Musculoskeletal Flashcards
Aspirin
1) Low dose - decr plt aggregation. Middle dose - antipyretic, analgesic. High dose - anti-inflammatory
2) Irreversibly inhibits COX1/2 by acetylation –> decr TXA2 and Prostaglandins. Incr Bleeding time.
3) Gastric ulcer, TINNITUS (CN8)**. Chronic use: acute renal failure, interstitial nephritis, upper GI bleed. Reyes in children. Stimulate respiratory center, hyperventilation and respiratory alkalosis
4) Prevents recurrence/transformation of adenomatous polyps
NSAIDs (Ibuprofen, naproxen, indomethacin, ketorolac)
1) Use: Antipyretic, analgesic, anti-inflammatory. Indomethacin is used to close a PDA.
2) Class/MOA: Reversibly inhibits cyclooxygenase (both COX-1 and COX-2). Block prostaglandin synthesis.
3) Interstitial nephritis, gastric ulcer, renal ischemia (PGs vasodilate afferent arteriole)
COX-2 Inhibitor (celecoxib)
1) Use: Rheumatoid and osteoarthritis; patients with gastritis or ulcers.
2) Class/MOA: Reversibly inhibits the cycooxygenase (COX) isoform 2, which is found in inflammatory cells and vascular endothelium and mediates inflammation and pain
3) Side effects/ADEs: Increased risk of thrombosis. Sulfa allergy.
Acetaminophen
1) Use: Antipyretic, analgesic, but NOT anti-inflammatory. Used instead of aspirin to prevent Reye’s syndrome in children with viral infections.
2) Class/MOA: Reversibly inhibits COX, mostly in CNS. Inactivated peripherally.
3) Side effects/ADEs: OD –> hepatic necrosis, acetaminophen metabolite NAQPI depletes glutathione and forms toxic tissue adducts in the liver. N-acetylcysteine is antidote - regenerates glutathione (sulfhydryl groups). Glutathione makes NAQPI nontoxic.
Bisphosphonates (Alendronate; and other -dronates)
1) Use: Hypercalcemia, Paget’s diseases of the bone, osteoporosis.
2) Pyrophosphate analogs; bind hydroxyapaptite in bone, inhibit osteoclast activity
3) Side effects/ADEs: Corrosive esophagitis, osteonecrosis of the jaw.
4) pt should stay upright for 30 minutes after taking to prevent esophagitis
Chronic Gout Drug (Probenecid)
1) Use: Chronic Gout (urate lowering therapy)
2) Inhibits resorption of uric acid in the PCT (also inhibits secretion of penicillin)
3) Use w Cidofovir to decr nephrotoxicity
Chronic Gout Drug (Allopurinol)
1) Use: Chronic Gout (urate lowering therapy) 2) Class/MOA: Inhibits xanthine oxidase
Chronic Gout Drug (Febuxostat)
1) Use: Chronic Gout (urate lowering therapy) 2) Class/MOA: Inhibits xanthine oxidase
Acute Gout Drug (Colchicine)
1) Use: Acute Gout (urate lowering therapy) 2) Class/MOA: Binds and stabilizes tubulin to inhibit MT polymerization, impairing leukocyte chemotaxis, deregulation, and phagocytosis (Impairs the CYTOSKELETON)3) GI side effects (N/V/D**), especially if given orally
Acute Gout Drug (NSAIDs)
Naproxen and Indomethacin-use in acute gout(#1 choice in acute gout)
The alpha inhibitors (Entanercept)
1) Use: Rheumatoid arthritis, psoriasis, ankylosing spondylitis. 2) Class/MOA: Recombinant form of human TNF RECEPTOR* that binds TNF. 3) Side effects/ADEs: All TNF alpha inhibitors predispose to infection including reactivation of latent TB 4) Fun Facts: EntanerCEPT is a TNF decoy reCEPTor.
The alpha inhibitors (Infliximab)
1) Use: Chron’s disease, rheumatoid arthritis, ankylosing spondylitis. 2) Class/MOA: Anti-TNF antibody 3) Side effects/ADEs: All TNF alpha inhibitors predispose to infection including reactivation of latent TB 4) Fun Facts INFLIimab INFLIX pain on TNF-“xi-“ = chimeric
The alpha inhibitors (Adalimumab)
1) Use: Psoriasis, rheumatoid arthritis, ankylosing spondylitis2) Class/MOA: Anti-TNF antibody 3) Side effects/ADEs: All TNF alpha inhibitors predispose to infection including reactivation of latent TB
Acute gout drugs (glucocorticoids)
-Acute gout-Oral or intraarticular -Use in pts in who NSAIDS and Colchine are Contraindicated (i.e. pts w renal failure)
Drugs not to give in gout
Do not dive salicylates; all but the highest dosages depress uric acid clearance. Even high doses (5-6 g/day) have only minor uricosuric activity.
