FINAL arthritis gout and muscle relaxants Flashcards by Lux Smith

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

nonacetylate salicylates

same with pt on WARFARIN

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when would we use intraarticular glucocorticoids

KNEE OA

not hip

adjunct inj

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hyalgan
synvisc
supartz
euflexxa
gel-one

all used for

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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DMARDS used for

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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usually what order of drugs do we use in RA

1st DMARD
add second
NSAIDS prednisone

maybe a biologic

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dosing of methotrexate/rhematrex

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

NOT DAILY don’t want to wipe out immune system

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MOA of methotrexate

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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onset of methotrexate

1-2 months

w/ RENAL elimination

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SE of methotrexate

myelosupression
N/V/D
Ulcers
stomatitis

dose related hepatotox
pulm tox

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monitoring needed for metotrexate

CBC
SCr
LFTs

montly for 6 months

then every 1-2 more

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when would you check for liver damage with methotrexate

need LFTs regularly

liver biopsy after 4 g

then 1.5 g after that

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methotrexate can be used with what DMARD

hydroxychloroquin and sulfasalizine

NOT leufunomide

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avoid MTX in

pregnant
liver disease
immunodeficiency synfromes

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leflunomide

slow onset long half life

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

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when to use leflunomide

alt to methotrexate because of hepatotox

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monitoring for leflunomide **

CBC
SCr
LFTs

montly for 6 months

then every 1-2 more

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leflunomide should not be used in

pregnant pt

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this can be used for overdose with leflunomide

cholestyramine questran

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whart do you need before starting hydroxychloroquine

opthalmic exam to monitor effects

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interluken DMARDS

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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TNF biologic

Golimumab
Adalimumab
etanercept
certolizumab
infliximab

Goli named Ada (all libms) entanercepted CertainLIZ

inflicting Abb and dyyb

ADA BOY! TNF FTW

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other biologics

Apparently Ritu and Aba like Tofu and Vodo

Apremilast
Abatacept
Rituximab
Tofacitinib
Vedolizumab

Other weirdos like tofu and vodo

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biologics that can be used for AS

Ixekizumab

Secukinumab

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

etanercept

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common ADE with TNF I

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

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

hepatitis panel check TB check flu vaccinations get baseline LFTs

DDI TNFI

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

probably need to give this TNF I with MXT why?

infliximab contains mouse parts and we can develop AB

need to avoid these two TNFI in CHF

inflixi and entanercept

TNFI with longest half life

Goali

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

anakinra NO reactivation TB

NEVER combine IL drug with

TNFi or IL-drug with other IL-drug | Wont be able to fight infection, sepsis risk

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

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

this ILI can CAUSE IBD

secukinumab IBD will shut down the sec

which ILI can be used for plaque psoriasis

guselkumab

when would we use Tofascitinib

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

when would we use tofacitinib

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

CI with tofacitinib (xelijanz)

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)

monitoring and dose adj needed for tofacitinib

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

abatacept

prevents full T cell activation check PPD IV or subQ don't combine wiht other biologics

rituximab MOA

chimeric monoclonal AB that targets CD20 B lymphocytes.

adj needed for rituximab

NO NEED TO TB SCREEN | No need to dose adjust renal/hepatic

rituximab indications

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

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

apremilast

psych caution needed with this biologic

apremilast otezla

CYP! Inducers will DECREASE this biologic

apremilast conc

renal adjustment needed for apremilast

oral, dose adjust renal CrCl <30 | Need to titrate up oral dose!!

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

allopurinol ALOE PERANA AND FAT BOXER

allopurinol must be started with

Colchicine

how does colchicine work

DOES NOT EFFECT UA metabaolism inhibits leukocytes migration this is an anti-inflammatory with no analgesic effect

abatacept (Orencia)

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

SE common to colchicine

N/V/D 50-80% of pts CI in PUD bone marrow supression DOES NOT EFFECT URIC ACID METABOLISM

ADE with allopurinols

can cause a gout attack can cause rash (more common if on PCN) ``` elukopenia diarrhea nausea increased LFTs increase levels of azathioprine ```

DDI with allopurinole

can cause immune suppression want to avoid abnx and theophylline can increase INR if on warfarin

dosing adjustments for allopurinole

renal

which gout drug would you not want to take with ETOH

colchicine will increase GI tox also do not take with grapefruit or erythromycin

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

rituximab

what is unique about Tofacitinib

it is taken ORALLY JAK inhibitor

this drug inhibits pDE4 what is something that's exciting about this drug

apremilast ORALLY

1st line for gout

indomethacin

hwo does indomethacin work and what is in CI with

works to inhibit COX 1 CI in GI ades renal insufficiency or PUD

what are the ADE of probenacid

GI irritation rash hypersensitivity kidney stone formation

how does probenacid need to be given

with food or antiacids

why can't you give ASA with probenacid

it slows UA renal secretion and increases UA blood levels

how does febuxostat work

non-purine xanthine oxidase inhibitor which means it decrease ua PRODUCTION

pegloticase

inactivates uric acod

baclofen mOA

acts on GABAb causes hyperol thru increase K conductance | inhibits excitatory NT

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

baclofen when your back is hurten b/c of MS

what population is baclofen CI in

seizures DM caution in elderly

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

cyclobenzaprine flexeril

CI of cyclobenzapine

this is an ANTICHOLINERGIC CI in CV sz galucoma seizure disorder

ADE of cyclobenzapine

sedation confusion visual hallucination

this drug blocks Ca release from SR similar to PHT

dantrolene

dantrolene can be used to treat

malignant hypothermia m spasticity

dantrolene is CI

``` liver CD hepatitis muscle weakness sedation ```

do not give dantrolene if your pt is on

CCB or ESTROGEN

this sekeletal muscle relaxant is a lapha 2 agonsit

tizanidine

ADE of tizanidine

hypotension drowsniess dry mouth

methyprenisolone

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

methyprenisolone is CI 2/

NSAIDS | colchicine