Anti-Inflammatories, DMARDs Flashcards
is acetaminophen an anti-inflammatory ?
no
max dose acetaminophen daily
4 g daily
caution with giving acetaminophen to…
patients with liver disease, and (lesser) kidney disease
side effects of opiates
drowsiness
constipation
types of neuroactive drugs used for rheumatic pain
antidepressants
anti-epileptics
action of neuroactive drugs in treating pain
moderate activity of neurologic pain pathways, especially useful for neuro pain (fibromyalgia)
action of phospholipase C
membrane –> arachidonic acid
action of COX
arachidonic acid –> prostaglandin H2
action of lipoxygenase
arachidonic acid –> leukotriene A4
high doses of PGE’s do what to pain
directly induce pain
low doses of PGE’s do what to pain
sensitize tissues to respond to other stimuli (bradykinin)
how to PGE’s mediate body temperature
via interaction with the posterior hypothalamus
how do PGE’s relieve menstrual pain
direct relief of smooth muscle contraction
which is the “rheumatologist’s aspirin?”
Aspirin III- antiinflammatory.
COX1, 2, and signal transduction
toxicities of NSAIDs: GI
dyspepsia, gastritis, ulceration, bleeding
toxicities of NSAIDs: Renal
decreased GFR, Na retention, htn, edema
toxicities of NSAIDs: hematologic
increased risk of bleeding
toxicities of NSAIDs: pulmonary
asthma exacerbation
toxicities of NSAIDs: gynecologic
bleeding, delayed labor, premature closing of ductus arteriosus
COX 1 selective
GI cytoprotection
platelet activaty
renal function
COX 2 selective
inflammation
pain
fever
where does methotrexate precipitate
in the urine- so alkalinize the urine
what does methotrexate do
inhibits metabolism of folinic acid
how to enhance elimination of methotrexate
hemodialysis?
enzymamtic degradation w/ glucarpidase
colchicine need to know’s
narrow therapeutic index
intracellular accumulation
large volume of distribution
treatment of colchicine overdose
largely supportive
experimental antibodies
how to remove aspirin
alkalinize with bicarb, hemodialysis
acetaminophen is bioactivated by what
P450 2E1
how does alcohol affect 2E1
inducer (chronic)
inhibitor (acute)
acetaminophen toxicity results from
overwhelming normal detoxification pathway (glutathione)- build up of NAPQI
treatment for acetaminophen overdose
give NAC- glutathione precursor/substitute
