anti-inflammatory Flashcards
what receptors does aspirin (ASA) work on?
cox1 and cox2
what kind of drug is aspirin (ASA)?
salicylate
how is aspirin (ASA) absorbed? (route)
rapid and complete with PO - also rectal
how is aspirin (ASA) excreted?
through the kidneys
- the rate of excretion increases as pH increases
when does the rate of EXCRETION for aspirin (ASA) increase?
increased pH = increased aspirin (ASA) excretion
what are the therapeutic uses of aspirin (ASA)?
- anti-inflammatory - cox2 arthritis treatment
- analgesic - short lived pain relief
- antipyretic - fever
- antiplatelet - 8-day irreversible effect on COX1
what is salicylism?
too much salicylates - aspirin toxicity
- renal failure - dehydration, overwork, and competition
- tinnitus - CN8
- respiratory alkalosis - aspirin (ASA) is a respiration stimulant that will increase respiration rate
what group of people should not take aspirin (ASA)?
kids - can cause Reyes’s syndrome (brain and liver swelling)
what are the adverse effects of aspirin (ASA)?
- GI bleeding and distress
- renal
- salicylism
- reyes’s syndrome
- hypersensitivity
- drug interaction
- overdose/toxicity
- DECREASED URINE OUTPUT
what drug does aspirin (ASA) interact badly with?
Motrin - they bind to the same receptors in the P450 system which makes aspirin (ASA) less effective
what does cox1 interact with?
GI tracts, increases blood flow to kidenys, and platelet stickiness
what does cox2 interact with?
pain and inflammation
when does inflammation occur?
increased prostaglandins = increased inflammation
is aspirin (ASA) reversible?
no
what are the names of 1st generation NSAIDs?
- ibuprofen (advil, motrin)
- naproxen (naprosyn, aleve)
- indomethacin (indocin)
- ketorolac (toradol)
what receptors does ibuprofen (Advil, Motrin) work on?
cox1 and cox2
how long does ibuprofen (Advil, Motrin) last?
6-8 hours
is ibuprofen (Advil, Motrin) tolerated?
generally tolerated well
what does ibuprofen (Advil, Motrin) help with?
inflammation
what are the positives for ibuprofen (Advil, Motrin)?
less gastric bleeding and platelet inhibition than aspirin
what is the negative of ibuprofen (Advil, Motrin)?
decreased blood flow to kidneys
what receptors does indomethacin (Indocin) work on?
primarily cox1
what is indomethacin (Indocin) used for?
- arthritis
- bursitis
- tendonitis
- gout
- premature infants with patent ductus arteriosus
what is one abnormal use of indomethacin (Indocin)?
premature infants with patent ductus arteriosus
what route is indomethacin (Indocin) given?
PO and IV
what side effects are seen with indomethacin (Indocin)?
- more severe GI issues and headache
- increased risk for toxicity so not routinely used for pain and fever
- black box warning for increased risk of CVA and MI
what is ketorolac (Toradol) used for?
- pain relief equivalent to opioids
- for acute pain not for chronic pain
what group of people does ketorolac (Toradol) work well for?
people with a history of drug abuse due to its effective pain relief but it is not an opioid
what is the route for ketorolac (Toradol)?
PO, IV, and IM
how would ketorolac (Toradol) be taken?
every 5 days ( 5 days before surgery and 5 days after)
what needs to be monitored with ketorolac (Toradol)?
kidney function
what risk is there with ketorolac (Toradol)?
increased risk for stroke and bleeding
what receptors does ketorolac (Toradol) work on?
primarily cox1
what drug is a 2nd generation NSAID?
celecoxib (Celebrex)
what receptor does celecoxib (Celebrex) work on?
only inhibits cox2
what is celecoxib (Celebrex) used for?
- osteoarthritis
- rheumatoid arthritis (juvenile)
- acute pain
what adverse effects are seen with celecoxib (Celebrex)?
- GI distress
- renal impairment
- black box warning for increased risk for CVA and MI
who shouldn’t celecoxib (Celebrex) be used in?
people with sulfa allergies
what drug interaction does celecoxib (Celebrex) have?
increases effectiveness of warfarin (coumadin)
- would need to decrease the dose
what is acetaminophen (Tylenol) used for?
- analgesic - pain
- antipyretic - fever
what happens a lot with acetaminophen (Tylenol)?
overdose
- antidote is acetylcysteine
what is the antidote to acetaminophen (Tylenol)?
acetylcysteine
is acetaminophen (Tylenol) an anti-inflammatory?
no
what drugs are used for gout?
- colchicine
- allopurinol
- probenecid
what is the action of colchicine?
decreases inflammatory reaction to urate crystals
what is colchicine used for?
gout
- treat acute attacks
- prevent long-term attacks
what are the adverse effects of colchicine?
- nausea, vomiting, diarrhea
- hepatotoxicity
- bone marrow suppression
what is the action of allopurinol?
decreased blood levels of uric acid by inhibiting enzymes needed for production will then decrease inflammation
what is allopurinol used for?
- acute and chronic tophaceous gout
- kidney stones
what are the adverse effects of allopurinol?
steven johnson syndrome - deadly rash
what is the downfall of allopurinol?
takes months to see results
what is the action of probenecid?
uric acid excretion increases
- decreases hyperurecemia
what is the downfall of probenecid?
can initially increase acute attacks
is probenecid used alone?
often used as an adjunct therapy
what are the signs and symptoms of rheumatoid arthritis?
- fever
- weightloss
- weakness
- thin skin
- red sclera
- vascultitus
- worse in AM
- ulcers
- nodules
- warm to touch
what drugs are used to treat rheumatoid arthritis?
- NSAIDs
- DMARDs - TNF blockers
- glucocorticosteroids
what do DMARDs stand for?
disease-modifying antirheumatic drugs
what is the purpose of DMARDs?
reduction of joint destruction and slow disease progression
- catch early and slow progression
- delayed onset of benefits
what drugs are DMARDS?
- methotrexate (rheumatrex)
- hydroxychloroquine (plaquenil)
- TNF blockers
~ etanercept (enbrel)
~ infliximab (remicade)
~ adalimumab
what kind of drug is methotrexate (Rheumatrex)?
DMARDs
what is the action of methotrexate (Rheumatrex)?
stop folic acid metabolism especially in areas where cells reproduction is rapid (fetuses and bloodstream)
what else could methotrexate (Rheumatrex) be used for?
abortion
what is the most common and most rapid DMARD?
methotrexate (Rheumatrex)
what education is needed with methotrexate (Rheumatrex)?
- takes 3-6 weeks to see the effectiveness
- would need a negative TB and pregnancy test before starting
what are the side effects of methotrexate (Rheumatrex)?
- hepatic fibrosis
- fetal death
- bone marrow suppression
- GI ulceration
- clotting
- risk for infection
what kind of drug is hydroxychloroquine (Plaquenil)?
DMARD
what is the action of hydroxychloroquine (Plaquenil)?
suppress cellular reproduction
- doesn’t slow the progression of RA but helps with long term outcome
what else is hydroxychloroquine (Plaquenil) used for?
antimalaria
what can be taken with hydroxychloroquine (Plaquenil)?
NSAIDs or steroids
what education is needed with hydroxychloroquine (Plaquenil)?
an eye exam would be needed every 6-12 months due to possible retinopathy
- hye=eye
what kind of drugs are TNF blockers?
- etanercept (enbrel)
- infliximab (remicade)
- adalimumab (humira)
what kind of drug are TNF blockers?
DMARDs
what is the action of TNF blockers?
suppress inflammation by neutralizing (decreasing) TNF - tumor necrosis factor
what are TNF blockers used for?
RA, psoriasis, chron’s disease
what are the adverse effects of TNF blockers?
- decreased white blood cells (immunosuppression)
- fever
- increased risk for infection
what teaching is needed with TNF blockers?
- would need a negative TB test
- no live vaccines like chickenpox or shingles
what are glucocorticoids?
powerful anti-inflammatory agent
- can relieve symptoms and may slow down disease progression
what are glucocorticoids used for?
- RA
- lupus
- COPD
- psoriasis
- allergies
what is the route for glucocorticoids?
PO or intra-articularly for a specific joint
should glucocorticoids be used short-term or long-term?
short term
what do glucocorticoids increase the risk of?
infection
what are the 7 s’s of glucocorticoids?
- swollen
- sepsis
- sugar decrease
- skinny bones (fractures)
- sight (cataracts)
- slow taper
- stress
do glucocorticoids have a fast or slow onset?
fast
what drugs are used for osteoporosis?
- calcium
- vitamin D (diet and sun)
- calcitonin (miacalcin, osteocalcin, salomine)
- selective estrogen receptor modulators (SERMs)
what is the action of calcitonin (miacalcin, osteocalcin, salomine)?
inhibits osteoclast activity - treats osteoporosis but doesn’t prevent
what is the route for calcitonin (miacalcin, osteocalcin, salomine)?
nasal spray - 1 spray per day, alternate nostrils
what is the ending for bisphosphates?
dronate
- alendronate (fosamax)
- risedronate (actonel)
- ibandronate (boniva)
what is the action of bisphosphates (-dronate)?
prevent and treat osteoporosis - works by inhibiting bone resorption by osteoclasts
what is the teaching needed with bisphosphates (-dronate)?
- must be given on empty stomach with a full glass of water and sit up for 30 minutes after to help with esophagus irritation
- tell dentist due to jaw osteonecrosis
what is the name of the drug that is selective estrogen receptor modulators?
raloxifene (Evista)
