BLOOD_GOUT 4 Flashcards
is the only over the counter NON-anti-inflammatory analgesic.
acetaminophen
- A weak COX-1 and COX-2 inhibitor
- An analgesic and antipyretic agent
- lacks anti-inflammatory or antiplatelet effects
acetaminophen
Overdosage of acetaminophen in px with severe liver impairement results to
hepatotoxic
Prompt administration of this drug which is a sulfhydryl donor, may be lifesaving after an overdose.
Acetylcysteine
People who regularly consume ___ per day are at increased risk of acetaminophen-induced hepatotoxicity.
3 or more alcoholic drinks
- has anti-inflammatory actions in several connective tissue disease
- called disease-modifying drugs (reversal joint damage)
- called slow-acting antirheumatic drugs (6 week to 6 months)
Disease-Modifying Antirheumatic Drugs (DMARDS)
- anti-inflammatory drugs with an intermediate rate of action
- too toxic for routine chronic use
- reserved for temporary control of severe exacerbations
- long term use in px w/ severe disease not controlled by other agents
Costicosteroids
Interfere with the activity of T lymphocytes
- sulfasalazine
- hydroxychloroquine
- cyclosporine
- leflunomide
- mycophenolate
- mofetil
- abatacept
Interfere with the activity of B lymphocyte
rituximab
Interfere with the activity of macrophage
- gold compounds
DMARDS that are given orally.
- sulfasalazine
- hydroxychloroquine
- methotrexate
- cyclosporine
- peniccillamine
- leflunomide
DMARDS that are given by injection
- anti TNF-alpha drugs
Gold compound are available for parenteral and oral use.
- Parenteral: AuNa thiomalate and aurothioglucose
- Oral: auranofin
Are initiated fairly early in px w/ moderate to severe rheumatoid arthritis in an attempt to ameliorate disease progression
methotrexate
Short courses of glucocorticoids can cause
- behavioral changes
- - impaired glucose control
Toxicity of DMARDs
- severe or fatal toxicities
Is associated w/ increased serum conc of uric acid. Acute attacks involve joint inflammation initiated by precipitation of uric acid crystals.
Gout
Are effective in inhibiting the inflammation of acute gouty arthritis.
indomethacin
A selective inhibitor of microtubule assembly, reduces leukocyte migration and phagocytosis; this drug may also reduce production of leukotrine B4 and decrease radical formation.
Colchicine
Toxicity of colchicine.
- significant gastrointestinal disturbance (diarrhea)
- damage the liver and kidney
Lower doses of this are used to prevent attacks of gout in px with a history of multiple acute attacks.
colchicine
Toxicity of NSAIDs and indomethacin
- renal damage
- bone marrow depression (indomethacin)
Mostly of the uric acid is filtered by the kidney is reabsorbed in the
proximal tubules
Uricosuric drugs (xanthine oxidase inhibitors) are used orally to treat
chronic gout
Toxicity of Uricosuric Agents
- precipitate an attack of acute gout during early phase
- may share allergenicity with other classes of sulfonamides
The production of uric acid can be reduced by inhibition of ___, the enzyme that converts hypoxanthine to xanthine and xanthine to uric acid.
xanthine oxidase
is converted to oxypurinol (alloxanthine) by xanthine oxidase
allopurinol
is an irreversible suicide inhibotr of the xanthine oxidase
alloxanthine
is a nonpurine inhibitor od xanthine oxidase that is more selective than allopurinol and alloxanthine which inhibit other enzyme involved in purine and pyrimidine metabolism
febuxostat
Is more effective in lowering serum uric acid.
febuxostat
Is used as an adjunct to cancer chemotherapy to slow formationn of uric acid from purines released by the death of large numbers of neoplastic cells.
Allopurinol
Toxicity of Allopurinol
- gastrointestinal upset
- rash
- peripheral neuritis
- vasculitis
- bone marrow dysfunction
- aplastic anemia
Toxicity of Febuxostat.
- liver function abnormalities
- headache
- gastrointestinal upset
Among NSAIDs, aspirin is unique because it
A. irreversibly inhibits its target enzyme
B. Prevents episodes of gouty arthritis w/ long term use
C. reduces fever
D. reduces the risk of colon cancer
E. Selectively inhibits the COX-2 enzyme
irreversibly inhibits its target enzyme
W/c of the ff is an analgesic and antipyretic drug that lacks an anti-inflammatory action?
Acetaminophen
16 y.o girl comes to the ED suffering from the effects of an aspirin overdose. W/c of the ff syndromes is the px most likely to exhibit as a result of this drug overdose?
- Hyperthermia
- metabolic acidosis
- coma
