DRUG LIST Flashcards
Osteoprotegrin (OPG)
decoy receptor for RANKL - prevents osteoclast activation
glucorticosteroids
prolonged use - OSTEOPOROSIS
(bone resorption increased + calcium absorption gut decreased
raloxifene
SERM
- selective oestrogen receptor modulator
- increases oestrgenic actions in bone - reduces bone turnover-slows osteoporosis
- only acts in BONE (not breast/uterus-malignancy)
FOR OSTEOPOROSIS
BISPHOSPHONATES
- administration
- MOA
- name 5
- oral
- osteoclast apoptosis + decrease RANKL expression
- ALEN/RISE/IBAN/PAMI/ZOLE-dronate
FOR OSTEOPOROSIS
teriparatide
recombinant PTH
- stimulates Ca resorption bone + kidneys
- stimulates osteoblast - osteoclast activity
- stimulates active vit D formation
FOR OSTEOPOROSIS (severe cases)
denosumab
=monoclonal antibody for RANKL
=SC injection (6monthly)
(prevents RANK binding to RANKL on osteoclasts)
prevents OSTEOCLAST ACTIVITY
FOR OSTEOPOROSIS
Treatment for inflammatory myopathies
- corticosteroids (until CK levels normal)
2. adjunctive therapy = MTX + AZT
Treatment for fibromyalgia
- TCAs
- SSRIs
- exercise
Strontium ranelate
OSTEOPOROSIS
-strontium-similar size to calcium -taken up by bones
-MOA
=decreases bone resorption + increase Ca absorption gut
=stimulates osteoblasts secrete (OPG)
colchicine
GOUT
inhibits:
-microtubule formation - mitosis
-neutrophil motility + proliferation
riloncept
GOUT (+RA)
IL-1 blocker
DIMERIC fusion protein - IL1R + Fc of HUMAN IgG1
anakinra
GOUT (+RA)
- human recombinannt IL1 receptor antagonist
- binds IL-1R
- SC injection
allopurinol
CHRONIC GOUT
xanthine oxidase inhibitor
rasburicase
CHRONIC GOUT
catalytic enzyme =xanthine- allantoin -more soluble
probenecid
CHRONIC GOUT
uricosuric - increase renal excretion uric acid
(less SE than allopurinol)
treatment pseudogout
intra-articular corticosteroid + NSAIDs
ASPIRIN
action + SE
CARDIOVASCULAR
3A= anti-inflammatory + analgesic + antipyretic
delays labour + antiplatelet aggr
SE= peptic ulcers + hyperuricaemia
NSAID - eye drops
KETOROLAC -cox 1 selectivity
NSAID- exclusively for pain
PARECOXIB
NSAIDs for inflammation
aceclofen/etodol/sulind-AC
meloxi/tenoxi-CAM
azapropa/nabumet-ONE
etoricoxib (cox2 inhibtor)
NSAIDs for inflammation + pain
diclofenac ibro/keto/dexketo/feno/fluribi-PROFEN indomethacin naproxen piroxicam celecoxib
prostaglandins roles
pyretic, inflammatory, hyperalgesia + inhibit gastric acid + platelet aggregation + increase RBF
NSAIDs selective for COX 2
piroxicam
meclofenamate
sulindave
diclofenac
tramadol
ANALGESIA
weak mu opoid receptor agonist - centrally acting opoid
methadone
most powerful OPIOD - powerful analgesia
naloxone
opoid receptor antagonist - prevents opiod induced constipation (when given in combination with an opiod)
GABAPENTINOIDS - pregabalin + gabapentin
CHRONIC + NEUROPATHIC PAIN
-blocks α2δ subunit VGC - reduces pain transmission
Clonidine
ANALGESIA
α2 adrenergic agonist
Capsaicin
TOPICAL ANALGESIA
- activates TRPV1 channel - activate heat + pain neurons
- lowers threshold for TRPV1 (sensitisation)
- over time = unresponsive to pain - deplete NT Substance P (released by neurons for pain transmission)
methotrexate (MTX)
RA
- ORAL
- FOLIC ACID ANTAGONIST- inhibits DIHYDROFOLATE REDUCTASE- reduces purine synthesis- DNA + RNA synthesis
(use in chemotherapy)
sulfasalsine
RA
- ORAL
- acts in GUT
- reduces extra-articular compli. -ulcerative colitis + IBD
(use as antibiotic)
SE = active metabolite - sulfapyridine - agranulocytosis
hydroxchloroquine
- ORAL
- block toll-like receptor 9 - induce inflammatory response -by activation innate immune system
SE= nausea/cramps/diarrhoea/ worsens existing PSORASIS
leflunomide
RA
inhibits DIHYDROOROTATE DEHYDROGENASSE - pyrimidine biosynthesis
azathioprine
RA
immunosuppresant drug - purine synthesis inhibitor
steroid sparing drug
ETANERCEPT
RA
- biological DMARD
- fusion protein-TNF receptor 2 + Fc HUMAN IgG1
- SC injection once per week
INFLIXIMAB
RA
- biological DMARD
- monoclonal antibody aganist TNFα = human Fc + MOUSE Fv
- Infusion 2hrs 2-6weekly
SE = PUSTULAR PSORIASIS
ADALIMUMAB
RA
- biological DMARD
- HUMAN TNFα monoclonal antibody
- SC injection
RITUXIMAB
RA
- biological DMARD
- chimeric monoclonal antibody against CD20 on Bcells
- INFUSION (only 1 dose- depletes malignant + NORMAL B cells)
ABATACEPT
RA
- fusion protein = IgG + CTLA4
- inhibits co-stimulation of T cells by APC (CTL4 has a higher affinity for APC than T cell CD28 (protein)
normal T cell activation
- T cell binds to MHC on APC
- co-stimulatory signal T cell- CD28 binds to APC -B7 protein
TOCILIZUMAB
RA
- biological DMARD
- HUMANISED monoclonal antibody against IL6 receptor
- IV monthly
Biological DMARDs given in combination with MTX
- Rituximab
- Tocilizumab
CIPROFLOXACIN + PIPERACILLIN
SEPTIC ARTHRITIS (or OM) -broad spectrum antibiotics used in intial treatment before a blood culture has been done to determine the specific type of infection present in the joints
FLUCLOXACILLIN
SEPTIC ARTHRITIS (or OM) -gram positive antibiotic
VANCOMYCIN cement beads injection
CHRONIC OSTEOMYELITIS
- cement- temporarily fill in the dead space created after the debridement of infected bone (+ non-toxic)
- high antibacterial concentration directly to area of infection (maintaining low serum levels)
(Pharmacokinetic studies have shown that the local concentrations of antibiotic achieved are 200 times higher than levels achieved with systemic (oral) antibiotic administration)
