B6-005 Pharmacotherapy of RA and Joint Pain Flashcards
side effects of NSAID
GI distress (nausea, diarrhea)
centrally acting, non-narcotic analgesic
acetaminophen
side effect of high efficacy opiod
constipation
protective effects of aspirin
-decreased incidence of myocardial ischemia
-protective against colon cancer
COX inhibition by aspirin is […] and […]
nonselective and irreversible
COX inhibition reduces [….] production
prostaglandin
inhibit the transcription of inflammatory gene products
corticosteroids
sequesters TNF-a cytokines with “decoy” receptors
etanercept
COX-2 selective inhibitor
celecoxib
contraindicated in cardiovascular patients due to increased risk of clotting
celecoxib
blocks the production of IL-2, IL-3 and TNF-a
cyclosporine
gout symptoms can be exacerbated by […] diuretics
thiazide
inhibits the chemotactic and phagocytic action of neutrophils
colchicine
most commonly used gout therapy
NSAIDs
indomethacin and other NSAIDs inhibit […] phagocytosis
urate crystal
have largely replaced colchicine as drug of choice for gout
NSAIDs
gout patients who have failed or cannot tolerate NSAIDs can be given
corticosteroids
beneficial to patients when just one or two large joints are affected
intra-articular steroid injection
good option in elderly people with many illness to manage who only have pain in one or two joints
intra-articular steroid injection
non selective NSAIDs [3]
aspirin
ibuprofen
indomethacin
COX-2 selective NSAID
celecoxib
nonselective COX inhibitor that irreversibly inhibits COX and platelet aggregation
aspirin
aspirin is most effective in reducing mild/moderate pain through reducing
inflammation
can have antipyretic effect likely mediated by COX and IL-1 inhibition in the CNS
aspirin
most common adverse effect of aspirin
gastric upset, ulcers
nonselective COX inhibitor often prescribed in lower doses with analgesic but no anti-inflammatory efficacy
acetaminophen
nonselective COX inhibitor that works particularly well for gout and ankylosing spondylitis
indomethacin
incidence of cardiovascular thrombotic events is associated with […] inhibitors
COX2
weak inhibitor of peripheral COX enzymes
acetaminophen
causes direct CNS analgesic effects
acetaminophen
acetaminophen is not […] at typical doses
anti-inflammatory
danger of liver damage due to acetaminophen occurs at doses of
> 4g/day
inhibits microtubule aggregation which disrupts leukocyte chemotaxis and phagocytosis
colchicine
gout prophylaxis is usually initiated after […] of symptoms
greater than one year
**not used for intial, acute attacks
xanthine oxidase inhibitors
allopurinol
febuxostat
increase renal clearance of uric acid by inhibiting tubular absorption
probenecid
probenecid can increase the risk of […]
kidney stones
inhibits URAT1, preventing renal reabsorption of uric acid
lesinurad
inhibits AICAR transformylase and thymidylate synthetase affecting polymorphonuclear chemotaxis
methotrexate
decreases IgA and IgM rheumatoid factor production
sulfasalazine
cell growth arrestor (G1 phase)
leflunomide
purine synthesis inhibitor, supresses B and T cell function
azathioprine
inhibits IL-1 and IL2 production in T cells
cyclosporine
cross links DNA to prevent cell replication
cyclophosphamide
gold compounds alter the capabilities of
macrophages
Anti TNF agents
etanercept
infliximab
adalimumab
b cell depleting agent
rituximab
inhibits receptor-ligand co-stimulation of T cells
abatacept
IL-1 inhibitor
anakinra
IL-17 inhibitors used for psoriasis [2]
secukinumab
ixekizumab
what class of drugs inhibits the transcription of genes that encode inflammatory proteins?
steroids
strength of opioids
fentanyl > hydromorphone > oxycodone > morphine/methadone > meperidine > codeine