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Pharm Exam 2 > anti-inflammatory > Flashcards

anti-inflammatory Flashcards

1
Q

what receptors does aspirin (ASA) work on?

A

cox1 and cox2

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2
Q

what kind of drug is aspirin (ASA)?

A

salicylate

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3
Q

how is aspirin (ASA) absorbed? (route)

A

rapid and complete with PO - also rectal

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4
Q

how is aspirin (ASA) excreted?

A

through the kidneys

- the rate of excretion increases as pH increases

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5
Q

when does the rate of EXCRETION for aspirin (ASA) increase?

A

increased pH = increased aspirin (ASA) excretion

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6
Q

what are the therapeutic uses of aspirin (ASA)?

A
  • anti-inflammatory - cox2 arthritis treatment
  • analgesic - short lived pain relief
  • antipyretic - fever
  • antiplatelet - 8-day irreversible effect on COX1
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7
Q

what is salicylism?

A

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
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8
Q

what group of people should not take aspirin (ASA)?

A

kids - can cause Reyes’s syndrome (brain and liver swelling)

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9
Q

what are the adverse effects of aspirin (ASA)?

A
  • GI bleeding and distress
  • renal
  • salicylism
  • reyes’s syndrome
  • hypersensitivity
  • drug interaction
  • overdose/toxicity
  • DECREASED URINE OUTPUT
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10
Q

what drug does aspirin (ASA) interact badly with?

A

Motrin - they bind to the same receptors in the P450 system which makes aspirin (ASA) less effective

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11
Q

what does cox1 interact with?

A

GI tracts, increases blood flow to kidenys, and platelet stickiness

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12
Q

what does cox2 interact with?

A

pain and inflammation

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13
Q

when does inflammation occur?

A

increased prostaglandins = increased inflammation

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14
Q

is aspirin (ASA) reversible?

A

no

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15
Q

what are the names of 1st generation NSAIDs?

A
  • ibuprofen (advil, motrin)
  • naproxen (naprosyn, aleve)
  • indomethacin (indocin)
  • ketorolac (toradol)
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16
Q

what receptors does ibuprofen (Advil, Motrin) work on?

A

cox1 and cox2

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17
Q

how long does ibuprofen (Advil, Motrin) last?

A

6-8 hours

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18
Q

is ibuprofen (Advil, Motrin) tolerated?

A

generally tolerated well

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19
Q

what does ibuprofen (Advil, Motrin) help with?

A

inflammation

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20
Q

what are the positives for ibuprofen (Advil, Motrin)?

A

less gastric bleeding and platelet inhibition than aspirin

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21
Q

what is the negative of ibuprofen (Advil, Motrin)?

A

decreased blood flow to kidneys

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22
Q

what receptors does indomethacin (Indocin) work on?

A

primarily cox1

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23
Q

what is indomethacin (Indocin) used for?

A
  • arthritis
  • bursitis
  • tendonitis
  • gout
  • premature infants with patent ductus arteriosus
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24
Q

what is one abnormal use of indomethacin (Indocin)?

A

premature infants with patent ductus arteriosus

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25
Q

what route is indomethacin (Indocin) given?

A

PO and IV

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26
Q

what side effects are seen with indomethacin (Indocin)?

A
  • 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
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27
Q

what is ketorolac (Toradol) used for?

A
  • pain relief equivalent to opioids

- for acute pain not for chronic pain

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28
Q

what group of people does ketorolac (Toradol) work well for?

A

people with a history of drug abuse due to its effective pain relief but it is not an opioid

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29
Q

what is the route for ketorolac (Toradol)?

A

PO, IV, and IM

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30
Q

how would ketorolac (Toradol) be taken?

A

every 5 days ( 5 days before surgery and 5 days after)

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31
Q

what needs to be monitored with ketorolac (Toradol)?

A

kidney function

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32
Q

what risk is there with ketorolac (Toradol)?

A

increased risk for stroke and bleeding

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33
Q

what receptors does ketorolac (Toradol) work on?

A

primarily cox1

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34
Q

what drug is a 2nd generation NSAID?

A

celecoxib (Celebrex)

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35
Q

what receptor does celecoxib (Celebrex) work on?

A

only inhibits cox2

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36
Q

what is celecoxib (Celebrex) used for?

A
  • osteoarthritis
  • rheumatoid arthritis (juvenile)
  • acute pain
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37
Q

what adverse effects are seen with celecoxib (Celebrex)?

A
  • GI distress
  • renal impairment
  • black box warning for increased risk for CVA and MI
38
Q

who shouldn’t celecoxib (Celebrex) be used in?

A

people with sulfa allergies

39
Q

what drug interaction does celecoxib (Celebrex) have?

A

increases effectiveness of warfarin (coumadin)

- would need to decrease the dose

40
Q

what is acetaminophen (Tylenol) used for?

A
  • analgesic - pain

- antipyretic - fever

41
Q

what happens a lot with acetaminophen (Tylenol)?

A

overdose

- antidote is acetylcysteine

42
Q

what is the antidote to acetaminophen (Tylenol)?

A

acetylcysteine

43
Q

is acetaminophen (Tylenol) an anti-inflammatory?

A

no

44
Q

what drugs are used for gout?

A
  • colchicine
  • allopurinol
  • probenecid
45
Q

what is the action of colchicine?

A

decreases inflammatory reaction to urate crystals

46
Q

what is colchicine used for?

A

gout

  • treat acute attacks
  • prevent long-term attacks
47
Q

what are the adverse effects of colchicine?

A
  • nausea, vomiting, diarrhea
  • hepatotoxicity
  • bone marrow suppression
48
Q

what is the action of allopurinol?

A

decreased blood levels of uric acid by inhibiting enzymes needed for production will then decrease inflammation

49
Q

what is allopurinol used for?

A
  • acute and chronic tophaceous gout

- kidney stones

50
Q

what are the adverse effects of allopurinol?

A

steven johnson syndrome - deadly rash

51
Q

what is the downfall of allopurinol?

A

takes months to see results

52
Q

what is the action of probenecid?

A

uric acid excretion increases

- decreases hyperurecemia

53
Q

what is the downfall of probenecid?

A

can initially increase acute attacks

54
Q

is probenecid used alone?

A

often used as an adjunct therapy

55
Q

what are the signs and symptoms of rheumatoid arthritis?

A
  • fever
  • weightloss
  • weakness
  • thin skin
  • red sclera
  • vascultitus
  • worse in AM
  • ulcers
  • nodules
  • warm to touch
56
Q

what drugs are used to treat rheumatoid arthritis?

A
  • NSAIDs
  • DMARDs - TNF blockers
  • glucocorticosteroids
57
Q

what do DMARDs stand for?

A

disease-modifying antirheumatic drugs

58
Q

what is the purpose of DMARDs?

A

reduction of joint destruction and slow disease progression

  • catch early and slow progression
  • delayed onset of benefits
59
Q

what drugs are DMARDS?

A
  • methotrexate (rheumatrex)
  • hydroxychloroquine (plaquenil)
  • TNF blockers
    ~ etanercept (enbrel)
    ~ infliximab (remicade)
    ~ adalimumab
60
Q

what kind of drug is methotrexate (Rheumatrex)?

A

DMARDs

61
Q

what is the action of methotrexate (Rheumatrex)?

A

stop folic acid metabolism especially in areas where cells reproduction is rapid (fetuses and bloodstream)

62
Q

what else could methotrexate (Rheumatrex) be used for?

A

abortion

63
Q

what is the most common and most rapid DMARD?

A

methotrexate (Rheumatrex)

64
Q

what education is needed with methotrexate (Rheumatrex)?

A
  • takes 3-6 weeks to see the effectiveness

- would need a negative TB and pregnancy test before starting

65
Q

what are the side effects of methotrexate (Rheumatrex)?

A
  • hepatic fibrosis
  • fetal death
  • bone marrow suppression
  • GI ulceration
  • clotting
  • risk for infection
66
Q

what kind of drug is hydroxychloroquine (Plaquenil)?

A

DMARD

67
Q

what is the action of hydroxychloroquine (Plaquenil)?

A

suppress cellular reproduction

- doesn’t slow the progression of RA but helps with long term outcome

68
Q

what else is hydroxychloroquine (Plaquenil) used for?

A

antimalaria

69
Q

what can be taken with hydroxychloroquine (Plaquenil)?

A

NSAIDs or steroids

70
Q

what education is needed with hydroxychloroquine (Plaquenil)?

A

an eye exam would be needed every 6-12 months due to possible retinopathy
- hye=eye

71
Q

what kind of drugs are TNF blockers?

A
  • etanercept (enbrel)
  • infliximab (remicade)
  • adalimumab (humira)
72
Q

what kind of drug are TNF blockers?

A

DMARDs

73
Q

what is the action of TNF blockers?

A

suppress inflammation by neutralizing (decreasing) TNF - tumor necrosis factor

74
Q

what are TNF blockers used for?

A

RA, psoriasis, chron’s disease

75
Q

what are the adverse effects of TNF blockers?

A
  • decreased white blood cells (immunosuppression)
  • fever
  • increased risk for infection
76
Q

what teaching is needed with TNF blockers?

A
  • would need a negative TB test

- no live vaccines like chickenpox or shingles

77
Q

what are glucocorticoids?

A

powerful anti-inflammatory agent

- can relieve symptoms and may slow down disease progression

78
Q

what are glucocorticoids used for?

A
  • RA
  • lupus
  • COPD
  • psoriasis
  • allergies
79
Q

what is the route for glucocorticoids?

A

PO or intra-articularly for a specific joint

80
Q

should glucocorticoids be used short-term or long-term?

A

short term

81
Q

what do glucocorticoids increase the risk of?

A

infection

82
Q

what are the 7 s’s of glucocorticoids?

A
  • swollen
  • sepsis
  • sugar decrease
  • skinny bones (fractures)
  • sight (cataracts)
  • slow taper
  • stress
83
Q

do glucocorticoids have a fast or slow onset?

A

fast

84
Q

what drugs are used for osteoporosis?

A
  • calcium
  • vitamin D (diet and sun)
  • calcitonin (miacalcin, osteocalcin, salomine)
  • selective estrogen receptor modulators (SERMs)
85
Q

what is the action of calcitonin (miacalcin, osteocalcin, salomine)?

A

inhibits osteoclast activity - treats osteoporosis but doesn’t prevent

86
Q

what is the route for calcitonin (miacalcin, osteocalcin, salomine)?

A

nasal spray - 1 spray per day, alternate nostrils

87
Q

what is the ending for bisphosphates?

A

dronate

  • alendronate (fosamax)
  • risedronate (actonel)
  • ibandronate (boniva)
88
Q

what is the action of bisphosphates (-dronate)?

A

prevent and treat osteoporosis - works by inhibiting bone resorption by osteoclasts

89
Q

what is the teaching needed with bisphosphates (-dronate)?

A
  • 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
90
Q

what is the name of the drug that is selective estrogen receptor modulators?

A

raloxifene (Evista)

Pharm Exam 2 (5 decks)

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