MUSCULOSKELETAL Flashcards
Which musculoskeletal drug is a decoy receptor for TNF alpha
etanercept
Which NSAID is injectable?
ketorolac
What do all of the bisphosphonates end in?
dronate
With which disease is urate nephropathy associated? What drug can prevent?
tumor lysis syndrome in patients with leukemia etc, allopurinol
What are 3 indications for bisphosphonates?
osteoporosis, hypercalcemia, Paget’s disease of bone
What are the side effects of bisphosphonates?
osteonecrosis of the jaw and corrosive esophagitis
What is the MOA of colchicine for gout?
Binds and stabilizes tubulin to inhibit polymerization and leukocyte chemotaxis (i.e. the gout crystals induce complement = chemotaxis (C5a), this drug prevents them from actually infiltrating the gouty tissue)
What is the function of PGI2?
causes vasodilation and inhibits platelet aggregation
When is it okay to give a kid aspirin?
If they have Kawasaki disease (Kawasaki arteritis) the risk of coronary aneurysm is greater than the risk for Reye’s syndrome?
Which musculoskeletal drug can cause corrosive esophagitis?
Bisphosphonates (alendronate and other dronates)
How exactly does aspirin inhibit COX 1 and 2?
via acetylation
What 2 NSAIDs are indicated for acute gout?
naproxen and indomethacin
What is the toxic metabolite of acetaminophen?
N-acetyl-para-benzoquinone imine
What are 2 indications for celecoxib? With what underlying condition would you choose this over an NSAID?
Osteoarthritis and Rheumatoid arthritis; if they have gastritis or ulcer you would choose these over a traditional NSAID
T/F: aspirin is an NSAID
TRUE
Which musculoskeletal drug can cause osteonecrosis of the jaw?
Bisphosphonates (alendronate and other dronates)
What is the effect of low, medium, and high dose aspirin?
low (under 300) is for decreasing platelet aggregation; medium is for antipyretic/analgesic (300-2400); high is anti-inflammatory (2400-4000)
What happens when a person overdoses on acetaminophen? What is the antidote?
Hepatic necrosis due to toxic adducts; N-acetylcysteine
Which cranial nerve may be negatively affected by aspirin?
CN VIII (causes tinnitus)
What is the MOA of bisphosphonates?
They are pyrophosphate analogs and bind to hydroxyapatite in bone and inhibit osteoclast activity
What are the options for acute Tx of gout?
NSAIDs (indomethacin, naproxen) and oral/intra-articular glucocorticoids
What effect does aspirin have on breathing?
stimulates respiratory centers leading to hyperventilation and metabolic alkalosis
Name to COX-2 selective inhibitors
celecoxib and rofecoxib
Why would a patient being treated for leukemia or lymphoma be placed on allopurinol or febuxostat?
Prevent tumor lysis syndrome
What effect does aspirin have on PT, PTT, and bleeding time?
only increases bleeding time (because decreases platetlet aggregation) but no effect on the others which indicate effects on clotting factors
What effect do NSAIDs have on renin activity?
increased, this is due to loss of prostacyclin (PGI2) in the afferent arteriole, leads to increased renin and HTN
Which drugs should not be given with allopurinol?
Salicylates as all depress uric acid secretion (I’m guessing this is why you don?t give aspirin for your NSAID of choice in acute gout??)
What is the MOA of adalimumab and infliximab?
anti-TNF-alpha monoclonal antibody
Which drugs are increased in concentration with co-administration of allopurinol?
6 mercaptopurine and azathioprine
Which drug is a reversible inhibitor of COX only in the CNS?
acetaminophen
Which aspect of the nephron does probenicid exert its effects?
Proximal tubule, prevents reabsorption of uric acid
Which enzyme, inhibited by aspirin will only be inhibited in tissue that is actively inflammed?
COX-2 since that is the inducible one
How is the effect of LTB4 different from LTC4, D4 and E4?
B4 is chemotactic for neutrophils and the others are all active on smooth muscle, mediating vaso/bronchoconstriction
How is the MOA of etanercept different from that of adalimumab/infliximab?
Etanercept is a decoy receptor for TNF-alpha (a fusion protein of TNF alpha and IgG1 Fc) whereas the others are monoclonal abs against TNF-alpha
Which drug inhibits the reabsorption of uric acid in the PCT?
probenicid
How is the MOA of acetaminophen different from NSAIDs?
it acts CENTRALLY to inactivate COX, it is inactivated peripherally
What are 3 major issues that arise with chronic aspirin usage?
acute renal failure, interstitial nephritis, and UGIB
Name 4 chronic gout drugs
febuxostat, allopurinol, and probenicid
What should you give a child with a viral infection and fever?
Acetaminophen, if you give aspirin there is risk for Reye’s syndrome
What NSAID is used to close a PDA
indomethacin
