Content Flashcards
Localized deep, aching pain
Early am stiffness
crepitus
instability of weight bearing joints
osteoarthritis
No lab test –> diagnosed by clinical presentation
OA - general pharmacology
APAP NSAIDS, COX 2 inhibitors Corticosteroids - oral and injectable Hyaluronate Glucosamine
Acetonide, Diacetate, Hexacetonide - class?
injectable CS
How often can you give injectable CS for OA?
q 4-6 months (max 3-4 times year)
Injectable CS risks
scarring and infection
Never inject an infected joint
What can be given for pain management in patients with OA that fail pharmacological and analgesic therapy?
Hyaluronate injections (only for the knee)
Hyaluronate injections - MOA
replicates viscoelastic properties
Supartz, Synvisc, Hyalgan, Nuflexxa - class?
Hyaluronate injection
Hyaluronate injection - caution and education
Caution: allergy to avian protein, eggs, feathers
Avoid weight bearing x 48 hrs (b/c given with 18-22g and med can leak out the track)
OTC product to reduce arthritic pain and slow narrowing of joint
Glucosamine
No SE, No DDI, well tolerated, works for 40-50%
Gout - acute treatment options
Colchicine
NSAIDS
corticosteroids
Gout - chronic treatment options
Allopurinol or Febuxistat
Colchicine
Colchicine + Probenacid
Pegloticase (Krystexxa)
Gout treatment option if resistant case or not able to take Colchicine or NSAIDS
CS
Injectable triamcinolone hexacetonide if single joint
Oral prednisone x 3-5 days then taper over 10-14 days to avoid rebound
Why are xanthine oxidase inhibitors not given in acute gout attack?
may cause the uric acid crystals to mobilize and settle in another joint (but if on for chronic management, can keep giving)
What urate-oxidase enzyme can be given as the last resort for gout treatment?
Pegloticase (Krystexxa) Given IV (premeditate for infusion reaction Antihistamine + CS)
When is Krystexxa contraindicated?
G6PD
Krystexxa adverse reactions/SE
anaphylaxis
infusion reaction
gout attack
HF exacerbation
Diet management for gout
decrease red meat (high in blood = purine)
Probenacid, Sulfinpyrazone - class?
uricosuric agents
Uricosuric agents - MOA
increase renal uric acid clearance by inhibiting renal tubual reabsorption
Methotrexate, Azathioprine, Hydroxychloroquine, Leflunomide - class?
DMARDS
Why are DMARDS used for RA?
reduce and prevent join damage (start within 3 months of diagnosis)
Education - DMARDS
can take 1-6 months
give NSAIDs +/- steroids until effective
effective contraception (teratogenic)
RA - DOC
Methotrexate
if fails, combine with biologic agent
Antidote Methotrexate
Leucovorin
Azothiaprine (Immuran) DDI
Allopurinol and febuxostate (increases levels of allopurinol and increases risk for myelosuppression)
decrease azothiaprine 1/3 to 1/2
Adalimubab (Humira), Infliximab (Remicade) - class?
TNF alpha antagonists
TNF alpha antagonists SE
worsening of CHF (Caution: do not use in NYHA III and IV CHF)
Increased invasive infections (listeria, viral, fungal, etc.)
Increased risk of TB (must to skin test to check latent TB)
because decreases immune system
Amphetamine derivative - MOA
increase release of norepinephrine and dopamine
Methylphenidate product - MOA
inhibits re-uptake of norepinephrine and dopamine
Lisdexamphetamine - advantage over other stimulants
PO - only absorbed from GI tract (less chance of diversion)
Which stimulant comes as a patch?
Methylphenidate
Atomoxetine (Straterra), Clonidine, Guanfacine - Stimulants or non-stimulants?
Non-stimulants
Alzheimer’s - DOC
Donepizil (Cholinesterase Inhibitor)
best tolerated - less N/V
Donepazil, Rivastigmine, Galantamine - class?
Cholinesterase Inhibitors (AChEl)
AChEl - SEs
N/V
diarrhea
Dosing of AChEl’s
Donepazil (easiest) - 5-10 po qd
Galantamine and Rivastigmine are BID and titrate dose up
Which AChEl is available as a patch?
Rivastigmine
Pharmacologic options for ED
PDE5 inhibitors and synthetic prostaglandin E1 analog (Alprostadil)
PDE5 inhibitors - MOA
inhibits breakdown of cGMP by PDE5
PDE5 inhibitors contraindication
concurrent use of nitrates
PDE5 inhibitors SE
hypotension, flushing, HA
Rare: CV risks (angina, MI, stroke), sudden hearing loss, priapism
PDE5 inhibitors DDI
organic nitrates
CYP3A4 inhibitors (PI, Emycin, itraconazole…)
ETOH (hypotension risk)
Avanavil (Stendra), Sildenafil (Viagra), Tadalafil (Cialis) - class?
PDE5 inhibitor
Anticholinergic agents - MOA
anticholinergic activity through a competitive inhibition of the muscarinic receptors in the bladder
Darifenacin, Fesoterodine, Oxybutynin, Solifenacin, Tolterodine (Detrol), Trospium - class?
anticholinergics
Which populations may experience negative side effects on anticholinergics?
elderly
myasthenia gravis
BPH
glaucoma
Anticholinergics - DDI
CYP450 (2D6 and 3A4)
except trospium
Gout treatment - UA level goal
<6
