exam 4 meds Flashcards
Aldendronate
Raloxifene
Calcitonin-salmon
pharm for?
osteoporosis
osteoporosis
class
1. Bisphosphonates
2. Selective estrogen receptor modulators (SERMs)
3. Hormone therapy
Raloxifene
Aldendronate
Calcitonin-salmon
- Aldendronate
- Raloxifene
- Calcitonin-salmon
osteoporosis pharm
MOA
1. MOA – binds permanently to surfaces of bones to inhibit osteoclast activity (reduce bone breakdown)
2. MOA – mimics estrogen by increasing bone density, inhibits bone resorption
3. MOA – inhibits bone removal by osteoclasts
Raloxifene
Aldendronate
Calcitonin-salmon
- Aldendronate
- Raloxifene
- Calcitonin-salmon
osteoporosis pharm
- Used as prevention and treatment
- must take at least 5 years to see long term benefits
- Treatment ONLY (not prevention)
Raloxifene
Calcitonin-salmon
- Raloxifene
- Calcitonin-salmon
- Calcitonin-salmon
- GI issues – n/v/d and Esophageal ulcerations
- Hot flash and Leg cramping
BLACK BOX WARNING - Stroke risk
- Hot flash and Leg cramping
- nasal irritation
Raloxifene
Aldendronate
Calcitonin-salmon
- Aldendronate
- Raloxifene
- Calcitonin-salmon
osteoporosis pharm
- Take with water
- Don’t take with food, drinks (other than water), calcium or vitamins for 2 hours – very low bioavailability
- Don’t lie down for 30 mins after taking – esophageal ulcers
- Take with water
- Must take adequate calcium and vitamin D replacement for it to work
- d/c at least 72 hours before planned procedures, any prolonged immobilization periods, high risk of blood clotting
- don’t smoke or drink alcohol
- don’t use if pregnant
- Must take adequate calcium and vitamin D replacement for it to work
Raloxifene
Aldendronate
Calcitonin-salmon
- Aldendronate
- Raloxifene
- NSAIDS
- Glucocorticoids (Prednisone – most common) – short term, Use only when symptoms not controlled with NSAIDS, Not best choice for long term therapy – usually small doses
- DMARDS disease modifying anti-rheumatic drugs (metho and hydroxy)– slow/stop progression
treatment for?
RA
Methotrexate
Hydroxychloroquine
Biologic agents
treatment for?
RA (and lupus)
RA and lupus pharm
- DMARDS disease modifying anti-rheumatic drugs
Antineoplastic
Anti-rhematic
- DMARDS disease modifying anti-rheumatic drugs
antimalarial
Anti-rhematic
- Newer generation of DMARDS disease modifying anti-rheumatic drugs
Hydroxychloroquine
Biologic agents
Methotrexate
- Methotrexate
- Hydroxychloroquine
- Biologic agents
RA and lupus pharm
MOA
1. MOA – immunosuppressive
- Anti-inflammatory processes
- Biologic response modifiers
Target parts of the immune system that trigger inflammation that cause joint and tissue damage
Hydroxychloroquine
Biologic agents
Methotrexate
- Methotrexate
- Hydroxychloroquine
- Biologic agents
RA and lupus pharm
indications
1. slow/stop progression of RA
(ALSO FOR LUPUS)
Slows progression of RA when used with other DMARDs
2. slow/stop progression
used with methotrexate for early/mid RA
(ALSO FOR LUPUS)
Hydroxychloroquine
Biologic agents
Methotrexate
- Methotrexate
- Hydroxychloroquine
s/e
RA and lupus pharm
DMARDS
- GI , Bone marrow suppression , Shortened life expectancy
11 BLACK BOX WARNINGS - Retinopathy
- Can increase risk of severe skin or lung infections, skin cancer, serious allergic reactions
Hydroxychloroquine
Biologic agents
Methotrexate
- Methotrexate
- Hydroxychloroquine
- Biologic agents
RA and lupus pharm
- Route - PO, SQ, IV
- Patient needs folic acid supplementation
- NO alcohol
- Teratogenic – NEVER ok for pregnant
- High risk of infection – contact HCP if s/s of infection
- Caution with liver and kidney disease
- Aplastic anemia risk when using with NSAIDS
- Given weekly – death can occur if given daily - Used with methotrexate
- Usually given with methotrexate
Very expensive
Hydroxychloroquine
Biologic agents
Methotrexate
- Methotrexate
- Hydroxychloroquine
- Biologic agents
_______ pharm
NSAID
Allupurinol
Colchicine
Probenecid
which is 1st line?
which is 2nd line?
gout pharm
NSAIDS - 1st line
Allupurinol
Colchicine - 2nd line
Probenecid
gout pharm
class
1. XOE inhibitor
2. Uricosuric agent
Probenecid
Allupurinol
Colchicine
- Allupurinol
- Probenecid
gout pharm
MOA
1. MOA – inhibits the xanthine oxidase enzyme which prevents uric acid production
- Reduces inflammatory response to the deposits or urate crystals in joint tissues
- Inhibits reabsorption of uric acid in kidneys
Promote excretion
Probenecid
Allupurinol
Colchicine
- Allupurinol
- Colchicine
- Probenecid
gout pharm
indications
1. Gout is r/t excess uric acid production (hyperuricemia)
Prevention only !!
- Gout flares short term
- Prophylaxis - Treats hyperuricemia with gout
Used alone or with allopurinol when not effective alone
Probenecid
Allupurinol
Colchicine
- Allupurinol
- Colchicine
- Probenecid
gout pharm
s/e
- Agranulocytosis
- Aplastic anemia
- Fatal skin reactions – SJS/TENS
Monitor: - WBC
- CBC
- Agranulocytosis
- GI bleed, GU bleed
Powerful inhibitor of cell mitosis and can cause
- short term leukopenia
- bone marrow suppression - GI upset – take with food
- Dizzy
- h/a
- kidney/liver impairment – watch for signs of kidney issues
- lots of drug interactions
Probenecid
Allupurinol
Colchicine
- Allupurinol
- Colchicine
- Probenecid
gout pharm
- Drug interactions:
Increases effect of antidiabetic meds and warfarin when taken with _______
Monitor:
Sugar and INR levels - Contraindications
- Sever renal disorder
- GI disorder
- Hepatic disorder
- Cardiac disorder
- Bleeding disorder
Route – PO only
vomiting = toxicity, stop med
Probenecid
Allupurinol
Colchicine
- Allupurinol
- Colchicine
_________ pharm
Abx
1. Obtain culture
2. Empiric abx therapy - administration of antibiotics based on the most likely diagnosis, b/c we don’t want to delay treatment
- Nafcillin
- Cefazolin
- Vancomycin – sometimes continuous infusions, other times direct therapy such as infusing abx though a wound vac
3. Switch to bacteria-specific therapy
Osteomyelitis
__________ pharm
Mild to moderate
- acetaminophen
- topical capsaicin - heat sensation
- NSAIDS - OTC
Moderate to severe
- NSAIDS – Rx strength
- NSAIDS + colchicine
- Acetaminophen + tramadol
- Opioids
- Steroid injections into joint
Osteoarthritis
_______ pharm
agents used depend on system involved
- NSAIDS = h/s, musculoskeletal, pleuritis, pericarditis
- High dose corticosteroids = severe kidney disease, CNS
- Low dose corticosteroids = arthritis
- Antimalarials/DMARD (hydroxychloroquine) = skin, musculoskeletal, prevention of kidney and CNS organ damage
- Immunosuppressives/DMARD (methotrexate) = severe organ involvement
Lupus
