Naplex - Systemic Steroids and Autoimmune Conditions

BM will begin hydroxychloroquine (Plaquenil) therapy for rheumatoid arthritis. Choose the correct counseling statements:

A. This medication is safe to use in pregnancy for rheumatoid arthritis.

B. She will need eye exams while receiving this medication.

C. She can take this medication on an empty stomach.

D. She should notice symptom improvement within 2-3 days of starting therapy.

E. This medication is an injection; administer subcutaneously once daily

B.

Which of the following medications can be used to treat mild systemic lupus erythematous?

A. Etanercept

B. Cyclophosphamide

C. Abciximab

D. Hydroxychloroquine

E. Minocyclin

D.

Hydroxychloroquine is used for the treatment of mild systemic lupus erythematosus. Minocycline can cause SLE.

GM has had mild rheumatoid arthritis for many years. She failed methotrexate due to elevated liver enzymes. Fortunately, her liver enzymes returned to normal after the drug was discontinued. The physician suggested that she try etanercept injections, but she refused to self-inject. What medication would be a reasonable option to try next to help control disease progression and reduce joint damage?

A. Hydroxychloroquine

B. Celecoxib

C. Ibuprofen

D. Nabumetone

E. Infliximab

A.

Hydroxychloroquine is not hepatotoxic and would be a good choice for a patient with mild to moderate RA.

CF, a patient with a diagnosis of rheumatoid arthritis, has been taking prednisone 20 mg PO daily for 6 months. Which of the following are side effects that can occur from her prednisone therapy? (Select ALL that apply.)

A. Impaired wound healing

B. Weight gain

C. Osteoporosis

D. Hyperglycemia

E. Cataracts

All

Which of the following medications can cause yellow-orange urine discoloration?

A. Methotrexate

B. Teriflunomide

C. Tofacitinib

D. Sulfasalazine

E. Dimethyl fumarate

D.

BH's physician is inquiring about rituximab for rheumatoid arthritis. She asks you about the boxed warnings for rituximab. Which of the following is not a boxed warning for rituximab?

A. Fatal infusion reactions

B. Cardiotoxicity

C. Progressive multifocal leukoencephalopathy

D. Severe mucocutaneous reactions

E. Hepatitis B reactivation

B.

A patient using methotrexate for rheumatoid arthritis should receive the following instructions from the pharmacist concerning the dosing schedule:

A. This medication is taken weekly.

B. This medication is taken daily.

C. This medication is taken monthly.

D. This medication is used only when you have an acute flare.

E. If you experience an acute flare, double the daily dose.

A.

CM is a 35 year-old female presenting with fatigue, arthralgia, and a butterfly rash over the bridge of her nose. She has been diagnosed with systemic lupus erythematosus (SLE). Which non-pharmacologic therapies should the pharmacist recommend for CM to reduce triggering SLE flares? (Select ALL that apply.)

A. Avoid exercise which may exacerbate arthralgia

B. Avoid smoking which may trigger the disease

C. Avoid drugs that may induce SLE

D. Avoid prolonged exposure to the sun to reduce photosensitivity

E. Avoid citrus foods as they have been shown to trigger the disease

B, C, D

Enbrel carries the following warnings: (Select ALL that apply.)

A. Teratogenicity

B. Liver damage

C. Exacerbation of heart failure

D. Risk of infection

E. Reactivation of latent TB

B, C, D, E

EW is diagnosed with rheumatoid arthritis. Which of the following medications should be started to reduce disease progression?

A. Prednisone

B. Methotrexate

C. Anakinra

D. Sulfasalazine

E. Rituxumab

B.

Methotrexate should be used first-line, if no contraindications, for treating rheumatoid arthritis.

Which of the following steroids has the greatest anti-inflammatory potency?

A. Fludrocortisone

B. Prednisone

C. Betamethasone

D. Triamcinolone

E. Cortisone

C.

A patient is taking hydroxychloroquine, methotrexate, magnesium, calcium, raloxifene and atorvastatin. She reports that her mouth, including her gums, are sore. Upon inspection, the oral cavity appears inflamed. This complaint is most likely due to the following medication:

A. Hydroxychloroquine

B. Methotrexate

C. Raloxifine

D. Atorvastatin

E. Magnesium

B.

KT has rheumatoid arthritis, hypertension, and asthma. She takes Enbrel, Tylenol, hydrochlorothiazide, Flovent, Proair HFA, and a daily multivitamin. Which vaccines can she receive at this time? (Select ALL that apply.)

A. Zostavax

B. Fluzone

C. Havrix (Hep A)

D. Pneumovax 23

E. FluMist

B, C, D

Tysabri is an effective agent for treating multiple sclerosis. What is the boxed warning for this medication?

A. Progressive multifocal leukoencephalopathy

B. Hepatotoxicity

C. Optic neuritis

D. Acute renal failure

E. Nerve demyelination syndrome

A.

What is first-line treatment for Raynaud's Phenomenon?

A. Angiotensin receptor blockers

B. Phosphodiesterase inhibitors

C. Calcium channel blockers

D. ACE inhibitors

E. Statins

C.

A patient with a severe, rheumatoid arthritis exacerbation is prescribed a short course of oral prednisone. Choose the correct statement:

A. Patients with severe rheumatoid arthritis should always use inhaled, not oral steroids.

B. Oral steroids can cause many problems, including hypoglycemia.

C. Prednisone is a prodrug of prednisolone.

D. A brand name is Medrol.

E. Oral steroids reduce appetite and cause anorexia.

C.

What is the pathophysiology of Raynaud's Phenomenon?

A. Atherosclerosis

B. Vasospasm

C. Hypotension

D. Joint damage and destruction

E. Small clots in the vasculature

B.

What is the active ingredient in Restasis?

A. Tacrolimus

B. Cyclosporine

C. Mycophenolate

D. Polyethylene glycol 3350

E. Pilocarpine

B.

JC has rheumatoid arthritis and has been taking Enbrel for 1 year. He continues to experience daily symptoms and poor quality of life. Which drug could be added to his rheumatoid arthritis regimen? (Select ALL that apply.)

A. Humira

B. Rheumatrex

C. Orencia

D. Motrin

E. Rituxan

B, D

The patient is already on Enbrel and should avoid simultaneous use of another biologic agent. Concurrent use of biologics can increase the risk for serious infection.

SC is a 78 year-old female patient with Sjogren's syndrome. She has considerable difficulty with dry eyes, and dry mouth. She asks the pharmacist for advice on helping her manage the dry mouth. Which of of the following statements concerning dry mouth are correct? (Select ALL that apply.)

A. Glycopyrrolate may be helpful.

B. Sugar free-gum containing xylitol will worsen dry mouth.

C. Muscarinic agents are helpful for this condition.

D. Antimuscarinic agents are helpful for this condition.

E. A major complication of dry mouth is tooth decay.

C, E

What other medication should OP be taking since he is on Rheumatrex?

A. Vitamin B12

B. Leucovorin

C. Glucarpidase

D. Aspirin

E. Folic acid

E.

Which of the following are side effects associated with cyclophosphamide therapy when treating patients with systemic lupus erythematosus? (Select ALL that apply.)

A. Nephrolithiasis (kidney stones)

B. Hemorrhagic cystitis

C. Bone marrow suppression

D. Infertility

E. Infections

B, C, D, E