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Advanced Pharmacology > Drugs for inflammatory processes > Flashcards

Drugs for inflammatory processes Flashcards

1
Q

What is gout?

A

a type of arthritis where purine metabolism is disrupted, there is hyperuriciemia and uric acid crystal deposits in joints

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2
Q

What are the phases of gout?

A

aysmptomatic hyperuricimia, acute gouty arthritis, intercritical gout, chronic tophaceous gout

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3
Q

How does acute gout present?

A

acute onset of pain, erythema, decreased movement of joint, and swelling

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4
Q

How do anti-gout drugs work and what are they?

A

Reduce inflammation or decrease uric acid: allopurinol, febuxostate, and cochicine; probenecid and sulfinpyrazone

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5
Q

How does allopurinol work?

A

acts directly on purine metabolism, reduces uric acid, serum changes in 2-3 days

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6
Q

How does febuxostate work?

A

inhibits xanthine oxidase, reduces uric acid, 2 weeks to see effects

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7
Q

How does cochicine work?

A

Decreases movement of granulocytes to inflammed area, reduces inflammation

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8
Q

When are ucicosuric drugs used?

A

Not for inflammation or acute attacks of gout?

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9
Q

How does probenecid work?

A

inhibits reuptake of urate in renals, decreases uric acid levels

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10
Q

How dose sulfinpyrazone work?

A

same as probenecid but also inhibits platelet and prostaglandin synthesis

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11
Q

What is absorption of anti-gout drugs like?

A

all absorbed well when taken orally, metabolized in liver, excreted in urine, probenecid and sulfinpyrazone highly protein bound

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12
Q

What are the precautions and contraindications for anti-gout drugs?

A

watch for renal impairment and hepatotoxicity, use cautiously in people with peptic ulcer, many of the drugs are pregnancy category C, probenecid is category b, sulfinpyrazone is category D

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13
Q

What are the adverse drug reactions to anti-gout meds?

A

May cause uric acid crystals, up fluid intake to 3 L a day and add sodium bicarb or potassium citrate;
GI upset, colchicine causes diarrhea, probenecid and sulfipyrazone are sulfa drugs so watch for allergies; colchicine can lead to myopathy and neuropathy, colchicine interferes with vitamin b 12 absorption

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14
Q

What are anti-gout drug interactions?

A

colchicine has few; probecenid can inhibit clearance of PCNs and cephalosporins, sulfipyrazones can causes problems excreting anions and has many drug interactions, all are mutually antagonistic with salicylates, febuxostate should not be given with drugs metabolized by xanthine oxidase because of toxicity: theophylline, mercaptopurine, and azathioprine

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15
Q

What are the clinical uses and dosing of colchicine?

A

give low dose at first sign of flare and then and hour later; preventative attacks, off label uses for cirrhosis, schleroderma, mediterrean fever, thrombocytopenia purpura

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16
Q

What is the clinical dosing and use for allopurinol?

A

preventative drug for high uric acid levels, tophaceous gout, and urinary calculi; hypericemia associated with malignancies, and recurrent calcium calculi

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17
Q

What is febuxostat used for?

A

chronic gout with hyperuricemia; start at 40 and then increase to 80, monitor liver levels, may cause acute gout attack and need colchicine and Nsaids initially

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18
Q

What is probenecid for?

A

People that overproduce urate; start low and gradually increase; taper dose as urate decreaes, wean off if uric acid starts to rise

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19
Q

What is the rational drug selection for anti-gout meds?

A

colchicine is used for acute attacks and can be given IV if needed; allopurinol or febuxostat work for people who overproduce uric acid; allopurinol is good for renal issues and in people who overproduce urate and have secondary gout; probecenid is for people who undersecrete uric acid and have good renal function

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20
Q

How should anti-gout drugs be montiored?

A

monitor uric acid levels; baseline, 1-3 weeks later, and periodically throughout treatment; allopurinol monitor baseline and later for liver and renal; probenecid monitor CBCs for blood dyscrasias

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21
Q

What is patient education for anti-gout drugs/

A

take as prescribed, don’t stop taking, don’t stop preventative, don’t take NSAIDS if on probenecid or sulfinpyrazone; Watch for GI upset, hypersensitivity, rashes, colchicine may cause myopathy or neuropathy; eat an alkaline diet, avoid alcohol, drink alot of lfuids

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22
Q

What does cortisol do?

A

helps with wake and sleep patterns, labile emotions, glucogenesis, protein catabolism, decreases fibroblasts which leads to poor wound healing

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23
Q

What do glucocorticoids do?

A 
inhibit immune and inflammatory systems;
increase circulating RBCs;
increase appetite;
fat deposts in face and cervical areas
lipolysis in extremities
increase uric acid excretion
decrease serum calcium
promotes gastric acid secretion
decreaes secretion and synthesis of ACTH
suppresses prostaglandin E production and growth hormone production
skeletal wasting
potentiates effects of catecholamines, growth hormone, and thyroid hormone on adipose tissue
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24
Q

What do mineral corticoids do?

A

retain sodium and water;
excrete potassium
no antinflammatory processes

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25
Q

HOw do corticosteroids move in the body?

A

well absorbed orally, active metabolites from liver, excreted by kidney

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26
Q

What are corticosteroid precautions?

A

careful with patients who have untreated infections, diabetes who struggle with glycemic control, GI bleed problems, people with CV problems because of sodium and water retention leading to high blood pressure; menopausal women and osteoporsis issues, CNS issues, endocrine issues

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27
Q

What are the adverse drug reactions of corticosteroids?

A

muscle and skin atrophy, poor healing, hiriutism, moon face, buffalo hump, truncal obesity; osteoporosis, eye issues like glaucoma, ocular issues, cataracts;
peptic ulcers

28
Q

What is the clinical use and dosing for corticosteroids?

A

adrenal insufficiency, inflammation, immune suppression, rheumatoid arthritis

29
Q

What are the drugs of choice for adrenal insufficiency?

A

hydrocortisone, cortisone, and prednisone

30
Q

How should prednisone and similar be given?

A

Give doses but taper over time, give first dose in morning 9 am

31
Q

What corticosteroids are used for inflammation?

A

methylprednisone, prednisonse, dexamethason, triamcinolone; different potencies

32
Q

What corticosteroid is used for immune suppression?

A

prednisone for short half life

33
Q

What corticosteroids are used fro RA?

A

First start with NSAIDs, then low dose prednisone, can use calcium and vitamin D supplements for osteoporosis

34
Q

What are the principles for prescribing corticosteroids?

A

match circadian rhythm, first dose in morning;
initial dose depends on disease being treated;
maintenance dose by tapering dose to lowest therapeutic level;
taper after long therapy to avoid adrenal insufficiency crisis;
most diseases can be controlled by every other day therapy with double the dose in morning;
alternate day scheduling is same dose with no tapering

35
Q

What is the rational drug selection of corticosteroids?

A

short acting less likely to affect HPA axis; only use long acting if you need high level maintenance dose;
what is the problem? Adrenal insufficiency, inflammation, or need immunosuppression

36
Q

What about corticosteroids needs to be monitored?

A

baseline, weight, electrolytes, CBC, glucose;
long term therapy lipids and GI bleeds;
long term therapy cataracts and glaucoma

37
Q

What is the patient education for corticosteroids?

A

take as prescribed, described alternate day or tapered dosing, don’t stop abruptly;
watch for immune suppression, GI bleeds, non-healing sores, mood changes, weight gain;
need to wear medic alert bracelet; eat lots of potassium, not so much sodium and carbs, watch caloric intake

38
Q

How do NSAIDs work?

A

They inhibit cox 1 and 2, and thus inhibit prostaglandin production

39
Q

What is cox 1 responsible for?

A

Present in all tissues, especially platelets, endothelium, GI, and renals

40
Q

What is cox 2 responsible for?

A

an inducible enzyme responsible mainly for inflammation and pain

41
Q

What are NSAIDs for?

A

inflammation and mild to moderate pain

42
Q

What is acetaminophen for?

A

anlagesic and antipyretic

43
Q

How does acetaminophen work?

A

not completely known, but inhibits peripheral and central prostaglandin synthesis.

44
Q

How does acetaminophen reduce fever?

A

Acting on hypothalamic temperature centers

45
Q

What makes acetaminophen better than NSAIDS in some ways?

A

Does not affect cox enzymes so doesn’t lead to GI upset or bleeding.

46
Q

How is acetaminophen absorbed?

A

rapid absorbed orally, but food delays it

47
Q

Where are NSAIDs and acetaminophen metabolized?

A

in liver, excreted in urine

48
Q

How does acetaminophen hurt liver?

A

in large doses, glutathione stores are depleted and hepatic necrosis can occur

49
Q

What are the adverse drug reactions for NSAIDs?

A

Mainly GI upset; take with food and watch for GI bleeds;
can cause renal insufficiency
can cause bleeding with platelet issues;
can cause fluid retention and peripheral edema;
indomethacin can aggravate dispression and other psych stuff;
COX 2 inhibitors and all NSAIDS have a black box warning because they can increase the risk of having a heart or stroke.

50
Q

What are the adverse drug reactioins for acetaminophen?

A

10 to 15 grams can cause hepatic necrosis, doses above 25 grams usually fatal.

51
Q

What is the treatment for acetaminophen poisoning?

A

refer to poison center, get acetaminophen level, use N-acetylcysteine for antidote, untreated toxicity can require liver transplant

52
Q

What is the clinical use and dosing for NSAIDs?

A

NSAIDS or celebrex for RA, follow American college of rheumatology guidelines, watch for complications
osteoarthritis;
gout: indomethacin, sulindac, naproxen
mild to moderate pain: mainly ibuprofen and naproxen;
primary dysmenorrhea; ibuprofen and naproxen;
tenonitis and bursitis: indomethacin XR, naproxen, sulindac;
fever: ibuprofen

53
Q

What is the clinical use for acetaminophen?

A

mild to moderate pain relief in pregnancy, GI bleed, people with coagulation disorders, aspirin allergy, upper GI disease
drug of choice for fever in older adults, children, and especially children with flu like fever

54
Q

What is important to monitor with NSAIDs?

A

renal function and GI bleeds, get CBC before and after long term therapy

55
Q

What should be monitored with acetaminophen?

A

unintentional overdosing esp. with otc meds;

liver function when on long term therapy

56
Q

What is patient education for NSAIDs?

A

take as directed, limit alcohol use, no more than 4 gm tylenol in 24 hours

57
Q

What are ADRs of NSAIDS?

A

Report GI bleed/upset or coffee ground emesis

58
Q

What are aspirin and salicylates for?

A

analgesic, antiinflammatory, antipyretic, antiplatelet

59
Q

How does aspirin work?

A

Mediated through inhibition of prostaglandin synthesis; aspirin helps with platelets; low dose aspirin reduces V mortality

60
Q

How does aspirin move thru the body?

A

rapidly absrobed, but food slows; distributed to all tissues; metabolized by liver and excreted thru liver: urine pH affects excretion

61
Q

What are aspirin adverse drug reactions?

A

GI ulcers, irritation, bleeding iron deficient anemia;
ototoxic at high levels:
assoicated with Reye syndrome in children;
avoid after surgery due to bleeding risk
pregnancy category D

62
Q

What happens with aspirin poisoning?

A

lethal doses are 10-30 grams, and respiratory alkalosis occurs;
treatment is emesis or gastric lavage if less than two hours after digestion;
alkalizing urine may increase excretion;
hemodialysis neeeded for severe poisoning

63
Q

What are the clinical uses and dosing for aspirin?

A

good as antipyretic, dont’ use in pregnancy or children;
mild to moderate pain (gold standard);
good for RA, but there is narrow range between toxicity and therapeutic levels
juvenile RA take aspirin;
osteoarthritis
acute rheumatic fever
helps prevent MI: 81-325 mg a day helps 20% reduction; take 325 mg aspirin at first sign of MI;
transient ischemic attacks; take 50/325 a day to prevent stroke

64
Q

What should be monitored with aspirin?

A

saliciylate level within 7 to 10 days;
renal function
CBC at baseline and annually
fecal blood

65
Q

What is aspirin patient education?

A

take with alot of water and remain upright 10 to 30 mintues;
dont’ chew enteric coated,
vinegar smelling tabs should be thrown away

66
Q

What are adverse drug reactions of aspirin?

A

GI upset illness, bleeds;

Reye’s when given to children with flu-like illness

67
Q

What lifestyle modifications hsould be used with aspirin

A

rest, heat, exericse

Advanced Pharmacology (4 decks)

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