MSK Flashcards
Acetaminophen:
MOA?
**One exceptionally important use??
Describe what happens in toxicity; what is the antidote?
MOA:
- REVERSIBLE inhib COX esp. in CNS
- No anti-inflammatory effects (I think this is why advil works better for my period pains…)
Tx: Feverish kiddos (NOT ASA!!!)
Toxicity: P450 Metabolism–> NAPQI = toxic metabolite–> Liver toxicity–> TREAT W/ N-ACETYLCYSTINE
Aspirin: MOA? Therapeutic use? ADRs (4)? What happens in toxicity?
MOA:
- IRREVERSIBLE inhib COX1, COX2–> Inhib TXA2, PGs
- ^ Bleeding time w/o affecting PT, PTT
Tx:
- UNDER 300 mg/ day = Inhib platelet agg
- 300-2400 mg/day = antipyretic/ analgesic
- 2400-4000 mg/day = anti-inflammatory
ADRs:
- GI bleed/ ulceration
- TINNITUS
- ARF/ Interstitial nephritis
- Reyes
Toxicity:
Respiratory ALKALOSIS–> Metabolic ACIDOSIS
Celecoxib:
MOA + advantage to use?
Therapeutic use?
ADRs/ CI?
MOA:
- REVERSIBLE inhib COX2 (inflam. cells, endothelium)
- SPARES gastric mucosa and platelets
Tx: RA, osteoarthritis
ADR/ CI: ^ risk thrombosis
CI: SULFA ALLERGY
List 5 high yield NSAIDS.
What is their common MOA?
What are their therapeutic uses?
What are their ADRs (2)?
Ibuprofen, Naptoxin, Indomethacin, Ketorolac, Diclofenac
MOA: ALL inhibit COX1, COX2–> Inhib PGs
Tx: Antipyretic, analgesic, anti-inflammatory
ADRs:
- GI ulcer
- Interstitial nephritis + renal ischemia
(PGs act at AFFERENT arteriole)
INDOMETHACIN does what for little guys in the NICU?
Closes patent PDA!
Lefunomide: MOA Therapeutic use? ADRs? CI?
MOA:
REVERSIBLE inhib dihydroorate dehydrogenase–>
Inhib PYRIMIDINE synthesis–> STOP T CELL prolif.
Tx: RA, psoriatic arthritis
ADRs: Diarrhea, HTN, HEPATOTOXIC
CI: PREGGOS
When should you never give your patient NSAIDS?
WHEN THEY PREGGOS.
Bisphosphonates:
List the 4 you should know–what is their common ending?
MOA?
ADRs (3)?
Alend, Iband, Rised, Zoled-RONATE
MOA: Pyrophosphate analog
Bind Hypoxyapatate–> STOP OSTEOCLAST ACTIVITY
Tx:
- Osteoporosis, Pagets, Bone mets, OI
- Hypercalcemia
ADRs:
- Corrosive esophagitis
- Jaw osteonecrosis
- Atypical stress fractures
Teripartatide:
MOA?
Therapeutic use?
ADRs?
MOA:
Recombinant PTH; admin SQ daily to ^ OSTEOBLAST activity
Tx: Osteoporosis (best at ^ bone growth)
ADRs: Transient HYPERcalcemia
What are 4 drugs used to treat gout + their MOAs?
- Allopurinol (inhibits Xanthane oxidase)
- Febuxostat (inhibits Xanthane oxidase)
- *These stop Hypoxanthine–> Xanthane**
- Pegloticase
(Recomb Uricase: UA–> allantoin = H2O soluble) - Probenecid (inhibits UA reabsorption in PT of nephron)
What are two therapeutic uses for allopurinol?
- Treats gout
- Prevents tumor-lysis asstd. nephropathy
How do allopurinol and febuxostat affect 6MP and azathioprine metabolism?
^ 6MP, Azathioprine concentrations bc they are normally metabolized by xanthane oxidase
Pegloticase: MOA
Recomb Uricase: UA–> allantoin = H2O soluble
Probenecid: MOA
What are two therapeutic uses?
ADR?
Inhibits UA reabsorption in PT of nephron
Treats Gout, INHIBITS PENICILLIN EXCRETION
May cause uric acid calculi
What are the three drug classes used to treat ACUTE GOUT?
- NSAIDs (Naproxen, Indomethacin)
- Glucocorticoids
- Colchicine
What are the two NSAIDS used to treat ACUTE gout?
Why are salicylates CI?
Naproxen, Indomethacin
Salicylates DECREASE UA clearance, and are therefore CI…
NEVER USE SALICYLATES FOR ACUTE GOUT!!!
What is the MOA for Colchicine?
What is it used to treat?
What are its ADRs?
MOA:
STABILIZES Tubulin–> STOP polymerization–> STOP neutron chemotaxis and degranulation
(COLchicine = COLD = FREEZE Tubulin)
Tx: Acute, Px Gout
ADRs:
Serious GI upset; NSAIDS better tolerated for acute flare ups
TNF-a Inhibitors:
Therapeutic use relevant to MSK?
ADR/ risk?
What should you always check before starting on a TNF-a inhibitor?
Treats Gout (Px)
- ^ infection risk
- Always do PPD because can cause reactivation of TB
Which TNF-a inhibitor can be used to treat IBD?
Which AI disease is it NOT good to treat?
Infliximab (the one that starts with an “I”)
NOT good for psoriasis
Etanercept:
MOA?
Therapeutic use?
EtanerCEPT = TNF decoy reCEPTor
(fusion protein receptor for TNFa, IgG,1, FC)
Treats RA, psoriasis, ankylosing spondylitis
Inflicimab + Adalimumab:
MOA
Therapeutic Uses?
TNFa monoclonal Ab
Treats IBD, RA, ankylosing spondylitis, psoriasis
Rasburicase:
MOA?
Therapeutic use?
Recombinant uricase: UA–> Allantoin–> Pee out
This is used to prevent/ treat tumor lysis syndrome
Random: How can you ID tumor lysis syndrome?
Look for patient on chemo with peaked T waves due to release of lots of intracellular K+
What are the two recombinant uricase drugs?
- pigloticase
- rasburicase
