4.1.1 Pharmaceuticals for Musculoskeletal Pain

Question 1

What is the immune response?

Answer 1

Immunologically competent cells are activated in response to foreign organisms.

May be beneficial or deleterious

Numerous molecular mediators

Question 2

What is the general strategy in pain management?

Answer 2

Relief of pain

Delay or arrest of disease process

Question 3

Arachadonic acids is a precursor molecule for?

Answer 3

Prostaglandins

Thromboxane

Prostacyclin

Question 4

Where in the arachidonic acid pathway do the COX enzymes work?

Answer 4

Question 5

What is the difference between COX1 and COX2

Answer 5

COX1 - Constitutively active, provides protection in the gut, protective function

COX2 - Inducible, inflammatory response

Question 6

How does acetaminophen differ from other drugs?

Answer 6

Acetaminophen works on the CNS as well

Question 7

What are the anti-inflammatory effects of asprin?

Answer 7

Nonselective inhibitor or COX isoforms

Irreversibly inhibits COX and platelet aggregation

Question 8

What are the analgesic effects of asprin?

Answer 8

Most effective in reducing pain of mild to moderate intensity through reducing inflammation

Question 9

What are the antipyretic effects of asprin?

Answer 9

Antipyretic effects probably mediated by both COX inhibition in the CNS and inhibition of IL-1

Question 10

What are some of the adverse effects of asprin?

Answer 10

Gastric Upset

Question 11

How is ibuprofen different that asprin?

Answer 11

Often prescribed in lower doses with analgesic, but not anti-inflammatory efficacy

NSAIDS

Question 12

What is a good use for indomethacin?

Answer 12

Particularily popular for gout and ankylosing spondylitis

NSAID

Mainly used for severe inflammation

Question 13

What are the characteristics of COX-2 selective inhibitors?

Answer 13

Inhibit prostaglandin synthesis by COX-2 induced at sites of inflammation.

Lower liability for GI upset

No impact on platelet aggregation though

Question 14

What are some of the COX-2 selective inhibitors?

Answer 14

Celecoxib

Etoricoxib

Meloxicam

Question 15

What are the characteristics of acetaminophen?

Answer 15

Weak inhibitor of COX enzymes

Central direct analgesic effects

Not an anti-inflammatory at typical doses

Antipyretic

Question 16

Describe the dietary manipulation of inflammation,

Answer 16

Question 17

What are the characteristics of the Disease-Modifying Anti-Rheumatic Drugs (DMARDs)?

Answer 17

Question 18

What are the characteristics of methotrexate?

Answer 18

Inhibition of AICAR tranformylase leading to secondary effects on chemotaxis

Question 19

What are the characteristics of cyclophosphamide

Answer 19

Cross-linking DNA to prevent cell replication

Question 20

What are the characteristics of cyclosporine?

Answer 20

Inhibits IL-1 and IL-2

Question 21

What are the characteristics of Azathioprine?

Answer 21

Suppresses B and T cell function Ig production and IL-2 secretion

Question 22

What are the characteristics of sulfasalazine?

Answer 22

IgA and IgM rheumatoid factor production are decreased

Question 23

What are the two meanings for biologic therapies?

Answer 23

Question 24

What are the anti-TNF agents?

Answer 24

Etanercept - cytokine receptor fusion protein

Infliximab - anti-TNF chimeric monoclonal antibody

Adalimumab - anti-TNF monoclanal antibody

Question 25

What is the action of rituximab?

Answer 25

B-cell depleting agents

Question 26

What is the action of abatacept?

Answer 26

T-cell co stimulation inhibitor

Question 27

What are the actions of leflunomide?

Answer 27

Cell growth arrestors - G1 phase

Question 28

What is the action of anakinra?

Answer 28

IL-1 inhibition

Question 29

What is the action of Secukinumab (Costenyx)?

Answer 29

IL-17A inhibitors

Question 30

What is the action of Ixekizumab (Taltz)?

Answer 30

IL-17A used in plaque psoriasis

Question 31

What are the characteristics of steroidal anti-inflammatory therapy?

Answer 31

Inhibition of NF-kB and AP-1 transcription Net result is decreased lymphocytes, monocytes, eosinophils and basophils

Question 32

What are the different steroid medication and what are their durations? Why do physicians do not what to keep patients on for extended periods?

Answer 32

Question 33

What is gout?

Answer 33

Metabolic disease characterized by recurrent episode of acute arthritis due to **depositions of monosodium urate** in joints and cartilage

Question 34

What are the therapeutic goals for gout?

Answer 34

Providing control of **pain and inflammation**

Question 35

What are the characteristics of Colchicine?

Answer 35

**Inhibits microtubule aggregation which disrupts leukocyte chemotaxis and phagocytosis** Inhibition of crystal-induced production of chemotatic factors Producesdiarrhea and other GI side effects

Question 36

What treatments have replaced colchicine?

Answer 36

NSAIDs Indomethacin - inhibits urate crystal phagocytosis

Question 37

What are the drugs that are used in the prophylaxis of gout?

Answer 37

Xanthine Oxidase inhibitors Allopurinol - blocks conversion of xanthine to uric acid Febuxostat - New class of xanthine oxidase inhibitor, more selective

Question 38

What are the characteristics of the Uricosuric drugs?

Answer 38

Question 39

What are the characterisitcs of Opoid analgesics? Not super specific

Answer 39

Morphine is derived from opium