Drugs for RA and Gout 3-4

Question 1

Patho of RA

Answer 1

-autoimmune
-inflammation of synovial membranes in joints
-pannus formation + cartilage erosion = fuse bone

Question 2

Goals of RA treatment

Answer 2

Non-Drug Therapy:
-balance rest and exercise
-massage
-warm baths
-heat to affected areas

Drug therapy:
-NSAIDS: s/s relief and for flare ups
-glucocorticoids: s/s relief and for flare ups
-DMARDS: slows progression (start early!!!)

Question 3

Nonbiologic DMARDS: Methotrexate

Answer 3

-is an immunosuppressant
(reduce activity of T and B lymph)

Question 4

Methotrexate adverse

Answer 4

-hepatic fibrosis
-bone marrow suppression
-GI ulceration
-pneumonitis

-DONT take with Allopurinol: worsen bone marrow suppression

Question 5

Nonbiologic DMARDS: Hydroxychloroquine
(Plaquenil)

Answer 5

-early use improves long term outcome
-combined with methotraxate
-take with food or milk

-most serious toxic: retinal damage –> pre treat eye exam + checkup every 6 months

Question 6

PA of GOUT

Answer 6

-recurrent inflammatory disorder –> episodes of severe joint pain (toe)
(in men alot)
-altered purine metabolism
-hyperuricemia: uric acid level >7 in men and >6 in women
-uric acid deposits in joints –> tophi

Question 7

Gout treatment overview

Answer 7

-NSAIDS: first choice
-glucocorticoids: PO or IM
-Colchicine
-Allopurinol

Question 8

Colchicine

Answer 8

-anti-inflammatory action ONLY in gout
(controls pain only in acute gout, not other inflammatory disorders; not an analgesic)
-DOESNT decrease uric acid levels or affect its clearance

Question 9

Colchicine adverse

Answer 9

-GI toxic: n/v/d, abd pain
-myelosuppression
-rhabdomylosis: muscles breakdown –> can affect kidneys

Question 10

Colchicine considerations and interactions

Answer 10

-statins: risk muscle injury (increase myopathy)
-caution in elderly (s/s: confusion, mental status changes)

Question 11

Allopurinol (Zyloprim)

Answer 11

-inhibits uric acid formation–> decreases serum uric acid levels (and also purines levels)
-maintenance therapy DOC: for LONG TERM gout (chronic tophaceous gout)

-also good to prevent tumor lysis syndrome (increase in uric acid)

Question 12

Allopurinol adverse

Answer 12

-generally well tolerated
-hypersensitivity rxn: rash (SJS), fever, liver or kidney
-GI and neuro effects

-DONT take with methatraxate