MSK Pharm Flashcards
What is the goal of these meds?
reduce pain, inflammation
What is the one drug that doesn’t affect inflammation in any significant way?
Acetaminophen
Acetaminophen
Drug: N-acetylpara-aminophenol (APAP) or paracetamol
Indications: pain mild-mod, fever
MOA: partial COX inhibitor and reduction of prostaglandins in CNS, may inhibit the COX pathway in the central nervous system but not peripheral tissues
Result: analgesic and antipyretic
NSAIDS
Indications: pain mild-severe, including OA, RA, gout (indomethacin, naproxen)
MOA: inhibits cyclooxygenase, reduces prostaglandin and thromboxane synthesis
Result: analgesia and decreased inflammation
Drugs: ibuprofen, naproxen, diclofenac, indomethacin, meloxicam
What is the first line treatment for severe pain?
NSAIDS
COX 2 inhibitors
Indications: OA, RA, ankylosing spondylitis, and acute pain
MOA: selectively inhibits cyclooxygenase 2 (COX-2) and reduces prostaglandin synthesis
Result: analgesia and decreased inflammation
Drug: celecoxib(celebrex)
Central opioid agonists
Indications: mod-severe pain acute or chronic
MOA: unknown, binds to mu opioid receptors, weakly inhibits NE(norepi)/serotonin uptake
Result: analgesia
Drug: tramadol
*abuse, dependence, and overdose risk
Anti-rheumatologic drugs
-Used to modulate the immune system
-Often have indications for many rheumatologic diseases
-Corticosteroids
-DMARDS: Disease modifying antirheumatic drugs (impacts the progression of the disease)
Conventional
Anti-TNF
B-cell depletors
Others
T/F Anti-rheumatologic drugs reduces the number of flares but does NOT slow disease progression
False, it does
Conventional DMARDs
Indications: rheumatoid arthritis (RA), IBD, psoriatic arthritis (methotrexate); some leukemia/lymphomas (methotrexate)
Azathioprine: inhibits T-lymphocytes
Methotrexate: exact mechanism unknown, folate antagonist: inhibits lymphocyte proliferation, inhibits dihydrofolate reductase
Sulfasalazine: exact mechanism unknown, blocks cyclooxygenase and inhibits prostaglandin production
Result: alters immune response and reduces inflammation, reduce disease progression, reduce exacerbations
Anti-TNF DMARDs
Indications: RA, IBD, ankylosing spondylitis, psoriatic arthritis
MOA: binds and inhibits TNFa
Result: reducing inflammation and altering immune response
Drugs
Adalimumab
Etanercept
Infliximab
Corticosteroids
Indications: acute inflammatory processes or exacerbations of chronic rheumatologic diseases (OA, RA, gout, psoriatic arthritis, ankylosing spondylitis, etc.)
MOA: glucocorticoid and mineralocorticoid effects, inhibits multiple inflammatory cytokines
Result: decreases inflammatory response
Drugs: prednisone, methylprednisolone, triamcinolone (intra-articular)
What are the 2 drugs used for gout?
- Allopurinol
- Colchicine
Allopurinol
Indications: gout prophylaxis
MOA: inhibits conversion of precursors to uric acid to decrease uric acid levels
Result: decreased uric acid so fewer exacerbations
Colchicine
Indications: gout acute or prophylaxis
MOA: inhibits neutrophil aggregation and reduces inflammation that worsens gout symptoms
Results: reduced symptomatology and decreased number/severity of flares
What is an acute gout attack?
overproduction or under secretion of uric acid and it forms crystals that deposit in synovial fluid and it causes pain
Which drug cannot be given to someone with an acute gouty attack because it makes it worse
Allopurinol
Osteoperosis
occurs in different populations, generally the patients are older- post menopausal women b ut can be seen in male pateits and younger pts who have undergone hystercetomy. deproprovera can be linked to it, pts w hyperthyroidism and vit d deficiecny
What is the main treatment of Osteoporosis ?
Bisphosponates
Bisphosponates
Indications: osteoporosis
MOA: Inhibits osteoclast activity
Result: Reduces bone resorption and turnover
Drugs: alendronate, risedronate, ibandronate, zoledronic acid
Estrogenic agents
Indications: osteoporosis and breast cancer prevention (raloxifene)
MOA: selectively binds to estrogen receptors
Result: decreases bone turnover and resorption
Drugs: estradiol(not used specifically for osteoporosis, just for perimenopausal symptoms) , raloxifene
RANKL inhibitors
Indications: osteoporosis, cancer-treatment induced bone loss
MOA: inhibits osteoclast formation and maintenance
Result: reduces bone resorption and turnover
Drug: Denosumab (prolia)
PTH Analogs
Indications: severe osteoporosis
MOA: Regulates bone metabolism, increased intestinal calcium resorption, and increased renal tubular calcium resorption
Result: builds bone if given for less than 2 years cumulatively
Drug: teraparatide
What is the end line treatment of osteoperosis
PTH analogs
