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Pharm II > FINAL arthritis gout and muscle relaxants > Flashcards

FINAL arthritis gout and muscle relaxants Flashcards

1
Q

what would for a pt that had arthritis that was non responsive to NSAIDS or we were worried about GI issues

A

nonacetylate salicylates

same with pt on WARFARIN

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2
Q

when would we use intraarticular glucocorticoids

A

KNEE OA

not hip

adjunct inj

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3
Q 
hyalgan
synvisc
supartz
euflexxa
gel-one

all used for

A

these are intraarticular hyaluronic acid all used for knee OA

Hulk Hogan
into synergyvic
and her supartz
wants to euflexxa

or gel-one

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4
Q

DMARDS used for

A

RA
AS
Psoriatric arthritis
psoriasis

also crohn’s
UC

NOT OA!!!!! immune not inflamamtion

used to give prednisone first to delay use of DMARDs but now

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5
Q

usually what order of drugs do we use in RA

A

1st DMARD
add second
NSAIDS prednisone

maybe a biologic

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6
Q

dosing of methotrexate/rhematrex

A

7.5-25 mg SC/IM A WEEK!!!!!!!!!

NOT DAILY don’t want to wipe out immune system

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7
Q

MOA of methotrexate

A

dihydrofolate reducatse inhibitor that inhibits DNA synthesis

a lot of proliferation and cytokines can be stopped (can be used for cancer)

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8
Q

onset of methotrexate

A

1-2 months

w/ RENAL elimination

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9
Q

SE of methotrexate

A

myelosupression
N/V/D
Ulcers
stomatitis

dose related hepatotox
pulm tox

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10
Q

monitoring needed for metotrexate

A

CBC
SCr
LFTs

montly for 6 months

then every 1-2 more

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11
Q

when would you check for liver damage with methotrexate

A

need LFTs regularly

liver biopsy after 4 g

then 1.5 g after that

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12
Q

methotrexate can be used with what DMARD

A

hydroxychloroquin and sulfasalizine

NOT leufunomide

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13
Q

avoid MTX in

A

pregnant
liver disease
immunodeficiency synfromes

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14
Q

leflunomide

A

slow onset long half life

1-3montjs and 1/2 life 14-15 days

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15
Q

when to use leflunomide

A

alt to methotrexate because of hepatotox

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16
Q

monitoring for leflunomide **

A

CBC
SCr
LFTs

montly for 6 months

then every 1-2 more

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17
Q

leflunomide should not be used in

A

pregnant pt

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18
Q

this can be used for overdose with leflunomide

A

cholestyramine questran

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19
Q

whart do you need before starting hydroxychloroquine

A

opthalmic exam to monitor effects

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20
Q

interluken DMARDS

A 
ana kinra
gusselkumab
usetekinumab
ixekizumab
secukinumab
tocilizumab

Anna and Guss use Icky Sec Tock

they are inter each other but Luke wants Ana

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21
Q

TNF biologic

A 
Golimumab
Adalimumab
etanercept
certolizumab
infliximab

Goli named Ada (all libms) entanercepted CertainLIZ

inflicting Abb and dyyb

ADA BOY! TNF FTW

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22
Q

other biologics

A

Apparently Ritu and Aba like Tofu and Vodo

Apremilast
Abatacept
Rituximab
Tofacitinib
Vedolizumab

Other weirdos like tofu and vodo

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23
Q

biologics that can be used for AS

A

Ixekizumab

Secukinumab

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24
Q

you can not use this TNF I for IBD like the rest

A

etanercept

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25
Q

common ADE with TNF I

A

Malignancies, new onset psoriasis, invasive fungal infection, sepsis, TB, Hep B react

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26
Q

what do you need to do before starting someone on a tNFI

A

hepatitis panel
check TB
check flu vaccinations
get baseline LFTs

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27
Q

DDI TNFI

A

•Liver toxic, lymphoma: Cannot give with other TNF-a inhibitors

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28
Q

probably need to give this TNF I with MXT why?

A

infliximab

contains mouse parts and we can develop AB

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29
Q

need to avoid these two TNFI in CHF

A

inflixi and entanercept

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30
Q

TNFI with longest half life

A

Goali

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31
Q

IL-1 antagonist that is : $$$$, hardly used (maybe consider in TB patient??)

A

anakinra

NO reactivation TB

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32
Q

NEVER combine IL drug with

A

TNFi or IL-drug with other IL-drug

Wont be able to fight infection, sepsis risk

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33
Q

no renal or dose adjustments are in needed in all but one ILI

A

tocliizumab

it can cili-u

Potential to cause FATAL anaphylaxis
•Can cause neutropenia, LFT changes, decrease platelets. If LFTs>1-3x ULN, decrease dose. If ANC <500 d/c. IF platelets <50K d/c

34
Q

this ILI can CAUSE IBD

A

secukinumab

IBD will shut down the sec

35
Q

which ILI can be used for plaque psoriasis

A

guselkumab

36
Q

when would we use Tofascitinib

A

: mod-severe monotherapy or combine with NON-biologic DMARDS in pts who fail MXT

37
Q

when would we use tofacitinib

A

Hypotension, HA: can cause neutropenia, decreased WBCs, decreased hemoglobin

38
Q

CI with tofacitinib (xelijanz)

A

CYP3A4/2C19 drugs will INCREASE Xeljanz. Reduce dose to 5mg when on ketoconazole, fluconazole.
•Do NOT combine with IL-drug, TNF drug, or other “other biologic”
•Avoid with azathioprine (drug that prevents organ rejection), tacrolimus, cyclosporine (increased immunosuppression risk)

39
Q

monitoring and dose adj needed for tofacitinib

A

RENAL and HEPATIC:

reduce dose CrCl <40 and hepatic impairment, CONTRAINDICATED in SEVERE Hepatic dysfunction
•Monitor CBC: d/c if lymphocytes <500 or ANC <500. If Hgb <8 interrupt therapy until it normalizes

40
Q

abatacept

A

prevents full T cell activation

check PPD
IV or subQ

don’t combine wiht other biologics

41
Q

rituximab MOA

A

chimeric monoclonal AB that targets CD20 B lymphocytes.

42
Q

adj needed for rituximab

A

NO NEED TO TB SCREEN

No need to dose adjust renal/hepatic

43
Q

rituximab indications

A

benefits RA pts refractory to TNF-a inhibitors. Can combine with MXT

44
Q

PD-E4 inhibitor, increase cAMP, diminished T-cell secretion cytokines

A

apremilast

45
Q

psych caution needed with this biologic

A

apremilast

otezla

46
Q

CYP! Inducers will DECREASE this biologic

A

apremilast conc

47
Q

renal adjustment needed for apremilast

A

oral, dose adjust renal CrCl <30

Need to titrate up oral dose!!

48
Q

this drug inhibits zanthine oxidase which in turn decreases uric acid production

A

allopurinol

ALOE PERANA AND FAT BOXER

49
Q

allopurinol must be started with

A

Colchicine

50
Q

how does colchicine work

A

DOES NOT EFFECT UA metabaolism

inhibits leukocytes migration

this is an anti-inflammatory with no analgesic effect

51
Q

abatacept (Orencia)

A

selective co-stimulation modulator:

Fragment of Fc domain of human IgG1 & extracell domain of human cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4)
Prevents full T-cell activation

Abba loves tofu and rita and Apremi but doesn’t like Tea
prevents full T

52
Q

SE common to colchicine

A

N/V/D 50-80% of pts

CI in PUD

bone marrow supression

DOES NOT EFFECT URIC ACID METABOLISM

53
Q

ADE with allopurinols

A

can cause a gout attack
can cause rash (more common if on PCN)

elukopenia
diarrhea
nausea
increased LFTs
increase levels of azathioprine
54
Q

DDI with allopurinole

A

can cause immune suppression want to avoid abnx and theophylline

can increase INR if on warfarin

55
Q

dosing adjustments for allopurinole

A

renal

56
Q

which gout drug would you not want to take with ETOH

A

colchicine

will increase GI tox

also do not take with grapefruit or erythromycin

57
Q

this biologic that targets CD20 lymphocytes does not need to be TB screened and can last 3-6 months after infusions on day 1 and 15

A

rituximab

58
Q

what is unique about Tofacitinib

A

it is taken ORALLY

JAK inhibitor

59
Q

this drug inhibits pDE4

what is something that’s exciting about this drug

A

apremilast

ORALLY

60
Q

1st line for gout

A

indomethacin

61
Q

hwo does indomethacin work and what is in CI with

A

works to inhibit COX 1

CI in GI ades
renal insufficiency
or PUD

62
Q

what are the ADE of probenacid

A

GI irritation
rash
hypersensitivity
kidney stone formation

63
Q

how does probenacid need to be given

A

with food or antiacids

64
Q

why can’t you give ASA with probenacid

A

it slows UA renal secretion and increases UA blood levels

65
Q

how does febuxostat work

A

non-purine xanthine oxidase inhibitor

which means it decrease ua PRODUCTION

66
Q

pegloticase

A

inactivates uric acod

67
Q

baclofen mOA

A

acts on GABAb causes hyperol thru increase K conductance

inhibits excitatory NT

68
Q

tis drug is a skeletal muscle relaxant used to treat spasticity secondary to MS

A

baclofen

when your back is hurten b/c of MS

69
Q

what population is baclofen CI in

A

seizures
DM
caution in elderly

70
Q

this skeletal muscle relaxant has a similar structure to TCA like amityptyline and can be used for acute spasms trauma or sprains

A

cyclobenzaprine

flexeril

71
Q

CI of cyclobenzapine

A

this is an ANTICHOLINERGIC CI in CV sz galucoma seizure disorder

72
Q

ADE of cyclobenzapine

A

sedation confusion visual hallucination

73
Q

this drug blocks Ca release from SR similar to PHT

A

dantrolene

74
Q

dantrolene can be used to treat

A

malignant hypothermia

m spasticity

75
Q

dantrolene is CI

A 
liver
CD
hepatitis
muscle weakness
sedation
76
Q

do not give dantrolene if your pt is on

A

CCB or ESTROGEN

77
Q

this sekeletal muscle relaxant is a lapha 2 agonsit

A

tizanidine

78
Q

ADE of tizanidine

A

hypotension
drowsniess
dry mouth

79
Q

methyprenisolone

A

intra-articular glucocorticoid used at the knee and inj for OA

80
Q

methyprenisolone is CI 2/

A

NSAIDS

colchicine

Pharm II (16 decks)

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