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M3 Pharm B1 > Anti-inflammatory Drugs 3 > Flashcards

Anti-inflammatory Drugs 3 Flashcards

1
Q

Rheumatoid Arthritis (RA)

A

Buzzword: Extra-articular involvement
Joints, eyes, heart, lungs

F>M, all over the place, not localized
Symmetrical arthritis 
Synovium first 
Bones get thinner 
Rhematoid factor is + (though not primary diagnostic test)
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2
Q

RA: Dx

A

Buzzword: rheumatoid nodules

1 - Early morning stiffness for 1 hour or longer
2 - Simultaneous swelling of 3 or more joints

Always order joint X-ray

Order ESR to look for inflammation, with RA = Elevated ESR

Wrist, PIP, NOT DIP
Elbow, ankle, knee

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3
Q

RA: Rx

A

First: NSAIDs or COX2 Inhibitors

If this doesn’t work within 3 months , go to Disease-Modifying Antirheumatic Drugs (DMARDS)

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4
Q

RA: DMARDs definition

A

Disease-Modifying Antirheumatic Drugs

Used when NSAIDs or COX2 inhibitors don’t work

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5
Q

RA: DMARDS - Methotrexate

A

MOA: Inhibits Dihydrofolate Reductase; cytotoxic to lymphocytes

Adverse effects: Bone marrow suppression, hair loss, mucositis, worsens nodules

*also a cancer drug for chemotherapy

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6
Q

RA: DMARDS - Hydroxychloroquine

A

MOA: Stabilizes lysosomes and decreases chemotaxis

Adverse effects: GI distress and visual dysfunction (Cinchonism), and hemolysis from G6PD deficiency)

Also, increased LFTs: increased AST and ALT elevations.

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7
Q

RA: DMARDS - Sulfasalazine

A

MOA: ASA inhibits COX2
Sulfapyridine: decrease B cell functions

Adverse: ASA (GI distress), Sulfapyridine: rash, hemolysis, SLE like syndrome

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8
Q

RA: DMARDS - Corticosteroids

A

For flaring

MOA: Decreases LTs, IL-2, and PAF (platelet activating factor)

Adverse effects: ACTH depression, susceptibility to infections

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9
Q

RA: DMARDS - Gold Salts

A

MOA: Decrease lysosomal and macrophages functions

Adverse effects: stomatitis, rash, bone marrow depression, proteinuria, and nephrotic syndrome

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10
Q

RA: DMARDS - D-Penicillamine

A

Suppress T-cell and decreased rheumatoid factor

Adverse effects: aplastic anemia, myasthenia gravis

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11
Q

RA: DMARDS - Cyclophosphamide

A

Alkylating agents used in severe cases

Adverse: hemorrhagic cystitis

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12
Q

RA: DMARDS - Azathioprine

A

Immunosuppressive in autoimmune disease
MOA: Inhibits purine synthesis

Side effects: bone marrow suppression

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13
Q

RA: New DMARDs (Biologics) - Infliximab

A

Monoclonal antibody
MOA: Decreases TNF

Adverse effects: Infusion reactions, infections

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14
Q

RA: New DMARDs (Biologics) - Etanercept (Enbrel)

A

A recombinant of TNF receptor
BINDS to TNF (not inhibit; binding decreases effects)

Adverse effect: Hypersensitivity, infections

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15
Q

RA: New DMARDs (Biologics) - Leflunomide

A

MOA: Inhibits pyrimidine synthesis, inhibits dihydro-acid dehydrogenase

Adverse effects: apopecia, rash, hepatotoxicity

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16
Q

RA: New DMARDs (Biologics) - Anakinra

A

MOA: IL-1 receptor antagonist

Adverse effects: Reaction at injection site, infection

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17
Q

RA: New DMARDs (Biologics) - Adalimumab (Humira)

A

Recombinant Monoclonal antibody

BINDS TO TNF

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18
Q

RA: New DMARDs (Biologics) - Abatacept

A

Co-stimulation modulator
MOA: Inhibits T-cell activation by binding to cell surface markers (proteins) on leukocytes

Rx of RA

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19
Q

RA: So, what are the drugs that decrease TNF (not inhibit, but binds and decreases)?

A

Infliximab
Etanercept
Adalimumab

20
Q

Osteoarthritis: Defined

A

Buzz word: Increase with age

M=F
Most common form 
New bone formation = osteophytes
Weight bearing joints 
*Stiffness less than 30 minutes in the morning 
Primary most common
21
Q

Osteoarthritis: Secondary Osteoarthritis

A

Anything that affects cartilages (joint deformity)

22
Q

Osteoarthritis: Dx, Buzzword, Rx

A

Dx: X-ray

Buzz word: Unequal loss of joint space

Rx: Exercise, weight loss,

Rx Meds: Tylenol, Ibuprofen, COX-2 inhibitors (celecoxib)

23
Q

*Osteomyelitis: Defined

A

*NOT AN INFLAMMATORY DISEASE

Buzzword: Bacterial infection from Staph Aureus (gram positive –> highly resistant to antibiotics)

Any part of the bone: marrow, cortex, and periosteum

Children: Acute
Adult: Chronic

24
Q

Do blood cultures detect *Osteomyelitis?

A

No, because it doesn’t tell you if bone is involved

25
Q

Osteomyelitis: 1st Dx Test

A

1st: X-ray

26
Q

Osteomyelitis: If X-ray is (+)

A

Order biopsy
Rx
IV antibiotics

27
Q

Osteomyelitis: If X-ray is (-)

A

Bone scan and

If (+) –> biopsy –> Rx and IV antibiotics

If (-) –> Not osteomyelitis –> Rx: could be ulcer

28
Q

Osteomyelitis: Why is dx of bone involvement necessary before rx? Also, antibiotics for Staph aureus

A

You don’t wanna put someone in IV antibiotics for 6 weeks without a diagnosis of osteomyelitis

For Staph Aureus: Ox/Clox/Diclox and Naf (IV)

29
Q

Fibromyalgia: Defined

A

Buzzword: Labs are normal
Short sleeve shirt part –> shoulder, trapezius, and hip girdle

Widespread aching and stiffness for longer than 3 months
Look for tender points

30
Q

Fibromyalgia: Rx

A

Analgesics and antidepressants

Cymbalta (duloxetine) –> CNS depressant
Lyrica (Pregbalin, more potent than gabapentin)
Gabapentin

31
Q

Polymyalgia Rheumatica: Def, Lab, and Buzzword

A

Elderly with same presentation as fibromyalgia

Lab: Increased ESR
Buzzword: Giant Temporal Arteritis (Biopsy)

32
Q

Polymyalgia Rheumatica: *Tx

A

Give steroids 15 mg/day and taper

*If they come back with severe headache, increase steroids to 40 mg/day. If not, blindness has occurred

33
Q

Gout:

A

Crystal induced arthritis
Male 10:1
Buzz word: Big toe and elevated serum uric acid

Why:
Increased UA production: Idiopathic

Decreased UA excretion: (renal)

34
Q

Gout: Lab

A

Negative birefringence with polarized light

If positive: pseudo-gut

35
Q

Gout: Drugs

A

1st: NAIDS

Then, Indomethacin, Naproxen, and sulindac

36
Q

Gout: Acute Gouty Attack Buzzword and MOA

A

Colchicine

Binds to tubulin –> Decreases microtubular polymerization
Decreases LTB4 formation (inhibits leukocyte and granulocyte migration)

37
Q

Acute Gouty Attack: Colchicine Adverse effects

A

Acute: Diarrhea and GI pain

Long term: Mylosuppression, peripheral neuropathy, hematuria and alopecia

38
Q

Chronic Gouty Arthritis: Goal

A

To decrease uric acid

39
Q

Chronic Gouty Arthritis Drugs: Allopurinol

A

Allopurinol
MOA: Inhibits Xanthine Oxidase
Suicide substrate: own product inhibiting the enzyme (decreases purine metabolism, which decreases uric acid)

40
Q

Chronic Gouty Arthritis Drugs: Allopurinol Buzz word and Adverse Effects

A

Inhibits 6-mercaptopurine metabolism

If given with cancer drug, have to lower the dose of cancer drug, else severe liver toxicity

Peripheral neuropathy, stone formation, rash, vasculitis

41
Q

Chronic Gouty Arthritis Drugs: Probenicid MOA and Adverse Effects

A

MOA: Inhibits proximal tubular reabsorption of urate. Inhibits secretion of acidic drugs: Penicillins

Adverse: Higher excreter of urate –> urate crystals in the kidney

42
Q

Chronic Gouty Arthritis Drugs: Sulfinpyrazone

A

MOA: Similar to Probenicid

Activity is GFR dependent (not good below 30 ml/min)
Inhibits platelet aggregation

Adverse effects: Gi Distress, rash, nephritic syndrome

43
Q

Gout New Drug:

A

Febuxistat

44
Q

Corticosteroids: MOA at cellular level (4)

A
  1. Inhibit the release of inflammatory mediators
  2. Decrease migration of leukocytes
  3. Decrease capillary permeability
  4. Decrease phagocytosis
45
Q

Corticosteroids: MOA at the biochemical level (4)

A
  1. Inhibits PLA2
  2. Block COX2 expression
  3. Decrease platelet activating factor
  4. Decrease interleukins (IL-2)
46
Q

Corticosteroids: Adverse reactions (8)

A
  1. Electrolyte imbalance: edema, HTN
  2. Increase infection and decrease wound healing
  3. Hyperglycemia due to gluconeogenesis
  4. Osteoporosis
  5. ACTH suppression: cortical atrophy
  6. Iatrogenic Cushing’s syndrome
  7. Increase glaucoma and cataracts
  8. Steroid rage (mental dysfunction)

M3 Pharm B1 (8 decks)

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