Musculoskeletal Flashcards

1
Q

Aspirin: Mechanism

A

Irreversible inhibits cyclooxygenase (1 and 2) by acetylation, decreasing synthesis of thromboxane A2 and prostaglandins.

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2
Q

Aspirin’s effect on PT, PTT and bleeding time

A

Increased BT

No effect of PT and PTT

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3
Q

How much is Aspirin low dose? Usage?

A

Low dose: < 300 mg/day

Platelet aggregation

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4
Q

How much is Aspirin intermediate dose? Usage?

A

300-2400 mg/day

Antipyretic and analgesic

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5
Q

How much is Aspirin high dose? Usage?

A

2400-4000 mg/day

Antiinflammatory

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6
Q

Aspirin: Side effects (6)

A

Gastric ulceration
Tinnitus (CN VIII)

Chronic Use:
Acute renal failure
Interstitial nephritis
Upper GI bleeding
Reye's syndrome after viral
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7
Q

Aspirin: Acid-Base status

A

Respiratory alkalosis by hyperventilation

Anion gap metabolic acidosis

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8
Q

Where is COX 1 and COX 2 found?

A

COX1: platelets and GI
COX2: sites of inflammation

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9
Q
Ibuprofen
Naproxen
Indomethacin
Keterolac
Diclofenac
A

NSAIDS

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10
Q

NSAIDS: Mechanism

A

Reversibly inhibit COX1 and 2 -> blocks prostaglandin synthesis

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11
Q

NSAIDS: Use (3)

A

Antipyretic
Analgesic
Anti-inflammatory

Indomethacin also closes PDA

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12
Q

NSAIDS: Side effects (3)

A

Interstitial nephritis
Gastric ulcer
Renal ischemia

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13
Q

COX-2 inhibitors: Mechanism

A

Reversibly inhibit COX2

Spares COX-1, which helps maintain gastric mucosa and spares TXA1 production

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14
Q

COX-2 inhibitors: Use (3)

A

RA, osteoarthritis

Patients with gastritis and ulcers

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15
Q

COX-2 inhibitors: Side effects (2)

A

Increased thrombosis risk

Sulfa allergy

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16
Q

Acetaminophen: Mechanism

A

Reversibly inhibits COX, mostly in CNS; inactivated peripherally

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17
Q

Acetaminophen: Use (2)

A

Antipyretic, analgesic
Not anti-inflammatory

Used instead of aspirin to avoid Reye’s syndrome

18
Q

Acetaminophen: Side effects

A

Overdose produces necrosis

Depletes glutathione and forms toxic tissue adducts in liver

19
Q

Treatment for Acetaminophen overdose

A

N-acetylcysteine

Regenerates glutathione

20
Q

Alendronate: Family

A

Bisphosphonate

21
Q

Bisphosphonate: Mechanism

A

Pyrophosphate analog

Binds hydroxyapatite in bone, inhibiting osteoclast activity

22
Q

Bisphosphonate: Use (3)

A

Osteoporosis
Hypercalcemia
Paget’s disease of bone

23
Q

Bisphosphonate: Side effects (2)

A
Osteonecrosis of the jaw (serious dental work)
Corrosive esophagitis (take while sitting up)

Not for patients with achalasia

24
Q

Allopurinol: Mechnanism

A

Inhibits xanthine oxidase

Decrease conversion of xanthine to uric acid

25
Allopurinol: Use (2)
Gout | Lymphoma and leukemia to prevent tumor lysis associated urate nephropathy
26
Allopurinol increases what drug levels?
Azathioprine and 6-MP (both metabolized by xanthine oxidase)
27
Rasburicase: Mechanism
Urate oxidase to prevent uric acid stones
28
Febuxostat: Mechanism
Inhibits xanthine oxidase
29
Febuxostat: Use
Gout
30
Probenecid: Mechanism
Inhibits reabsorption of uric acid in PCT | Also inhibits secretion of penicillin
31
Colchicine: Mechanism
Binds and stabilizes tubulin to inhibit polymerization, impairing leukocyte chemotaxis and degranulation
32
Colchicine: Side effects
GI
33
When to use glucocorticoids for gout?
First line for renal failure patients
34
When to use colchicine for acute gout attacks?
when NSAIDS are contraindicated
35
Etanercept: Mechanism
``` Fusion protein (receptor for TNFA alpha and IgG1 Fc) TNF decoy receptor ```
36
Etanercept: Use (3)
RA Psoriasis Ankylosing spondylitis
37
Infliximab: Mechanism
Anti-TNF-alpha monoclonal antibody
38
Adalimumab: Mechanism
Anti-TNF-alpha monoclonal antibody
39
Anti-TNF-alpha MAB: Use (4)
Crohn's disease RA Ankylosing spondylitis Psoriasis
40
Anti-TNF-alpha MAB: Side effect
Predispose to reactivation of latent TB | TNF blockage prevents activation of macrophages and destruction of phagocytosed microbes