD examples Cyclosporine (Neoral) Cyclophosphamide (Cytoxan) Gold injections (Myochrysine) Hydroxychloroquine (Plaquenil) Leflunomide (Arava) Methotrexate (Rheumatrex and Trexall) Minocycline (Minocin) Sulfasalazine (Azulfidine)