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Pharmacology PaxFlan > gout + antiinflammatories > Flashcards

gout + antiinflammatories Flashcards

1
Q

what do you screen for when someone has gout

A

HTN, DM, hyperlipidemia, CKD

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2
Q

M/C cause of hyperuricemia

A

decreased excretion of urate by kidneys

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3
Q

2 main categories of gout MANAGEMENT

A

xanthine oxidase inhibitors

uricosuric agents

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4
Q

ACUTE gout anti-inflammatories

A
  1. NSAIDS - naproxen > ibuprofen
  2. prednisone (if CKD, cirrhosis, HF)
  3. colchicine
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5
Q

what two acute anti-inflammatory combos should you avoid & WHY

A

steroids, NSAIDS

can –> GI toxicity

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6
Q

risk factor reduction for gout

A

weight loss, decrease CV risk factors, manage BP, exercise, hydration, smoking
decrease intake of SSB (fructose!!), organ meats, red meats, ETOH

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7
Q

what pts should be on anti-hyperuricemic therapy

A
  • frequent/disabling gout attacks (>2/yr)
  • men <25 OR premenopausal women
  • gout w CKD
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8
Q

ADRs of colchicine

A
  • diarrhea
  • myopathy, rhabdo
  • bone marrow suppression
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9
Q

do not combine colchicine with…

A
  • 3A4 or pgp inhibitors (clarithromycin, cyclosporine)

- statins, fibrates

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10
Q

goals of serum [UA] in gout

A

<6 or <5 if tophi

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11
Q

when do you initiate anti-hyperuricemic therapy

A

when acute gout attack has resolved

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12
Q

xanthine oxidase inhibitors

A

allopurinol

febuxostat

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13
Q

xanthine oxidase of choice

A

allopurinol

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14
Q

what to screen for with allopurinol and why

A

HLA-B5801 –> at higher risk of DRESS

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15
Q

what do you adjust for with allopurinol tx

A

GFR

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16
Q

ADR of allopurinol

A

paradoxical gout flare
bone marrow suppression
drug fever
rash, DRESS

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17
Q

BBW for febuxostat

A

cardiac safety concerns

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18
Q

uricosuric agent

A

probenecid

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19
Q

probenecid MOA

A

basically, urate diuretic

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20
Q

before starting someone on probenecid, pts must have

A

good renal function - GFR >50

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21
Q

pegloticase MOA

A

turns UA into a water soluble metabolite that can be excreted

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22
Q

when would you use pegloticase

A

severe gout, debulking for tophi, last resort!

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23
Q

biosimilars must have the same __ compared to OG drug

A
  • MOA
  • dose
  • strength
  • route
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24
Q

how soon should you initiate non-biologic DMARD therapy

A

within 3 months of the diagnosis

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25
Q

when should you use a biologic DMARD

A

when pt doesn’t respond to non-biologic, have moderate disease, or intolerant to DMARD

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26
Q

triple therapy anti-inflammatory regimen

A

MTX + hydroxychloroquine + sulfasalazine

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27
Q

biologic therapy anti-inflammatory regimen

A

MTX + TNF-inhibitor

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28
Q

what to use to decrease inflammatory symptoms

A

low dose steroids, NSAIDS

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29
Q

immunizations for people with inflammatory conditions

A 
influenza
pneumonia (both)
VZV
HBV
HPV
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30
Q

when should immunizations be given

A

1 month prior to initiating DMARD

31
Q

non-biologic DMARDS

A
  • MTX
  • leflunomide
  • sulfasalazine
  • hydroxychloroquine
  • JAK inhibitors (-citinibs)
32
Q

MTX MOA

A

folate antimetabolite that inhibits DNA synthesis

33
Q

indications for MTX

A
  • tumors/CA
  • RA
  • psoriasis/psoriatic arthritis
34
Q

monitoring for MTX

A
  • CXR, PFT
  • HBV/HCV test
  • CBC, CMP
35
Q

ADRs for MTX

A
  • stomatitis
  • GI intolerance
  • pulmonary toxicity
  • hepatotoxicity (LFT abnormalities)
  • nephrotoxicity
  • bone marrow suppression
36
Q

drug interactions of MTX

A
  • other anti-folate drugs (TMP-SMX)
  • other drugs that affect kidneys (NSAID, transplant drugs, diuretics)
  • PPIs increase MTX conc.
37
Q

what should you supplement MTX with & why

A

folate to decrease ADRs

38
Q

when should you take pts off MTX & why

A

sick pts in hospital –> risk of aplastic crisis

39
Q

reversal agent for MTX

A

levocovorin

40
Q

leflunomide indications

A

RA/psoriatic arthritis in pt who had MTX toxicity

41
Q

leflunomide ADRs

A
  • diarrhea
  • reversible alopecia
  • LFT abnormalities
42
Q

hydroxychloroquine indications

A
  • RA
  • SLE
  • anti-malaria
43
Q

do not use hydroxychloroquine if…

A

hx of retinal/visual field abnormalities

pts with renal insufficiency

44
Q

hydroxychloroquine ADRs

A
  • ophthalmic issues
  • QTC issues
  • hemolysis in G6PD pts
45
Q

sulfasalazine indications

A
  • RA

- IBD

46
Q

common sulfasalazine ADRs

A
  • GI intolerance

* sulfa rash!

47
Q

JAK inhibitors

A

tofacitinib
baricitinib
upadacitinib

48
Q

JAK inhibitor indications

A

mod-severe RA

49
Q

what are pts on JAK inhibitors at risk of

A

thromboembolic events

50
Q

1ST line TNF-inhibitors

A
  • infliximab
  • adalimumab
  • etanercept
51
Q

2nd line TNF inhibitors

A

certolizumab

golimumab

52
Q

TNF inhibitors indications

A
  • mod-severe RA
  • psoriatic arthritis
  • severe plaque psoriasis
  • IBD
  • ankylosing spondylitis
  • sJIA
53
Q

what are TNF-inhibitors typically used with

A

MTX

54
Q

screening for pts on TNF inhibitors

A 
CA
TB (IGRA, TST)
CXR
HIV
HBV
HCV
55
Q

acute ADRs of TNF-inhibitors

A

injection site rxn
infusion rxn
URTI
GI intolerance

56
Q

serious ADRs of TNF inhibitors

A
  • lupus
  • MS
  • bone marrow suppression
  • malignancies
  • increased risk for serious infections
57
Q

what type of infections are pts on TNF inhibitors at risk of

A

TB reactivation
invasive fungal infection
bacterial infection

58
Q

all other drugs biologic DMARDS (besides TNF-inhibitors) are generally only used for…

A

RA pts who dont respond to TNF inhibitor

59
Q

T cell costimulation/activation inhibitor

A

abatacept

60
Q

cd20 mab

A

rituximab

61
Q

IL-1 antagonist

A

anakinra

62
Q

IL-6 antagonist

A

toclizumab

sarilumab

63
Q

acute psoriatic arthritis tx

A

NSAIDS, intraarticular or low-dose systemic steroids

64
Q

long-term psoriatic arthritis tx

A

mild: NSAIDS

mod-severe: MTX, leflunomide –> add TNF-inhibitors if no improvement in 12-16 weeks –> then other agents

65
Q

apremilast

A

PDE4 inhibitor

psoriatic arthritis

66
Q

secukinumab

A

il-17 antagonist

67
Q

ixekizumab

A

il-17 antagonist

68
Q

ustekinumab

A

il-12/23 antagonist

69
Q

what other non-biologic & biologic DMARD can you use for psoriatic arthritis

A

abatacept

tofacitinib

70
Q

systemic juvenile idiopathic arthritis characteristics

A

daily high fever
evanescent MP rash
inflammatory polyarthritis

71
Q

tx for mild-moderate sJIA

A
  • NSAID
  • systemic glucocorticoid
  • or both
72
Q

pts with sJIA with FEW systemic features (fevers)

A
  • DMARD (MTX + TNFinhibitor)
73
Q

pts with sJIA with prominent systemic features (fevers)

A
  • high does corticosteroids
  • tocilizumab or anakinra
  • canakinumab

Pharmacology PaxFlan (12 decks)

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