Musculoskeletal & CT

Question 1

Aspirin

Answer 1

1) Use: Low dose (s syndrome in children with viral infections.
4) Fun Facts

Question 2

NSAIDs (Ibuprofen, naproxen, indomethacin, ketorolac)

Answer 2

1) Use: Antipyretic, analgesic, anti-inflammatory. Indomethacin is used to close a PDA.
2) Class/MOA: Reversibly inhibits cycooxygenase (both COX-1 and COX-2). Block prostaglandin synthesis.
3) Side effects/ADEs: Renal damage, fluid retention, aplastic anemia, GI distress, ulcers.
4) Fun Facts

Question 3

COX-2 Inhibitor (celecoxib)

Answer 3

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; spares COX-1, which maintains the gastric mucosa. Thus, should not have the corrosive effects of other NSAIDs on the GI lining.
3) Side effects/ADEs: Increased risk of thrombosis. Sulfa allergy. Less toxicity to GI mucosa (lower incidence of ulcers, bleeding than NSAIDs).
4) Fun Facts

Question 4

Acetaminophen

Answer 4

1) Use: Antipyretic, analgesic, but lacking anti-inflammatory properties. Used instead of aspirin to prevent Reye’s syndrome in children with viral infections.
2) Class/MOA: Reversibly inhibits cycooxygenase, mostly CNS. Inactivated peripherally.
3) Side effects/ADEs: Overdose produces hepatic necrosis, acetaminophen metabolite depletes glutathione and forms toxic tissue adducts in the liver. N-aceylcystine is antidote - regenerates glutathione.
4) Fun Facts

Question 5

Bisphosphonates (Etidronate, pmidronate, alendronate, risedronate, zoledronate (IV))

Answer 5

1) Use: Maligancy associated hypercalcemia, Paget’s diseases of the bone, postmenopausal osteoproposis.
2) Class/MOA: Inhibit osteoclastic activity; reduces both formation and resorption of hydroxyapatite.
3) Side effects/ADEs: Corrosive esophagitis (except zoledronate), nausea, diarrhea, osteonecrosis of the jaw.
4) Fun Facts

Question 6

Chronic Gout Drug (Probenecid)

Answer 6

1) Use: Chronic Gout (urate lowering therapy)
2) Class/MOA: Inhibits resorption of uric acid in the PCT (also inhibits secretion of penicillin)
3) Side effects/ADEs:
4) Fun Facts

Question 7

Chronic Gout Drug (Allopurinol)

Answer 7

1) Use: Chronic Gout (urate lowering therapy)
2) Class/MOA: Inhibits xanthine oxidase, decreases conversion of xanthine to uric acid. Also used in lymphoma and leukemia to prevent tumor lysis-associated urate nephropathy. Increases concentration of azathioprine and 6-MP (both normally metabolized by xanthine oxidase).
3) Side effects/ADEs: 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.
4) Fun Facts

Question 8

Chronic Gout Drug (Febuxostat)

Answer 8

1) Use: Chronic Gout (urate lowering therapy)
2) Class/MOA: Inhibits xanthine oxidase
3) Side effects/ADEs:
4) Fun Facts

Question 9

Acute Gout Drug (Colchicine)

Answer 9

1) Use: Acute Gout (urate lowering therapy)
2) Class/MOA: Binds and stabilizes tubulin to inhibit polymerization, impairing leukocyte chemotaxis and deregulation.
3) Side effects/ADEs: GI side effects, especially if given orally (note: Indomethacin is less toxic, also used in acute gout).
4) Fun Facts

Question 10

Acute Gout Drug (NSAIDs)

Answer 10

1) Use: Acute Gout (urate lowering therapy)
2) Class/MOA: Naproxen.
3) Side effects/ADEs:
4) Fun Facts

Question 11

The alpha inhibitors (Entanercept)

Answer 11

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 since TNF blockade prevents activation of macrophages and destruction of phagocytosed microbe.
4) Fun Facts: EntanerCEPT is a TNF decoy reCEPTor.

Question 12

The alpha inhibitors (Infliximab)

Answer 12

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 since TNF blockade prevents activation of macrophages and destruction of phagocytosed microbe.
4) Fun Facts INFLIimab INFLIX pain on TNF

Question 13

The alpha inhibitors (Adalimumab)

Answer 13

1) Use: Psoriasis, 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 since TNF blockade prevents activation of macrophages and destruction of phagocytosed microbe.
4) Fun Facts