Anti-inflammatory agents/ DMARDS/ Anti-gout Flashcards
It is a non-selective COX inhibitor that is the only irreversible one. This is mostly used as an anti-platelet. They are used to prevent clot formation or thrombosis and is one of the emergency regimens for ACS. It is given 80 mg once daily
Aspirin
It is one of the propionic acid derivatives that has less irritation than ASA but should not be given with it
Ibuprofen
It is one of the propionic acid derivatives that has the longest half-life/ duration of action. It is C/I in patients with previous history of MIand those who had stroke who underwent CABG
ADR: Severe gastric irritation, emergence of MI
Flurbiprofen
The propionic acid derivatives of non-selective COX inhibitors
Ketoprofen
Ibuprofen
Flurbiprofen
It is a non-selective COX inhibitor that has minimal gastric irritation
Naproxen
It is the only non-acid derived NSAID because it is a ketone
Nabumetone
They are non-selective COX inhibitors used for post-operational therapy as substitutes for morphine
Etodolac
Ketorolac
It is a non-selective COX inhibitor that is related to sulfonamide
ADR: SJS
Sulindac
It is a non-selective COX inhibitor that inhibits PLA2. It is used for the closure of Patent Ductus Arteriosus and is given through the IV route (if unavailable, use paracetamol IV)
Indomethacin
Non-selective COX inhibitors
Aspirin
Ibuprofen
Ketoprofen
Flurbiprofen
Naproxen
Nabumetone
Etodolac
Ketorolac
Piroxicam
Sulindac
Indomethacin
COX-2 Selective Drugs
Celecoxib
Parecoxib
Etoricoxib
Lumiracoxib (phased out)
Valdecoxib (phased out)
Rofecoxib (phased out - due to thrombus formation)
It is a group of drugs used for RA that is used for pain. It is used for acute cases but it cannot stop the formation of new deformity and do not slow the progression of the disease
NSAIDS
It is a group of drugs used for RA for severe pain. It is too toxic for chronic use, so it is recommended for acute treatment only.
ADR: Cushing syndrome (chronic use); adrenal crisis (sudden stop)
Glucocorticoids
This is the main treatment which addresses the cause of RA. It is used in chronic cases as it prevents the formation of a new deformity and arrest the progression of the disease. They act as immunosuppressants
ADR: immunocompromised
DMARDS
DMARDS
Abtacept
Azathioprine
Cyclophosphamide
Cyclosporine
Chloroquine and hydroxychloroquine
Methotrexate
Mycophenolate
Sulfasalazine
Leflunomide
TNF alpha blocker: infliximab, adalimumab, etanercept
This is a DMARD that targets the CD80 and CD86, which are responsible for sending signals to the immune cells to attack
ADR: URTI
Abatacept
This is a DMARD prodrug that is converted to 6-thioguanine and this can inhibit the DNA synthesis by affecting the inosinic acid production
Azathioprine
It is a DMARD and an anti-cancer agent that acts as an alkylating agent- it donates an alkyl group to the DNA strand
ADR: Leukopenia, NDV, Hemorrhagic cystitis (rescue drug: Mesna)
Cyclophosphamide
It is a DMARD that targets calcineurin
ADR: hirsutism and gingival hyperplasia
Cyclosporine
It is a DMARD that is now an anti-malarial drug
ADR: Ocular toxicity and prolongation of QT interval
Chloroquine and hydroxychloroquine
It is a DMARD that inhibits dihydroorotate dehydrogenase that is used in purine and pyrimidine synthesis
ADR: GI toxicity and hepatotoxicity
Leflunomide
It is the current DMARD of choice that inhibits the folate synthesis by inhibiting:
AICAR Transformylase
Thymidylate synthetase
Dihydrofolate reductase
Rescue drug is folinic acid/ leucovorin
ADR: Mucositis
Methotrexate
It is a DMARD that inhibits cytosine monophosphate (CMP). Its full name is mycophenolate mofetil
ADR: Aplastic anemia
Mycophenolate
It is a DMARD that is a sulfonamide, and its metabolite, sulfapyridine, is the one giving the drug action
ADR: SJS
Sulfasalazine
It is a DMARD that inhibits THF alpha
ADR: reactivation of tuberculosis
TNF alpha blockers
They are DMARDs that are monoclonal antibodies
Infliximab and Adalimumab
It is a DMARD that blocks the TNF alpha receptor
ADR: TB
Etanercept
This is a drug for acute gout that inhibits tubulin synthesis which is important for WBC migration. It has a short DOA and is C/I to patients undergoing dialysis
ADR: Diarrhea, GI disturbance, Hepatotoxicity, Nephrotoxicity, Alopecia
Colchicine
This is a drug for chronic gout that is a xanthine oxidase inhibitor. It prevents the conversion of purine to uric acid. It is a prodrug with an active metabolite called alloxanthine
Allopurinol
This is a drug for chronic gout that is the first non-purine xanthine oxidase inhibitor. It prevents the conversion of purine to uric acid
Febuxostat
These are drugs for chronic gout that are used to inhibit the reabsorption of uric acid in PCT. They are known to be uricosuric agents
A drug from this class has an important interaction with penicillin. It prolongs the half-life of penicillin by inhibiting the tubular secretion of penicillin. However, prolonged duration makes penicillin toxic
Probenecid and Sulfapyrazone
Probenecid
