Anti-rheumatoid drugs MCQs

Answer- A. Quinolone Artemisinin derivative : Artesunate Quinine or Quinidine Plus one of the following : Doxycycline, Tetracycline and Clindamycin

This patient of RA is initiated with methotrexate PO 10-25 mg weekly. Option A- True. Folic acid 7–10 mg PO once weekly 24–48 hours after MTX administration Option B- True. Couple should plan for contraception while she's been on methotrexate treatment. If she plans to conceive, Sulfasalazine should be considered in patients with low disease activity. Option C- True. NSAIDs can inhibit the renal excretion of MTX, which may increase the risk for adverse effects. Option D- False. Given statement is true about CHQ therapy, should be consider in patients with low disease activity after remission. Not a first line of treatment. Reference- Basic & Clinical Pharmacology, Fourteenth Edition By Bertram G. Katzung Pg no. 995-996

Patients with refractory rheumatoid arthritis are frequently prescribed glucocorticoids (e.g., prednisone), which induce bone resorption and increase the risk of osteopenia and osteoporosis. Glucocorticoid-induced bone resorption is primarily mediated via the RANK ligand signaling pathway, a cascade that upregulates osteoclast activity and induces apoptosis of osteoblasts. Chronic glucocorticoid use can also induce mild hypocalcemia, which leads to PTH-mediated bone resorption. In addition, decreased estrogen levels following menopause increase this patient's risk for osteoporosis and osteopenia. Bisphosphonates and denosumab (anti-RANK ligand antibody) are used to treat glucocorticoid-induced osteoporosis Reference: Basic & Clinical Pharmacology, Fourteenth Edition By Bertram G. Katzung, Pg no. 713

Etanercept is a recombinant protein that binds to tumor necrosis factor and prevents its inflammatory effects. Reference: Basic & Clinical Pharmacology, Fourteenth Edition By Bertram G. Katzung Pg no. 656

The question deals with cyanosis in an otherwise well patient. Cyanosis is seen in hypoxia. But the patient with hypoxia will be dyspnoeic. Here the patient is otherwise normal. Rare cause of cyanosis is due to abnormal hemoglobins like methemoglobin or Sulfhemoglobin. The causes of methemoglobinemia includes: Nitrates, nitric oxide or nitrobenzene Aniline dyes Propanil(a herbicide) Dapsone Pyridium So the accurate among the options are drinking water contaminated with nitrates. Lead poisoning will not lead to cyanosis but bluish lines in the gums. Carbon monoxide poisoning will cause cherry red discolouration. Anorexia nervosa is a disease of distorted perception of body image, where the patient restricts food intake and will be malnourished. Reference: Harrison's Principles of Internal medicine, 21st edition Ch:459 Pg 3593

Beta blockers , particularly propranolol, in overdose can cause hyperkalaemia by transmembrane shifts. It is useful to think of the opposite - beta-agonists such as salbutamol are far more widely known to cause hypokalaemia. Overdose of digoxin therapy most commonly manifests as rhythm disturbance, and may be exacerbated by hyper- or hypokalaemia. Salicylate overdose causes metabolic acidosis and respiratory alkalosis. Reference: Harrison's Principles of Internal Principles, 20 th edition, pg:423

Drugs with a large volume of distribution are poorly dialysed. Haemodialysis is effective in lithium poisoning. LIST OF DIALYZABLE TOXINS Dialysis should be considered in cases of severe poisoning due to: Carbamazepine Ethylene glycol Isopropyl alcohol Lithium Methanol Theophylline Salicylates Valproate. Hemodialysis corrects the acid base balance as well as removal of toxins compared to hemoperfusion. Reference: Harrison's Principles of Internal Medicine, 21st Ed, Ch: 459, Pg: 3589.

The patient has a clear lung field with normal oxygen saturation which rules out primary lung of vascular pathologies like pneumonitis, pulmonary embolism and eosinophilia. Carbon monoxide poisoning is produced by the incomplete combustion of carbon containing fuels such as gas, coal, oil, wood and coke. CO increases the affinity of O 2 to Haemoglobin which results in cellular hypoxia in spite of a normal saturation. The O2 Hb dissociation curve shifts to the left. Headache is the most common symptom (90%) followed by nausea & vomiting, vertigo, alteration in consciousness and weakness. The cherry red skin colour occurs when COHb concentration exceeds 20% but it is rarely seen in life. Reference: Harrison's Principles of Internal medicine, 21st edition Ch:459 Pg 3593