NR 565 PHARMACOLOGY WEEK #4
EXAM QUESTIONS WITH COMPLETE
ANSWERS
Most common inflammatory form of arthritis - Answer-Gout
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
RA symptoms - Answer-Pain
Swelling
Warmth
Stiffness
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
Symptoms: Osteoarthritis - Answer-Pain
Bone enlargement
Treatment goals: RA - Answer-Relieve symptoms
Maintain joint function and ROM
Decrease systemic involvement
Delay disease progression
Medications: RA - Answer-NSAIDS
Glucocorticoids
, Conventional DMARDS
Biologic DMARDS
Mechanism of action: Conventional DMARDs - Answer-Immunosuppressant
Inhibits dihydrofolate reductase
Inhibits lymphocyte proliferation
Folate antagonist
Mechanism of action: Bioloic DMARDs - Answer-Inhibits JAK 1,2,3 = disruption of
cytokine and growth factor signaling pathways
Mechanism of action: Targeted DMARDs - Answer-Binds to and inhibits tumor necrosis
factor alpha = decreased inflammation and altered immune response
Medications: Conventional DMARDs - Answer-Methotrexate
Sulfasalazine (azulfidine)
Leflunomide (arava)
Hydroxychloroquine (plaquenil)
Medications: Biologic DMARDs - Answer-Adalimumab (Humira)
Certolizumab pegol (cimzia)
Etanercept (Enbrel)
Golimumab (Simponi)
Medications: Targeted DMARDs - Answer-Tofacitinib
Baricitinib
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
Baseline diagnostic data: Conventional DMARDs - Answer-ALT, AST, serum creatinine
Baseline diagnostic data: Methotrexate - Answer-Chest x-ray, pulmonary + GI status
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
EXAM QUESTIONS WITH COMPLETE
ANSWERS
Most common inflammatory form of arthritis - Answer-Gout
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
RA symptoms - Answer-Pain
Swelling
Warmth
Stiffness
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
Symptoms: Osteoarthritis - Answer-Pain
Bone enlargement
Treatment goals: RA - Answer-Relieve symptoms
Maintain joint function and ROM
Decrease systemic involvement
Delay disease progression
Medications: RA - Answer-NSAIDS
Glucocorticoids
, Conventional DMARDS
Biologic DMARDS
Mechanism of action: Conventional DMARDs - Answer-Immunosuppressant
Inhibits dihydrofolate reductase
Inhibits lymphocyte proliferation
Folate antagonist
Mechanism of action: Bioloic DMARDs - Answer-Inhibits JAK 1,2,3 = disruption of
cytokine and growth factor signaling pathways
Mechanism of action: Targeted DMARDs - Answer-Binds to and inhibits tumor necrosis
factor alpha = decreased inflammation and altered immune response
Medications: Conventional DMARDs - Answer-Methotrexate
Sulfasalazine (azulfidine)
Leflunomide (arava)
Hydroxychloroquine (plaquenil)
Medications: Biologic DMARDs - Answer-Adalimumab (Humira)
Certolizumab pegol (cimzia)
Etanercept (Enbrel)
Golimumab (Simponi)
Medications: Targeted DMARDs - Answer-Tofacitinib
Baricitinib
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
Baseline diagnostic data: Conventional DMARDs - Answer-ALT, AST, serum creatinine
Baseline diagnostic data: Methotrexate - Answer-Chest x-ray, pulmonary + GI status
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
