Musculoskeletal

Question 1

Calcipotriene (calcipotriol), calcitriol, and tacalcitol

Answer 1

Bind to and activate vitamin D receptor (nuclear transcription factor)

Causes inhibition of keratinocyte proliferation and stimulation of keratinocyte differentiation

Inhibits T cell proliferation and other inflammatory mediators

Used in psoriasis

Question 2

Vemurafenib

Answer 2

RAF kinase inhibitor used in melanoma patients with BRAF V600E mutation

Question 21

Leukotrienes

Answer 21

Bronchoconstriction, vasoconstriction, contraction of smooth muscle, and increase vascular permeability

Inhibited by zafirlukast

Question 22

Prostacyclin

Answer 22

Decrease platelet aggregation, decrease vascular tone, decrease bronchial tone, decrease uterine tone
Damaged endothelial cells lose ability to produce prostacyclin predisposing to thrombi and hemostasis

Synthetic used in pulmonary hypertension, peripheral vascular disease, and Raynaud syndrome

Question 23

Prostaglandins

Answer 23

Increase uterine tone
Decrease bronchial tone

Inhibited by NSAIDS, ACETAMINOPHEN and cox-2 inhibitors

Question 24

Thromboxane

Answer 24

Increase platelet aggregation
Increase vascular tone
Increase bronchial tone

Inhibited by NSAIDS, ACETAMINOPHEN and cox-2 inhibitors

Question 25

NSAIDs

Answer 25

Ibuprofen, naproxen, Indomethacin, ketorolac, diclofenac
MOA: reversibly inhibit COX-1 and COX-2 block prostaglandin synthesis

Clinical: antipyretic, analgesic, anti-inflammatory,
Indomethacin used to close PDA
Acute gout

Toxicity: interdigital nephritis, gastric ulcer, renal ischemia,

Question 26

Celecoxib

Answer 26

Selective COX-2 inhibitor
Found in inflammatory cells and vascular endothelium
Maintains gastric mucosa
Spares platelet function

Clinical: rhematoid arthritis, and osteoarthrits

Toxicity: increase risk of thrombosis and sulfa allergy

Question 27

Acetaminophen

Answer 27

Reversibly inhibits cyclooxygenase In CNS

Clinical: antipyretic, analgesics, but not anti inflammatory
Used in children with viral infection

Toxicity: hepatic necrosis (overdose)
Metabolite depletes glutathione and forms toxic tissue

N-acetylacysteine is antidote

Question 28

Bisphosphonates

Answer 28

Alendronate -donates

MOA: pyrophosphate analog. Binds hydroxyapatite in bone inhibiting osteoclasts

Clinical: osteoporosis, hypercalcemia, Paget disease

Toxicity: corrosive esophagitis (remain upright and drink water for 30 mins), osteonecrosis of jaw

Question 29

Allopurinol

Answer 29

MOA: inhibits Xanthine oxidase
Decreases conversion of xanthine to uric acid

Clinical: Gout, lymphoma and leukemia to prevent tumor lysis syndrome associated with urate nephropathy

AE: increased concentrations of azothioprine and 6-MP (normally metabolized by xanthine oxidase)

Do not give salicylates

Question 30

Febuxostat

Answer 30

Inhibits Xanthine oxidase

Chronic gout

Question 31

Probenicid

Answer 31

Inhibits reabsorption of uric acid in proximal convoluted tubule

Chronic gout

Question 32

Colcichine

Answer 32

MOA: binds and stabilizes Tubulin and inhibits microtubule polymerization
Impairs leukocyte chemotaxis and degranulation

Acute and prophylactic gout, used with renal failure and or peptic ulcer disease

AE: diarrhea nausea vomiting

Question 33

Etanercept

Answer 33

MOA: fusion protein produced by recombinant DNA
Receptor for TNF-a and IgG Fc
Decoy receptor for TNF-a

Clinical: rheumatoid arthritis, psoriasis, ankylosing spomdolytis

AE: immunosuppression including reactivation of TB

Question 34

Infliximab, Adalimumab

Answer 34

MOA: anti TNF-a monoclonal Ab

Clincial: irritable bowel syndrome, rhematoid arthritis ankylosing spondylitis, psoriasis

Question 35

Isotretinoin

Answer 35

Synthetic isomer of retinoic acid a derivative of vitamin A

Treats severe acne when given systemically

Inhibits follicular epidermal keratinization loosening keratin plugs facilitating their expulsion

Reduces size of sebaceous glands and inhibits sebum production

Teratogen and hypertriglyceridemia