Drugs for arthritis and inflammation

Question 1

How do NSAIDs work?

Answer 1

Block Prostaglandins

Question 2

What are prostaglandins?

Answer 2

pain mediating substances that irritate nociceptors and transmit feeling of pain to brain

Question 3

What are some important Fx of prostaglandins?

Answer 3

stabilize gastric lining and maintain renal artery vasodilation.

Question 4

When cell membrane is injured, what is released? and by what?

Answer 4

Arachidonic acid (AA)

by enzyme phospholipase A2

Question 5

What does AA act on>?

Answer 5

lipoxygenase making leukotrienes
orrrr
Cyclooxygenase making prostaglanding/thromboxane causing vasoconstriction

Question 6

What does prostaglandin do as opposed to Postacyclin?

Answer 6

vasoconstriction

Vasodilation

both make sticky platelets/ pain production

Question 7

Cyclooxygenase enzyme (makes prostaglandins)

2 types and purpose?

Answer 7

Cox-1: in platelet/kidney/stomach

Cox-2:in inflammation/infection only.

Cox-3:brain?

Question 8

MOA of aspirin?

Answer 8

inhibit Cox therefore block prostaglandin (anti-inflammatory) and thromboxane (cardiac protection) synthesis.

Question 9

low dose aspirin relation to cardiac?

Answer 9

protective bec binds to platelet for life. decreasing release of thromboxane. causing anticoagulation.

Question 10

Effects of aspirin?

Answer 10

dec pain
inflammation
prevent thrombus/colon cancer

Question 11

ADR of aspirin?

Answer 11

Gi problems
renal Dsfx
anemia
Bronchospasm

Question 12

signs of aspirin overdosE?

Answer 12

headache
tinnitus
confused
hyperventilating
metabolix acidosis

Question 13

NSAIDS MOA

Answer 13

reversibly block Cox

same as aspirin but don’t offer cardiac protection

watch for GI problems fr fr.

Question 14

ADR of NSAIDs

Answer 14

• BP increase
• Cns disturbances.
• affect cells of hypertrophy
• decrease effectiveness of diuretics/Betablockers/and ACE I

Question 15

Cox-2 Inhibitiors MOA

Answer 15

block action of Cox-2

muscle pain reduction.

to prevent Coz-1 inhibition but not platelet aggregation

Question 16

ADR of Cox-2 Inhibitors?

Answer 16

increased Cardio events.

Question 17

Acetaminophen MOA?

tylenol

Answer 17

inhibit Cox enzyme in CNS.

for pain+fever. no t inflammatory./cardio

Question 18

ADR of acetaminophen?

Answer 18

increase BP

liver toxicity

Question 19

If patient on aspiring and NSAID what u do?

Answer 19

take aspirin 2 hrs before NSAID so it can bind to platelet for life.

Question 20

Nsaid related to heart disease?

Answer 20

can elevate BP

reduce effect of anti-hypertensives

Question 21

Pathology of RA?

Answer 21

increased cytokines IL-6 induce c reactive protein (CRP predictor of cardiovascular risk)

increase chance of MI with RA

Question 22

Corticosteroids MOA

Answer 22

activate protein that inhibits Phospholipase A2 therefore impairing everything after. (inf/pglds/immune)

Question 23

Before DMARDS, what is given?

Answer 23

corticosteroids

1x/day

or 4 injections/year

Question 24

ADR of corticosteroids?

Answer 24

catabolic on tissue
OP
muscle wasting
HTN/glaucoma
bushings
hormone suppression..

WEAN OFF OF THEN+M> DONT STOP ABRUPTLY

Question 25

Conventional Synthetic DMARDS MOA

Answer 25

impair DNA synthesis (dec cytokines)

can cause GI/liver/hair loss/ulcer

Question 26

Targeted Synthetic DMARD MOA?

Answer 26

inhibit enzymes that trigger inflammation.

cause neutropenia/cholesterol

Question 27

Biologic DMARDS MOA?

Answer 27

lower levels of TNF-a.

lower ability to fight infection.

Question 28

Non TNF inhibitors?

oencia

Answer 28

prevent action of lymphocytes.. decrease inflammation but is a biologic DMARD so increased risk of infection

Question 29

Recommendations for RA?

Answer 29

start with traditional DMARD like methotrexate along with prednisone (steroid) and then move on to biologic.

Question 30

ADR of biologics?

Answer 30

TB
infection
Cancer
Skin rash

Question 31

injected hyaluronan to help restore normal viscosity of synovial fluid?

Answer 31

Viscosupplementation