Exam 10 Pharmacology Part II

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Arthritis
In osteoarthritis, what class of enzymes is most important in the initiating steps? 
For osteoarthritis, NSAIDs are used for initial pain relief. If that doesn't work, name a mu receptor agonist that might be used. 
What class of drug might you inject into a joint to relieve pain and inflammation from osteoarthritis? 
Name something you might inject into an arthritic joint to increase lubrication of the joint, relieve pain, and decrease joint damage 
The presence of crystals of what substance in synovial fluid is diagnostic for gout? 
True or false: Hyperuricemia is diagnostic for gout 
Name a drug that, if given early in an attack, can treat an exacerbation of gout by inhibiting microtubule assembly and thereby inhibiting leukocyte activation and migration 
What class of drug is used most often to treat an acute attack of gout? 
Name a member of the class referred to above that also increased urate excretion by the kidney 
For chronic gout, name a drug that inhibits xanthine oxidase and reduces uric acid synthesis 
Name a uricosuric, a drug that increases renal clearance of urate by inhibiting its reabsorption 
Which of the drugs that you just named also has anti-thrombotic activity by inhibiting platelet aggregation? 
Name the DMARD that is the first line of treatment for RA and both inhibits dihydrofolate reductase and induces adenosine release 
If a patient cannot tolerate the drug you just named, what is a good second choice? Hint: also used to treat mild IBD 
Name a modulator of cytokine secretion that also inhibits lysosomal enzyme release and inhibits macrophage function that is used to treat RA 
Name a pyrimidine synthesis inhibitor that is as effective as the first line DMARD 
Name a calcineurin inhibitor that is used for refractory RA cases because of its toxicity 
Name a humanized (not chimeric!) monoclonal antibody that binds to TNF alpha and is used to treat RA and IBD resistant to infliximab 
Name a recombinant TNF alpha receptor fused to the Fc region of immunoglobulin 
Name an immunoglobulin fusion protein that binds to APCs and blocks T cell activation 
Name a recombinant IL-1 receptor antagonist that must be given once daily by injection 
Pain
What is the general term for a derivative of arachidonic acid, including thromboxane A2, prostaglandins, prostacyclins, and leukotrienes? 
This drug's ability to prevent platelets from adhering is due to its irreversible inhibition of cyclooxygenases - the platelets, without a nucleus, can't regenerate the enzyme, so no thromboxane A2 is produced for the life of the cell 
Giving aspirin as an antipyretic in anyone under 18 for a viral infection can cause this complication 
A possible side effect of NSAID use is an increase in this asthma-inducing group of molecules due to the inhibition of prostaglandin synthesis 
Name a non-selective, OTC NSAID that is a potent inhibitor of COX-1 and COX-2 
Name a drug with the same characteristics as above available by prescription 
Name a weak, reversible inhibitor of cyclooxygenases that works mainly in the CNS 
Name a partially selective NSAID that reversibly inhibits COX-2 to a greater degree than COX-1 
Name the only relatively selective, reversible COX-2 inhibitor left on the market 
NSAID use can cause water weight gain because PGE2 works in the kidney to antagonize what hormone released from the posterior pituitary? 
Osteoporosis
At what T-score should a person be medicated for osteoporosis (assume no fractures to date)? 
What is the condition called when a person's bone density falls between normal and osteoporotic? 
What event experienced by aging females triggers a period of accelerated bone loss (3-5% per year)? 
What two components of a normal diet can be administered to help prevent osteoporosis? 
Name a synthetic calcitonin analog that inhibits osteoclast-mediated bone resorption 
What class of drugs consists of pyrophosphate analogs that inhibit osteoclast action and induce osteoclast apoptosis? 
Name a drug fitting the above description 
What hormone can be administered to reduce bone loss in postmenopausal women? 
Name a formulation of the above hormone 
Name a SERM that has the same effect as the above preparation without endometrial activity 
Name the only drug FDA approved to actually stimulate bone formation 
Of what hormone receptor is the above-named drug an agonist? 
In addition to stimulating osteoblasts, this drug stimulates the GI absorption and renal reabsorption of what element? 
Denosumab inhibits osteoclast maturation by its activity as a monoclonal antibody against what protein? 

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