Drugs for Bone & Joint Disorders Flashcards
Three drug classes used in the management of RA
NSAIDs
glucocorticoids
DMARDs
Which of the drug classes used in the management of RA does NOT slow disease progression?
NSAIDs
List the three types of DMARDs
conventional (traditional)
biologic
targeted
What does DMARD stand for
disease modifying antirheumatic drugs
What are the differences between the types of DMARDs used for RA?
conventional = nonspecific
biologic = targets one specific component of immune system
targeted = targets one specific component of RA immune response
Drug classes that are biologic DMARDs
TNF antagonists
B lymphocyte depleting agent
T cell activation inhibitor
Drug classes that are targeted DMARDs
IL-6 receptor antagonists
IL-1 receptor antagonist
JAK inhibitors
mechanism of action of methotrexate
folate antagonism
adverse effects of methotrexate
hepatic fibrosis
bone marrow suppression
GI ulceration
pneumonitis
all DMARDs result in:
immunosuppression (risk for infection)
cautions with DMARDs and vaccinations?
live vaccinations are contraindicated
inactivated vaccinations may not be as effective
Adverse effects of TNF antagonists
infection/neutropenia (black box warning)
injection site reactions
infusion reactions
skin reactions
Drugs used for the management of gout flare up
NSAIDs
glucocorticoids
colchicine
Potential mechanism of action of colchicine?
inhibition of WBC infiltration via disruption of cellular microtubules
adverse effects of colchicine
toxicity to rapidly proliferating cell groups:
- GI ulcers/perforation
- myelosuppression
- myopathy
Drugs used in long term preventative therapy of gout
xanthine oxidase inhibitors
probenecid
pegloticase & rasburicase
Goal of long term gout preventative therapy?
decrease uric acid concentrations
methods to decrease uric acid concentrations in the plasma?
- inhibit formation
- accelerate excretion
- convert to metabolite
List a xanthine oxidase inhibitor
allopurinol
febuxostat
mechanism of action of xanthine oxidase inhibitors
inhibit xanthine oxidase (which is required for uric acid formation)
adverse effects of xanthine oxidase inhibitors
GI reactions
drowsiness
headaches
initial therapy can induce a gout attack
treatment options for hypocalcemia
PO or IV calcium
treatment options for hypercalcemia
mild = drugs that inhibit calcium absorption (see future flashcard)
severe = IV saline + loop diuretic
two types of IV calcium
calcium chloride
calcium gluconate
what is cinacalcet used for
hyperparathyroidism
mechanism of action of cinacalcet
mimics calcium at PTH receptor = negative feedback & prevention of further PTH secretion
adverse effects of cinacalcet
N/V
diarrhea
hypocalcemia
how does exogenous vitamin D increase blood levels of calcium?
increased intestinal absorption
increased bone resorption
decreased renal excretion
mechanism of action of calcitonin
inhibition of osteoclasts (inhibits bone resorption)
inhibition of tubular calcium resorption (increases excretion)
What are bisphosphonates
structural analog of pyrophosphate, which is a normal constituent of bone
mechanism of action of bisphosphonates
incorporate into bone & remain active for years (decreases osteoclast activity, decreases bone resorption)
adverse effect of bisphosphonates
esophagitis! (drink with full glass of water & remain upright)
List some bisphosphonates
alendronate
risedronate
ibandronate
zoledronate
Both IV bisphosphonates can cause:
renal damage
administration of exogenous estrogen decreases bone resorption via what mechanism?
inhibits the increase in osteoclast number
Why may a SERM be preferred to exogenous estrogen in the treatment of bone demineralization?
increases bone density with less risks
