gout, OP, and RA Flashcards
3 agents for acute gout attacks
NSAIDS, steroids, colchicine
MOA of colchicine
inhibits leukocyte infiltration which prevents the destructive lysosomal enzymes
AE of colchicine
GI (25%), d/c if this occurs
dosing of colchicine
1.2 mg loading, 0.6 mg 1 hr later. 1.8 mg/24 hrs
rare but serious SE of colchicine
BM suppression, rhabdo, severe kidney/liver disease
other considerations for colchicine
NO grapefruit juice, d-d interactions: PGP or CYP3A4
prototype for inhibiting uric acid formation
allopurinol
what special considerations do you have to think about with allopurinol?
may cause acute gout attack!!
what other times can allopurinol be used?
in cancer, chemo, and blood dyscrasias.
increased levels of uric acid with chemotherapy because of cell death!
common AE of allopurinol
GI
rare but serious AE of allopurinol
hypersensitivity syndrome
d-d interactions with allopurinol
warfarin
pt teaching with allopurinol
increase fluids to flush kidneys and protect from urate crystals
vitamin supplementation for OP
vitamin D, Ca
drugs that decrease bone resorption AKA inhibit osteoclasts (classes of drugs)
calcitonin-salmon bisphosphonates estrogen replacement SERMS monoclonal antibodies
drugs that increase bone formation
PTH (forteo)
Calcium supplementation general info
1200 mg/day, divided doses
take Ca Carbonate!
lots of food interactions– leafy greens, beans, whole grains. separate by 1 hour.
vitamin D general info
diet and sunlight
oral supplementation– 800-1000 mcg/daily
characteristics of a hormone
calcitonin- salmon MOA
keeps Ca in the bone and prevents pulling Ca into the blood stream
SE of calcitonin
nausea, nasal drying, increased malignancies
admin of calcitonin
intranasal or subq
prototype of bisphosphonates
alendronate
MOA of bisphosphonates
undergo incorporation into the bone and decreases the osteoclast activity
integrates themselves into the bone!
alendronate bioavailability
0.7%, if taken with food- NONE is absorbed
AE of alendronate
esophagitis, atypical fracture of femur, MS pain, ocular inflammation, osteonecrosis of the jaw
pt teaching of alendronate
take on an empty stomach nothing to eat or drink for 30 mins remain upright for 30 mins take with a full glass of water don't chew or suck tablets
estrogen replacement general info
no longer standard therapy
suppresses osteoclast activity
increase risk of breast cancer and endometrial cancer, cholecystitis and MI/Stroke
SERMS MOA
block or mimic estrogen receptors.
mimics on bone, lipid metabolism, or blood clot
blocks on breasts
prototype of SERM
raloxifene
general info of SERM
improve bone density
improve lipid profiles and improves CV risk
risk of DVT and PE
no help with hot flashes and can cause them!
prototype of monoclonal antibodies
Denosumab
denosumab admin
subq every 6 months
SE of denosumab
back pain, MS pain, pain in extremities, UTI, hypercholesterolemia
injection site reaction
rare but serious SE of denosumab
serious infections, derm reactions, osteonecrosis of the jaw
MOA of denosumab
prevents activation of RANK
prototype of drugs that increase bone formation
teriparatide
MOA of teriparatide
form of PTH made by recombinant DNA technology
admin of teriparatide
given subq
SE of teriparatide
nausea, HA, back pain, leg cramps, ortho/hypo initially
increased risk of osteosarcoma
3 classes of drugs for RA
NSAIDS, steroids, DMARDS
Non-biological DMARD prototype
methotrexate
methotrexate general info
immunosuppressive
takes 3-6 weeks to work (take NSAID until it kicks in)
take folic acid 5mg/week
methotrexate SE
hepatic fibrosis, BM suppression, GI ulceration, pneumonitis
methotrexate other considerations
reduced life expectancy from CV disease, infection and certain cancers
category X!!
Bio DMARDS prototype
etanercept
bio DMARDs MOA
immunosuppresive drugs that target specific parts of the inflammatory process
- tumor necrosis factor
- promotes destruction of B cells
- inhibits activation of t-cells
other considerations of bio DMARDs (etanercept)
high risk of serious infection: test for TB!!!, fungal infection, hep B
made with recomb DNA
EXPENSIVE
used for other autoimmune infections too
AE of etanercept
injection site rxn
special considerations for etanercept
test for TB watch for Hep B reactivation no active infections while on it no live vax risk of HF, cancer, CNS disorders, rarely serious skin rxns.
