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Pharm Exam 2 > Anti-inflammatory and Gout > Flashcards

Anti-inflammatory and Gout Flashcards

1
Q

Cyclosporine MOA

A

Calcineurin inhibitor, suppressing production of interleukin-2

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2
Q

Cyclosporine DOC

A

Preventing organ rejection in allogeneic transplants

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3
Q

Cyclosporine Other uses

A

Autoimmune
RA
Psoriasis

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4
Q

Cyclosporine A/E

A

Risk for infection and neoplasms
HTN
Tremor
Male pattern hair growth

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5
Q

Cyclosporine Drug interactions

A

NSAIDS ( Aspirin) – other nephrotoxic drugs
CYP450 (Azoles, Erythromycin, Grapefruit juice) – increase level of Cyclosporine
Rifampin – decreases level of Cyclosporine

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6
Q

Cyclosporine Toxicity

A

Nephrotoxic due to renal blood flow/ filtration

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7
Q

Cyclosporine Monitoring

A

BUN
Cr
Could be toxicity or organ rejection

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8
Q

Tacrolimus MOA

A

Calcineurin inhibitor, prevents helper T cells from producing interleukin-2, interferon gamma and other cytokines

Same MOA as Cyclosporine, different chemical structure and binding place

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9
Q

Tacrolimus Use

A

Prevent organ rejection

Autoimmune

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10
Q

Tacrolimus A/E

A 
GI (N/V/D)
HTN
Hyperkalemia
Hyperglycemic
Gum hyperplasia
Anaphylaxis 
Overgrowth of hair 
Risk for infection and neoplasms
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11
Q

Tacrolimus Toxicity

A

Nephrotoxic

Neurotoxic (HA, Tremors)

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12
Q

Cyclosporine given with

A

glucocorticoids

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13
Q

Tacrolimus given with

A

Glucocorticoids

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14
Q

Tacrolimus Drug interactions

A

CYP3A4: Erythromycin, Azoles, grapefruit juice – increase levels of Tacrolimus
Rifampin – decreases level of Tacrolimus

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15
Q

Aspirin MOA

A 
1st gen NSAID 
non selective (irreversible) inhibitor of cyclooxygenase
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16
Q

Aspirin Use

A 
analgesic 
anti-inflammation 
antipyretic (DOC for adults with fever) 
suppression of platelet aggregation 
dysmenorrhea
cancer prevention ( possibly colorectal)
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17
Q

Aspirin Dosing

A

low: (81mg) platelet aggregation inhibitor
high: (325+mg) pain

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18
Q

Aspirin A/E

A

GI: distress, heartburn, bleeding
increased risk for bleeding
hypersensitivity
Reye’s syndrome ( swelling of the liver and brain)
Salicylate poisoning ( fever, tinnitus, due to not fully developed kidneys)
Acute poisoning: hyperkalemia, respiratory depression, dehydration, acidosis – life threatening OD

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19
Q

Aspirin Toxicity

A

Nephrotoxicity

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20
Q

Aspirin Drug interactions

A

Anticoagulants: increase risk for bleeding
Glucocorticoids: increase r/f gastric ulceration
ETOH: increase r/f gastric bleeding
Ibuprofen: decrease antiplatelet aggregation effects
ACE/ARBs increase renal impairment

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21
Q

Aspirin Contraindications

A

Pregnancy –anemia/ postpartum hemorrhage

Infants

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22
Q

Salicylate poisoning

A

babies, tinnitus, fever, N/V, lethargy/excitability, hyperventilation

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23
Q

Ibuprofen MOA

A

1st gen NSAID
inhibits cyclooxygenase and has inflammatory, analgesic and antipyretic actions
COX 1 and 2 inhibitor

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24
Q

Ibuprofen Use

A 
Fever-- given to children >6mo
Mild- Mod pain
anti-inflammatory
arthritis
better for dysmenorrhea
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25
Ibuprofen A/E
``` GI bleed SJS PUD fluid retention renal impairment (decreased blood flow) resistant HTN platelet inhibitor increase r/f CV disease ```
26
Ibuprofen Drug interaction
decreases effectiveness of BP meds
27
Celecoxib MOA
selective Cox 2 inhibitor
28
Celecoxib Use
osteoarthritis RA Acute pain saved for last form of long term treatment (cardic effects)
29
Celecoxib Contraindications
Sulfa allergy
30
Celecoxib A/E
``` Cardiovascular (heart attack, stroke, CV death) dyspepsia diarrhea abdominal pain URI peripheral edema GI discomfort/irritation ```
31
Celecoxib Toxicity
nephrotoxic (increase risk for HTN, HF, kidney disease)
32
Celecoxib Drug interactions
increase effects of warfarin decrease effects of diuretics (furosemide), ACE inhibitors increase level of Lithium fluconazole increases level of celecoxib
33
Celecoxib Dose
give the smallest dose for the shortest time possible
34
Acetaminophen MOA
inhibits prostaglandin synthesis in the CNS
35
Acetaminophen Use
Analgesic | Antipyretic: DOC for children <6mo
36
Acetaminophen does not
have anti-inflammatory effects
37
Acetaminophen Max dose
healthy person: 4000mg/day malnutrition: 3000mg/day liver diseases: talk to MD <3000mg/day
38
Acetaminophen A/E
SJS Acute generalized exanthematous pustulosis (AGEP) Toxic epidermal necrolysis (TEN)
39
Acute generalized exanthematous pustulosis
rare skin reaction
40
Acetaminophen S/S of Toxicity/ OD
``` Eary: -N/V/D -Sweating -abdominal pain Hepatic necrosis Hepatic failure Coma- death ```
41
Acetaminophen Toxicity
Hepatotoxic
42
Acetaminophen Drug interactions
ETOH increases risk for liver injury Warfarin increases risk for bleeding Blunts vaccine response
43
Acetaminophen Antidote
Acetylcysteine (mucomyst)
44
Ketorolac MOA
Inhibition of prostaglandin synthesis by competitive blocking of the enzyme cyclooxygenase (COX) Non selective COX inhibitor 1st generation NSAID
45
Ketorolac Use
short term pain relief-- equivalent to morphine C-section mild anti-inflammatory effects
46
Ketorolac Dose
5 days max!-- due to bleeding risk
47
Ketorolac A/E
``` GI bleed Peptic ulcer Prolonged bleeding time renal impairment hypersensitivity reaction increase Cardiovascular disease ```
48
Ketorolac Route
IV IM PO
49
Indomethacin Use
1st choice for Acute gout attack -- pain relief Arthritis Tendonitis Bursitis
50
Naproxen pt reports
works the best
51
Indomethacin Contraindications
inflants, children <14y/o PUD Psych patients Patients with seizures
52
Indomethacin A/E
``` Thrombosis** smoking increases risk for CV events Frontal HA-- common CNS: Confusion, dizziness, vertigo, depression, psychosis, seizures GI: N/V/D, bleeding Hematologic anemias Platelet aggregation inhibitor (slight) ```
53
Indomethacin Toxicity
Nephrotoxic
54
Indomethacin metabolized
liver
55
Indomethacin excreted
urine/ feces
56
Glucocorticoids Drugs
``` Hydrocortisone Prednisone Prednisolone Methylprednisolone Dexamethasone ```
57
Glucocorticoids MOA
Nearly identical to steroids produced by the adrenal cortex | Immune suppression
58
Glucocorticoids Use
``` Those who cannot take NSAIDs Gout that is unresponsive to NSAIDS Acute gout attack Concurrent use with Cyclosporine, Tacrolimus to prevent infection Premedicate to chemo RA SLE IBD Other inflammatory disorders Allergic conditions Asthma Dermatologic disorders Neoplasms Suppression of allograft rejection Prevents respiratory distress syndrome in preterm infants ```
59
Prednisone Use
Pain relief-- for those who cannot take NSAIDs
60
Glucocorticoid Doses
low doses: physiologic effects (usually for adrenal insufficiency) high doses: pharmacologic effects (immune suppression)
61
Glucocorticoid Drug interactions
``` Aspirin* cannot be combined due to GI bleed Diabetes oral meds K dumping drugs (hypokalemia) NSAIDs Vaccines ```
62
Glucocorticoid Contraindications
Systemic fungal infections Receiving live Vaccine Prone to hyperglycemia
63
Glucocorticoid A/E in general
increase everything
64
Glucocorticoid A/E
``` Increase: -Bp -BG -infection -wight Adrenal insufficiency Osteoporosis Myopathy (rhabdomyolysis) Fluid retention Hypernatremia Hypokalemia Growth suppression Psychological disturbances Glaucoma/ cataracts PUD Iatrogenic Cushing syndrome (pot belly, moon face, buffalo hump) Abnormal hair growth Thinning skin Insomnia Agitation ```
65
Glucocorticoid withdrawal
Taper for 5-7 days | If stopped immediately can cause Addison's disease
66
Treatment for Addison's disease
low dose of glucocorticoid, then taper off slowly
67
Glucocorticoid Nursing implementation
Give in the morning because the body is producing the most cortisol at that time and it causes insomnia Can be taken with food Increase dose when under stress Can be giving on alternating days Avoid long term use Use smallest dose for shortest time Topical can cause systemic reactions if gets into wound
68
Glucocorticoid Monitoring
BP | BG
69
Colchicine MOA
Unknown | Does not decrease production or removal of uric acid
70
Colchicine Use
Gouty arthritis Acute gouty attack : 2nd line drug Anti-inflammatory (when unresponsive to NSAIDs)
71
Colchicine Doses
``` Small dose (long term): prevents gout attacks High dose (short term): relieve attacks ```
72
Colchicine A/E
GI: N/V/D -- take with food Abdominal pain Myelosuppression Myopathy (rhabdomyolysis)
73
Colchicine Drug interactions
Statins: increase muscle injury PGP inhibitors CYP3A4 drugs
74
Colchicine Contraindication
Renal/ Hepatic impairment | pregnancy
75
Goal for hyperuricemia (gout)
``` Promote dissolution of urate crystals Prevent new crystal formation Prevent disease progression Reduce frequency of acute attacks Improve quality of life ```
76
Drugs for Hyperuricemia
Allopurinol Febuxostat Probenecid Pegloticase
77
DOC for acute gout attack
NSAIDs
78
Allopurinol and Febuxostat
inhibits uric acid formation
79
Probenecid
Increases uric acid excretion
80
Pegloticase
Converts uric acid to allantoin, a compound readily excreted by the kidneys
81
Allopurinol MOA
Inhibits xanthine oxidase (XO), an enzyme required for uric acid formation -reduces blood levels of uric acid
82
Allopurinol DOC
Chronic tophaceous gout
83
Allopurinol Other uses
Hyperuricemia due to chemotherapy
84
Allopurinol A/E
N/V/D - give with food abdominal discomfort HA Drowsiness Metallic taste Hypersensitivity syndrome (rash, fever, kidney and liver dysfunction) Initially may cause an acute gout attack Renal impairment ** (nephropathy from deposition of urate crystals in the kidneys)
85
Allopurinol Drug interactions
Warfarin
86
Allopurinol Nursing implementations
Promote hydration- 2-3 L/ day at least
87
Allopurinol Prevents
New tophus from forming and causing regression of tophi that have already formed
88
Allopurinol Improves
Joint function
89
Probenecid MOA
Acts on renal tubules to inhibit reabsorption of uric acid | Prevents formation of new topji and helps diminish existing tophi
90
Probenecid A/E
Same as Allopurinol N/V/D -- take with food Hypersensitivity reactions May exacerbate acute gout attacks (add Indomethacin)
91
Probenecid Toxicity
Nephrotoxic
92
Probenecid Nursing implementation
Promote hydration 2.5-3L/ day Need to alkalize urine to protect the kidneys Increasing uric acid excretion
93
Probenecid Drug interactions
Aspirin Indomethacin Sulfonamides (kidneys)
94
Pegloticase MOA
Recombinant of uricase, an enzyme that catalyzes the conversion of uric acid to allantoin, an inert water-soluble compound
95
Pegloticase Use
Last resort for Chronic gout (IV)
96
Pegloticase A/E
Anaphylaxis | Infusion reactions
97
Pegloticase Nursing implementation
Premedicate for reactions with antihistamine, acetaminophen, glucocorticoids
98
Pegloticase Contraindication
G6PD deficiency
99
DMARDS Drugs
Methotrexate Cyclosporine Etanercept
100
Methotrexate MOA
Traditional DMARD | Immunosuppression effects
101
Methotrexate DOC
Gold standard for RA (analgesic/ anti-inflammatory, start with in a year of Dx) Prevents joint destruction Prevents long term disability
102
Methotrexate Other use
Psoriasis Medical abortion Cancer/ chemo
103
Methotrexate Contraindication
Pregnancy
104
Methotrexate A/E
``` Bone marrow suppression Mucositis (ulcers) N/V Fatigue Pneumonitis: acute inflammation of the lung (SOB) Pulmonary fibrosis Methotrexate lung ```
105
Methotrexate lung
SOB Dry cough Fever -Most often seen in the first 6 mo
106
Methotrexate Toxicity
Hepatotoxic | Teratogenic
107
Methotrexate Baseline information
Chest Xray PFT HIV, HBV, HCV test Pregnancy test
108
Methotrexate Monitoring
CBC LFTs Pregnancy tests -every 4-8wk or every month or every other month
109
Methotrexate Nursing implementation
Takes 6wk to start working | Always give 1mg folic acid every day
110
Methotrexate Doses
low dose: RA | high dose: Cancer
111
Methotrexate Antidote
Leucovorin
112
Etanercept MOA
Produced by cells of immune system or inflammatory cells Acts to decrease inflammatory and immunologic responses Tumor Necrosis factor antagonists blockers (pro-inflammatory cytokine) -- inactivates TNF
113
Etanercept Use
Moderate to severe RA Given in combo with Methotrexate Psoriasis
114
Etanercept Starts working
sooner than Methotrexate: 2wk, at 3 mo you see extreme benefits, at 5 yr most patients have no further progression
115
Etanercept A/E
``` Increased risk for infection and neoplasms, and reactivation of TB Serious allergic reaction New or worsening Heart failure Hematological disorders (fatal) CNS demyelinating disorders ```
116
Etanercept Toxicity
Hepatotoxicity
117
Etanercept not often used because
VVVVVV expensive!!!

Pharm Exam 2 (4 decks)

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