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Chapter 16 Flashcards

1
Q

analgesic

A

compound with pain blocking properties

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2
Q

Antiinflammatory agents

A

drug that blocks effects of inflammatory response

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3
Q

antipyretic

A

blocking fever

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4
Q

Chrysotherapy

A

treatment with gold salts; gold is taken up by macrophages, which inhibit phagocytosis. Used in patients with whom other methods failed, can be toxic

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5
Q

inflammatory response

A

the bodys nonspecific response to cell injury resulting in pain, swelling, heat and redness

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6
Q

nonsteroidal antiinflammatory drugs

A

drugs that block prostaglandin synthesis and act as antiinflammatory, antipyretic, and analgesic agents

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7
Q

salicyates

A

salicyate acid compounds used as antiinflammatory, antipyretic, anaglesic agents; block prostoglandin system

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8
Q

salicylism

A

syndrome associated with high levels of salicylates - dizziness, ringing in ears, difficultly hearing, nausea, vomitting, diahrea, confusion

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9
Q

An inflammatory response is designed to protect the body from

A

injury and pathogens

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10
Q

Anti - inflammatory agents generally block or alter

A

chemical reactions associated with inflammatory response to stop one or more signs and symptoms of inflammation

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11
Q

What are corticosteroids used for?

A

systemically to block the inflammatory and immune systems.
*adverse effects - decreased resistance to infection

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12
Q

What are corticosteroids used for?

A

Systemically to block the inflammatory and immune systems.
*adverse effects - decreased resistance to infection

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13
Q

What are antihistamines used for

A

block the action of histamine in the initiation of the inflammatory response

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14
Q

Children & older adults are more susceptible to what effects of anti-inflammatory agents?

A

GI and CNS effects

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15
Q

What are the only salicylates recommended for children?

A

Choline magnesium trisalicylate
Aspirin

*do no use when any risk of Reye syndrome, viral infection, febrile, lethargic and personality changes

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16
Q

What are the NSAIDs approved in children?

A

Ibuprofen, naproxen, tolmetin, meloxicam and in some cases, indomethacin

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17
Q

What is the most used analgesic/antipyretic drug for children?

A

Acetaminophen

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18
Q

Children with arthritis may recieve treatment with

A

gold salts or etanercept
must be monitored closely for toxicity

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19
Q

Salicylates, NSAIDs and gold products have what effect on neonates and possibly the mother?

A

severe adverse effects

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20
Q

Geriatric warnings have been associated with which drugs?

A

Naproxen, ketorolac and ketoprofen bc of reports of increased toxicity

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21
Q

Salicylates are popular anti-inflammatory agetns because?

A

their ability to block inflammatory response, fever-blocking, and pain-blocking properties

**oldest anti-inflammatory used

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22
Q

Salicylates were extracted from where? by ancient peoples?

A

willow bark, poplar trees and other plants

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23
Q

What is the therapeutic action of salicylates?

A

Inhibit the synthesis of prostaglandin, an important mediator of the inflam response

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24
Q

How do salicylates decrease fever

A

-Antipyretic effects may be related to blocking prostaglandin mediator or pyrogens at thermoregulatory center of hypothalamus

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25
How do salicylates effect platelet aggregation & blood clot formation?
@low levels - -affects platelet aggregation by inhibiting synthesis of thromboxane A2 @high levels - inhibits synthesis of prostacyclin, a vasodilator that inhibits platelet aggregation
26
Salicylates are indicated for the treatment of ?
Mild to moderate pain, fever, and numerous inflammatory conditions
27
Rheumatoid arthritis is concerned a ____disease have high levels of? which interacts with what happens to the joint?
-Autoimmunse disease -high levels of rheumatoid factor (RF), an antibody to immunoglobulin G (igG) - interacts with circulating igG to form immune complexes that deposit in synovial fluid in joints, eye and other vessels -destroys the joint & fills with scar tissue/ a cycle of inflammation & destruction
28
What are the pharmacokinetics of salicylates?
-readily absorbed directly from the stomach -reaching peak levels in 5 to 30 mins -The half-life of 15 mins to 12 hours -Metabolized in liver & excreted in urine -Cross placenta & enter breast milk
29
What are the contraindications & cautions of salicylates?
Known allergy to salicylates, NSAIDS, tartrazine Bleeding abnormalities - changes to platelet Impaired renal function - excreted in urine Chickenpox or flu - risk of reye syndrome Surgery or invasive procedures w/in 1 wk - risk of bleeding pregnancy - adverse effects
30
What are the adverse effects of salicylates?
Nausea, heartburn, epigastric discomfort
31
What is salicylism?
Can occur with high levels of asprin dizziness, ringing in ears, difficulty hearing, nausea, vomiting, diahrea, confusion
32
Signs of salicylate toxicity include
hyperpnea, tachypnea, hemorrhage, excitment, confusion, pulmonary edema, convulsions, fever, coma, cardio, renal or respiratory collapse
33
Why do salicylates interact with other drugs?
because of alterations in absorption, effects on the liver, and extension of therapeutic effect
34
NSAIDS provide what kind of effects?
strong anti-inflammatory & analgesic effects w/o adverse effects with corticosteroids
35
What is the black box warning for NSAIDS?
increased risk in CV events and increased bleeding in GI tract
36
NSAIDS include:
Propionic acids acetic acids fenamates oxicam derivatives cyclooxygenase-2 (Cox-2) inhibators
37
What are the therapeutic actions of NSAIDS?
inhibition of prostaglandin synthese blocks 2 enzymes COX1 and COX2
38
What does COX1 do? What does COX 2 do?
COX1 - present in all tissues, blood clotting, protecting stomach lining, maintaining sodium water balance in kidney COX 2 - active @ sites of trauma or injury
39
What are NSAIDS used to treat?
Signs and symptoms of rheumatoid arthritis & osteoarthritis relief of mild to moderate pain treatment of dysmenorrhea fever reduction
40
What are the pharmacokinetics of NSAIDS?
Rapidly absorbed in GI tract reaching peak levels in 1-3 hours Metabolized in liver, excreted in urine Cross placenta & into breast milk
41
What are the contraindication of nSAID?
-allergy to NSAID, salicylate, celecoxib, sulfonamides -CV dysfunction or hypertension - effects of prostaglandins -Peptic ulcer or known GI bleed -Pregnancy -Caution should be used w/ renal or hepatic dysfunction
42
What are the adverse effects of NSAIDS?
nausea, GI pain, constipation, diarrhea, headache, dizziness, fatique -bleeding, platelet inhibition, hypertension, and bone marrow depression have been reported with chronic use
43
What are the important drug to drug interactions with NSAIDS?
Decreased effects with loop diuretics Decreased antihypertenive with beta blocker Lithium toxicity with ibprofien
44
What is acetaminophen used to treat?
moderate to mild pain & fever
45
What is the therapeutic action of acetaminophen?
Acts directly on thermoregulatory cells in the hypothalamus to cause sweating and vasodilation causes release of heat, and lowers fever
46
What are the pharmcokinetics of acetaminophen?
Rapidly absorbed from GI tract reaching peak levels in .5 to 2 hours MEtabolized in liver and excreted in urine half life of 2 hours **Also available for IV for adults & children over 2
47
What are the contraindications of acetaminophen?
allergy to acetaminophen pregnancy hepatic dysfunction or chronic alcoholism - liver
48
What are the adverse effects of acetaminophen?
headache, hemolytic anemia, renal dysfunction, skin rash, fever
49
What is the antidote for overdose of acetaminophen?
acetylcysteine
50
What are the drug to drug interactions with acetaminophen?
Anticoagulants - increased risk of bleeding chronic ethanol - toxicity barbiturates, carbamazepine, hydantoins or rifampin - hepatotoxicity
51
What is the gold salt available for use?
auranofin (ridaura)
52
What is the therapeutic action of chrysotherapy?
inhibition of phagocytosis which blocks the release of lysosomal enzymes and tissue destruction is decreased
53
What is the pharmacokinetics of gold salts?
absorbed at varying rates depending on route widely distributed but seem to concentrate in the hypothalamix-pituitary adrenocortical system & adrenal and renal cortices excreted in urine and feces crosses placenta and breast milk
54
What are the contraindications of gold salts?
quite toxic allergy to gold, severs diabetes. CHF, hypertension, recent radiation , toxic levels of heavy metals, pregnancy
55
What are the adverse effects of gold salts?
stomatitis, glossitis, gingivitis, pharyngitis, laryngitis, colitis, diarrhea & other GI inflammation, bone marrow depression, flushing, fainting, dizziness,
56
What are the drug to drug interactions of gold salts?
penicillamine, antimalarials, cytotoxic drugs or immunosyppressive drugs - toxicity
57
What are the tumor necrosis factor (TNF) drugs?
adalimumab (humira) certolizumab (Cimzia) etanercept (enbrel) golimumab (simponi) infliximab (remicade)
58
What is the therapeutic action of TNF blockers??
decrease local effects of TNF, which slowsa the inflammatory response and joint damage associated with it
59
What are TNF blockers prescribed for?
Rheumaotid arthritis polyarticular juvenile arthritis psoriatic arthritis plaque psoriasis
60
What are the pharmacokinetics for TNF blockers?
must be given subcutaneously **except of infliximab - IV Slow onset, usually peaking in 48-72 hours Excreted in tissues Half life - 115 hours to 2 weeks Cross placenta & breast milk
61
What are the contraindications of TNF blockers?
acute infection, cancer, sepsis, TB, hepatitis, demyelinating disorders - bc they block body immune response
62
What are the adverse effects of TNF blockers?
Black box - serious to fatal infections and development of lymphomas and other cancers Demyelinating disorders, MS, MI, heart failure, hypotension
63
What are the drug to drug interactions with TNF blockers?
other immune suppressant drugs - increase risk of serious infections & cancer live vaccines
64
Other DMARDS are?
Anakinra (kineret) Leflunomide (arava) Sarilumab (kevzara) tofacitinib (xeljanz) penicillamine (depen)
65
What are the therapeutic actions of Anakinra (kineret) Leflunomide (arava) Sarilumab (kevzara) tofacitinib (xeljanz) penicillamine (depen)
*Anakinra -interleukin-1 receptor antagoinst/blocks degradation of cartilage *Leflunomide - inhibits enzyme, dihydroorotate dehydrogenase, relieving signs of inflam & blocking damage *Sarilumab - interleukin 6 receptor antagonist - decrease inflam *tofacitinib- kinase inhibor - blocks signaling pathways within immune cells - oral *penicillamine - lowers immunoglobin M, relieving inflam *2-3 months
66
What are the pharmacokinetics of ANAKINRA
Anakinra - slowly absorbed in subcut, peak 3-7 hours. Metabolized in tissues excreted in urine half life - 4-6 hrs * do not use with other immune suppresants
67
What are the pharmacokinetics of Sarilumab (kevzara)
Subcut injection slowly absorbed peak 2-4 days half life 10 days **risk of TB and development of lymphomas/cancers
68
What are the pharmcokinetics of Leflunomide (arava)
slowly absorbed from GI tract peak n 6-12 hrs undergoes hepatic metabolism & excreted in urine 1/2 life 14-18 days *sever hepatic toxicity - monitor liver closely
69
What is the pharmacokinetics of penicillamine (depen)
oral - reaches peak in 1-3 hrs extensively metabolized in liver, excreted in urine 1/2ife 2-3 hrs *fatal myasthenic syndrome, bone marrow depression, assorted hypersensitive reactions **decreased if taken with iron salts or antacids
70
What are the pharmacokinetics of tofacitinib (xeljanz)
absorbed quickly peak 5-1 hr metabolized inliver, excreated in urine 1/2 life 3 hours *risk of TB and development of lymphomas/cancers **dont use with other immune supp
71
What are the adverse effects of Leflunomide (arava) Sarilumab (kevzara) tofacitinib (xeljanz) penicillamine (depen)
local irratation at injection sites increased risk of infection

Pharm (16 decks)

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