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Pharm > MSK/pain > Flashcards

MSK/pain Flashcards

1
Q

ASA/NSAIDs

A

ASA- irreversibly acetylates and inactivates COX other, NSAIDs- reversible COX inhibitors which decrease prostaglandins, which decrease pain and inflammation
-reduce inflammation, reduce pain, reduce fever
Used for mild to moderate pain for MSK
Do not USE ASA in less than 19 years old for risk of Reyes

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2
Q

Celecoxib

A

Selective COX2 inhibitor
Uses- RA, OA, acute pain similar to NSAID efficacy
ADE- HA, dyspepsia, diarrhea, abdominal pain, less likely for GI bleed

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3
Q

Acetaminophen

A

Inhibits prostaglandin in CNS reducing fever produce analgesic
Less peripheral COX effects weak anti inflammatory
Used for fevers, pain relief
Liver metabolites
IV- ofirmev
ADE- few, large doses live toxicity
antidote for OD- n acetyl cysteine

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4
Q

TDMA (traditional disease modifying anti rheumatic drugs)

A

Drugs- methotrexate*, hydroxychloroquine (plaquenil), leflunomide (arava), sulfasalazine (azulfidine)
Uses- RA
MOA- slow disease progression induce remission, and prevent further damage
Can be used in mono, combo or with TNF inhibitor or biologics

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5
Q

Methotrexate

A

Folic acid antagonist that inhibits cytokine production causing immune suppression and anti inflammatory
3-6 weeks for effectiveness
ADE- mucosal ulcers and nausea, leukopenia, cirrhosis, pneumonia like syndrome with chronic use
Folic acid to improve tolerability and. Reduce GI and liver ADE
Monitor LFTs, CBC, pregnancy status, infection

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6
Q

Hydroxychloroquine (plaquenil)

A

Mild early RA
MOA unknown
6-24 weeks for full effect
Less ADE on liver and immune compared to other DMARDs, ocular toxicity, CNS disturbances, GI upset, skin discoloration and eruptions

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7
Q

Leflunomide (arava)

A

Cell arrest of autoimmune lymphocytes through its action on dihydroorotate dehydrogenase
ADE- HA, diarrhea, nausea, weight loss, allergic reactions, flu like reaction, skin rash, alopecia, low potassium,
Hepatotoxicity
Contraindicated in pregnancy, monitor for infection, CBC, electrolytes and LFTs

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8
Q

Sulfasalazine (azulfidine)

A

RA like arava
MOA- unknown
Onset 4-12 weeks
ADE- nausea, vomiting, anorexia, leukopenia

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9
Q

Glucocorticoids

A

RA
Bridge into DMARDs become fully effective

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10
Q

biologics

A

TNF alpha use in caution with CHF can worsen condition
Increased risk for lymphoma or other CAs
Increased risk for infection
No live vaccines

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11
Q

Adalumumab (humira(

A

Recombinant MAB binds to TNF alpha with cell surface receptor
SQ weekly or Q2 weeks
ADE- HA, nausea, agranulocytosis, rash, injection site reactions, increased risk of infection

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12
Q

Certolizumab (cimzia)

A

Humanized antibody that neutralizes TNF alpha
SQ every 2 week
ADE- similar to TNF alpha inhibitors

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13
Q

Etanercept (embrel)

A

Protein binds to TNF alpha and blocks interaction with cell surface deceits
With MTX more effective
SQ weekly
Well tolerated

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14
Q

Golimumab (simponi)

A

Neutralizes the activity of TNF alpha by binding to it and blocking interaction in cells
SQ monthly
With MTX
Can increase LFTs

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15
Q

Infliximab (remicade)

A

Chimeric MAB
Binds to TNF alpha and inhibits its receptor
Not for mono therapy as it leads to anti remicade antibodies and reduced efficacy
Give with MTX
IV infusion Q 8 weeks

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16
Q

Abstacept (orenica)

A

Constimulation modulator and prevents T cell activation and decreases inflammatory cascade
IV infusion every 4 weeks
ADE- infusion related reaction, HA, URI, nausea

17
Q

Rituximab (rituxin)

A

MAB, directed at CD30 antigens
For RA
can cause B cell depletion
Given IV 4-6 months
Pre medicated with steroids, APAP, Benadryl to reduce reactions

18
Q

Toculizumbab (actemra), sarilumab (kevzara)

A

MAB binds to IL 6
SQ every 2 weeks
Actemra IV infusion every 4 weeks
ADE- elevated LFTs, DLP, neutropenia, HTN, infusion and infection related

19
Q

Tofactinib (xeljanz)

A

JACK inhibitor
For RA not responded to MTX
Monitor for Anemia, hemoglobin needs to be above 9 before starting, can increase CA risk, long term effects reserved for those who’s failed other agents

20
Q

Opioids not good with

A

Bone dull, aching, throbbing
Smooth muscle spasm
Voluntary muscle rigidity or spasticity
Neuropathic
Increased ICP

21
Q

Mild peripheral agents

A

Block pain impulses and substance P
Pain is relieved when inflammatory is reduced
-Tylenol
-NSAIDs
-ASA
-combo Tylenol with codeine, hydrocodone, Tramadol

22
Q

Signs of salicylate OD

A

Tinnitus **, vertigo; HA, confusion, drowsiness, swearing, hyperventilation, diarrhea, vomiting

23
Q

Triptans

A

First line for migraines
MOA- 5HT1B and 5HT1D agonist causes vasoconstriction and inhibit inflammation
Prototype- sumatriptan (imitrex)
Coronary vasospasm ***
ADE- burning at injection site; warm tingling sensation, flushing, tachycardia, neck jaw tightness, GI upset, heaviness in chest
Serotonin syndrome
Use in caution in CV disease, MOAIs, PVD, other SSRI, SNRI, Tramadol

24
Q

Ergots

A

MOA- bind to 5HT receptor as vasoconstrictor
Prototype- ergotamine tartrate (cafergot)
Potent vasoconstrictor
ADE- n/v, tingling, angina like pain, rebound vasodilation, rebound HA
Do not use in renal, hepatic, sepsis, CAD, CV disease
Contradicted with strong CYP3A4 and vasoconstrictors
Category X

25
Q

Dihydroergotamine

A

DOC for refractory migraines and cluster HA
Fewer ADE than ergots
Pregnancy X
Avoid in CVD, uncontrolled HTN,

26
Q

Migraine prevention

A

Beta blockers- inderal, nadaolol, timolol
Anti epileptics -topiramate, depakote
CCB- verapamil
TCA- amitriptyline, nortriptyline
SSRI/SNRI
Botox
NSAIDs

27
Q

Colchicine

A

Uses- gout
MOA- binds to tubulin and disrupts cellular function of neutrophils and decreases migration to inflamed joints
ADE- nausea, vomiting, abdominal pain, diarrhea with chronic use, myopathy, neutropenia, aplastic anemia, alopecia
Do not use in liver, renal or CV disease, or pregnancy
CYP3A4

28
Q

Allopurinol

A

MOA- xanthine oxidase inhibitor, decreases production of uric acid in last 2 steps of uric acid synthesis
Uses- gout, hyperuricemia
ADE- rash

29
Q

Fevuxostat (uloric)

A

Xanthine oxidase inhibitor unrelated to allopurinol
ADE- similar to allopurinol, but rash less likely
Use in caution in CV disease or stroke

30
Q

Probenecid

A

Uricosuric
Promotes renal clearance of uric acid by inhibiting urate anion exchanger in proximal tubule
Avoid in GFR less than 50
ADE- n/v, derm reactions, anemia, anaphylaxis

31
Q

Pegloticase (krystexxa)

A

Recombinant form of enzyme irate oxidase or uricase
Coverts uric acid to water soluble metabolites to be excreted
For gout which have failed other treatments
IV
ADE- infusion related

32
Q

Indomethacin

A

NSAID of choice for gout, but any can work as well

33
Q

Gout tx

A

Colchicine, NSAID or steroid with preventative drugs
Anti inflammatory stopped at 6 months and preventative continued

Pharm (16 decks)

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