Anti-inflammatory

Question 1

Aspirin

Answer 1

reversible acetylation of COX
low dose –> COX 1
high dose –> both COX 1 &2
is an ETC uncoupler–> decreasing ATP

Question 2

What is the treatment of Aspirin overdose?

Answer 2

activated charcoal

alkalization of urine

Question 3

What are the side effects of Aspirin ?

Answer 3

decrease gastric mucosa--> ulcerations 
GI bleeding 
increased bleeding time 
afferent arteriole vasoconstriction 
renal papillary necrosis 
increase lithium concentration 
hyperkalemia- hypoaldosteronism

metabolic acidosis with respiratory alkalosis
tinnitus

Question 4

What is the adverse affect in Children with viral illnesses?

Answer 4

Reyes syndrome -encephalopathy , hepatic dysfunction

Question 5

Who is contraindicated for NSAIDS

Answer 5

renal insufficiency

pregnant -trimester 3 ( indomethacin, ibuprofen )

Question 6

Celecoxib

Answer 6

selective COX 2 inhibitor
decreases GI ulcers and bleeding
increases platelet aggregation
is a sulfa drug

Question 7

Acetaminophen

Answer 7

inhibits COX 2
is antipyretic & analgesic
no anti platelet action, safe in asthma, safe in gout, no uncoupling

Question 8

What is the side effect with acetaminophen ?

Answer 8

overdose
hepatotoxic - P450 inducer,, alcohol, phenobarbital
NAPQI–>glutathione ( acetaminophen inhibits this process) –> increased NAPQI which causes damage to lier cells

Question 9

What is the treatment for acetaminophen toxicity ?

Answer 9

N- acetylcyesteine (first 10 hrs)

charcoal

Question 10

What treats acute gout?

Answer 10

NSAIDS
Glucocorticoids
Colchicine

Question 11

Allopurinol & Febuxostat

Answer 11

inhibit xanthine oxidase
for long term use
tx: leech Nyann syndrome

Question 12

Colchicine

Answer 12

tx: pain
microtubule polymerization that disrupts cytoskeleton of neutrophils –> decreased migration , phagocytosis, degranulation

Question 13

What are the side effects of colchicine?

Answer 13

Diarrhea & vomiting

Question 14

Characteristics of pseudo-gout

Answer 14

increase calcium pyrophosphate

positive rhomboid shaped bifringent crystals

Question 15

What other disease cause uric acid crystals?

Answer 15

lymphomas

lymphoblastic leukaemia

Question 16

What are the side effects of xanthin oxidase inhibitors?

Answer 16

decrease breakdown of 6 mercaptopurine & azathioprine –> toxicity (rash)

Steven johnson syndrome

DRESS syndrome - eosinophilia

Question 17

Probenecid

Answer 17

increase the rate of excretion of uric acid
decrease the reabsorption of filtered rate
aids in the retention of antibiotics
for long term use only

Question 18

What are the side effects of probenecid ?

Answer 18

sulpha allergy

urate renal stones

Question 19

How does aspirin affect uric acid?

Answer 19

at high doses it acts as probenecid and decreases its reabsorption

at low doses it inhibits uric acid excretion

Question 20

Pegloticase

Answer 20

used in chronic management
turns uric acid into water soluble form (allantoin )
IV administered

Question 21

Side effect of pegloticase

Answer 21

cause hemolysis in G6PD

anaphylaxis

Question 22

Rasburicase

Answer 22

tx: hyperurecemia in tumor lysis syndrome

Question 23

What are the dietary restriction when a patient has gout?

Answer 23

redmeats
beer
seafood
fructose containing beverages

Question 24

What foods and drink reduce gout?

Answer 24

cherries
whole grains
coffee