MSK disorders Flashcards
What drugs are indicated for RA treatment?
NSAIDs, steroids, and DMARDS
MOA of non-biologic (traditional) DMARDS?
- Reduces B and T lymphocyte activity
- Inhibits folic acid metabolism which prevents cell reproduction leading to death of rapidly replicating cells.
Which traditional DMARD is the gold standard?
Methotrexate
What are adverse effects of traditional DMARDS?
hepatotoxicity, bone marrow suppression, GI ulceration, kidney damage, pneumonitis, and fetal death
What labs should we monitor when giving DMARDs?
Kidney function
Liver: hepatotoxicity
CBC and platelet counts: risk of infection and bleeding
What are other indications for traditional DMARDS?
cancer, psoriasis, and abortion
MOA of biological DMARDS?
Neutralizes tumor necrosis factors (TNF) which promotes destruction of B lymphocytes and inhibits activation of T lymphocytes
Adverse effects of biologic DMARDS?
infection, reactivation of HBV and TB; new onset or worsening HF; increase risk for lymphoma or other malignancies; neutropenia, thrombocytopenia, and aplastic anemia.
Contraindications for biologic DMARDS?
demyelinating disorders (MS), severe HF, active HBV and TB
Who should be cautious in taking biologic DMARDS?
immunocompromised, mild HF, liver dysfunction, latent HBV, and DM
What is TNF?
Causes joint distortion in RA
What should we tell a patient who has latent TB before taking biologic DMARDS?
Need to have a negative TB test
Which vaccines should not be taken before taking biologic DMARDS?
live vaccines like herpes zoster and shingles vaccine
What is neutropenia?
neutrophils < 1,500
What is aplastic anemia?
leads to pancytopenia (reduction in RBC, WBC, and platelets)
Indications for colchicine?
acute gout exacerbations
Colchicine MOA?
unknown but it does not alter urate production or removal
Why should grapefruit be avoided when taking colchicine?
It disrupts the hepatic enzyme (CYP3A4) needed for metabolism
Adverse effects of colchicine?
GI toxicity and bone marrow suppression (infection)
Which labs should be assessed when taking Colchicine and why?
CBC due to bone marrow suppression
Indications for allopurinol?
chronic gout, hyperuricemia, chronic tophaceous gout
Allopurinol MOA?
inhibits xanthine oxidase
Adverse effects of allopurinol?
- long term use can cause cataracts
- may cause flare ups after initial tx
Indications for Probenecid?
chronic gout, hyperuricemia, prevention of tophi
MOA of Probenecid?
uricosuric drug; promotes urate excretion in the urine
Probenecid/ cautions?
- Don’t start during an acute attack b/c it will worse sx.
- drug interaction with ASA
Best gout drug for someone with poor kidney function?
Allopurinol because it is not a uricosuric drug
What is the difference between Allopurinol and Colchicine?
Allopurinol is used to prevent gout and Colchicine is to treat acute gout attacks
Do gout medications treat pain?
No, only decrease uric acid levels and inflammation
What should pts w/ gout use for pain relief?
NSAIDs
What medications will decrease bone resorption in osteoporosis?
estrogen, raloxifene, bisphosphonates, calcitonin, denosumab
What medications will promote bone formation in osteoporosis?
Teriparatide (Forteo)
What medications will reduce fx in osteoporosis?
Teriparatide, denosumab, and zoledronate
Bisphosphonate MOA?
decrease osteoclast activity. May also help prevent and tx bone metastases in patients with cancer.
Adverse affects of bisphosphonates?
ocular inflammation, osteonecrosis of the jaw (ONJ), atypical femur fx, and A fib
What is the most widely used oral bisphosphonate?
Alendronate (Fosamax, Fosamax Plus D)
How should you take Fosamax?
on an empty stomach, first thing in the morning, with a full glass of water, and should remain upright for @ least 30 minutes to prevent esophageal irritation.
Adverse effects of Fosamax?
esophageal ulceration, atypical femoral fx, esophageal cancer, MSK pain, ocular problems, ONJ, hyperparathyroidism, A fib
Indications for Selective Estrogen Receptor Modulators (SERM)?
osteoporosis, breast cancer, and can lower LDL
MOA of SERM with tx of osteoporosis?
Preserves BMD and reduces spinal fx by 55%
Which drug increases bone formation?
Teriparatide (Forteo)
Downside of using Forteo?
Increases risk for bone cancer
Which drug is a RANKL inhibitor?
Denosumab (Prolia)
Uses of Prolia?
post-menopausal osteoporosis and issues r/t bone metastases
Adverse effects of Prolia?
hypocalcemia, infections, skin rxn, and ONJ
What are calcimimetic drugs?
Reduce levels of PTH and serum calcium
What calcimimetic drug is used to treat hyperparathyroidism?
Cinacalcet (Sensipar)
How is hyperparathyroidism r/t osteoporosis?
in the bones PTH stimulates the release of calcium
Adverse effects of Sensipar?
N/V/D and hypocalcemia
Which 5 drugs have been approved for osteoporosis tx in men?
Fosamax, Actonel, Reclast, Forteo, and Prolia
What are the Black Box warnings for Raloxifine?
DVT, PE, stroke, fetal harm
