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Pharm Exam 4 > NSAIDS and Gout Treatment > Flashcards

NSAIDS and Gout Treatment Flashcards

1
Q

Salicylate drugs:

A

aspirin

salicylic acid

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2
Q

Non-specific NSAID drugs:

A

HIT BOTH COX1 and 2

  • *aspirin
  • *ibuprofen -
  • *indomethacin - gout
  • *ketorolac
  • *naproxen
  • *oxaprozin
  • *piroxicam
  • *sulindac
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3
Q

COX2 Inh drugs:

A

CeleCOXIB
EtorlCOXIB
Meloxicam

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4
Q

Analgesic/Antipyretic (not anti-inflammatory) drugs:

A

acetaminophen

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5
Q

Acute gout Tx drugs:

A
  • NSAIDS=Indomethacin - primary for severe

- Colchicine

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6
Q

Gout prophylaxis drugs (lower uric acid levels):

A

1) xanthine oxidase inh (des UA production:
- allopurinol
- febuxostat
2) uricosuric drugs (inc renal excretion of UA):
- probenecid
- sulfinpyrazone

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7
Q

Classic inflammatory symptoms:

A

1) redness
2) swelling
3) heat
4) pain

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8
Q

Molecular inflammatory mediators:

A

1) kinins- BRADYKININ
2) neuropeptides- Substance P
3) vasoactive amines- Histamine & 5-HT
4) Arachidonic acid metabolites
- COX (prostaglandin, tromboxanes, prostacyclin)
5) Cytokines- TNF-alpha

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9
Q
  • ACETAMINOPHEN IS NOT AN NSAID! –> NO ANTI-INFLAMMATORY PROPERTIES!
  • ONLY HAS ANALGESIC AND ANTIPYRETIC PROPERTIES
A
  • ACETAMINOPHEN IS NOT AN NSAID! –> NO ANTI-INFLAMMATORY PROPERTIES!
  • ONLY HAS ANALGESIC AND ANTIPYRETIC PROPERTIES
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10
Q

NSAIDs - Functional Characteristics:

A
  • analgesia
  • antipyretic
  • anti-inflammatory
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11
Q

NSAIDs -Primary target/MOA:

A

Dec prostaglandin production by inh COX1 and COX2

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12
Q

Products of arachodonic acid pathway that mediate inflammation & immunity?

A

PGE2 and PGI2 ==> Inc edema and vascular permeability

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13
Q

COX1:

A

always expressed and widely distributed–>keeping everything in check …such as in the stomach to protect mucosa via Prostaglandin production
–»PROTECTIVE!!!!

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14
Q

COX2:

A
  • INDUCIBLE –> PRODUCTION OF INFLAMMATORY MOLECULES

- essential for kidney function

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15
Q

Leukotrienes primarily affect:

A

airways = inflammation = asthma and allergic rhinitis

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16
Q

NSAID uses:

A 
pain (analgesic)
fever (antipyretic
inflammation (arthritis)
-antithrombotic
-->>bnch of other stuff
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17
Q

Original NSAID - prototype:

A

aspirin

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18
Q

Aspirin

-Pharmacokinetics:

A
  • significant amount is hydrolyzed to salicylic acid (reversible COX inh) in the blood
  • dose dependent uses (low=fever/pain and high=antiinflammatory)
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19
Q

Aspirin - why potential for drug interactions?

A

80% bound to plasma proteins

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20
Q

Low dose aspirin effects:

elimination?

A
  • analgesic & antipyretic

- first order

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21
Q

High dose aspirin effects:

elimination?

A

Anti-inflammatory

-zero order

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22
Q

Aspirin works on primarily which enzyme?

A

COX2

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23
Q

Aspirin

-Antipyretic effect MOA?

A
  • Inh of PGE2 via COX in the hypothalamus ==> resent temperature control
  • drop in temperature causes dilation of superficial blood vessel + profuse sweating
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24
Q

Aspirin

-Anti-inflammatory MOA?

A

-inhibit COX2 –> no PG synthesis

== inh inflammatory cell migration

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25
Aspirin | -Analgesic effects MOA?
-inhibit COX2 --> no PG synthesis | ==> most effective for muscular, vascular or inflammatory conditions
26
ASpirin | -Anti-coag effect MOA?
- prolongs bleeding time - inh thromboxane synthesis via COX - irreversible inh of platelet COX1
27
ASpriin prophylactic for:
MI | coronary artery disease
28
Aspirin | -advrse effects:
- GI upset and ulcers due to COX1 inh-protective COX (related to dose and duration) - PGI2 and PGE2 decrease gastric acid secretion - platelet inhibiton = prolonged bleeding time - hepatitis - renal tox- dec kidney function - hypersensitivity-->pruritus - tinnitus - reyes syndrome - encephalopathy
29
Similarities and differences bw NSAIDs and non-specific NSAIDs:
Same: pretty much everything - anti-pyretic, inflammatory, analgesic, side effects, effect on platelets DIFFERENCE IS IN DURATION OF ACTION AND POTENCY
30
Which nonselective NSAID is popular for gout and ankylosing spondylitis?
indomethacin
31
COX2 selective inh were developed to:
not effect COX1 protective effect on GI but still have anlgesic, antipyretic, anti-inflammatory effects! -NO IMPACT ON PLATELET AGGREGATION
32
Rofecoxib adverse event:
-cardiovascular thrombotic events
33
Celecoxib-drug type?
-COX2 selective inh
34
Etoricoxib -drug type?
-COX2 selective inh
35
Meloxicam-drug type?
-COX2 selective inh
36
Synthetic DMARD (disease modifying anti-rheumatic drugs) -- LIST DRUGS:
- methotrexate - leflunomide - chloroqine - hydroxychloroquine
37
Biologic DMARD (disease modifying anti-rheumatic drugs) -- LIST DRUGS:
- etanercept - infliximab - anakinra
38
Betablockers - list drugs - for what?
- propranolol - metoprolol -for preventative migrane therapy
39
Antidepressants - list drugs - for what?
- amitriptyline | - for preventative migrane therapy
40
Anticonvulsants - list drugs - for what?
- divaproex (valproic acid) - topiramate -for preventative migrane therapy
41
Ergot Alkaloid - list drugs - for what?
- ergotamine - dihydroergotamine +derivs -for acute migrane attacks
42
Triptans - list drugs - for what?
- sumaTRIPTAN - zolmiTRIPTAN -for acute migrane attacks
43
Acetaminopen - use? - what population?
- pain reliever - fever reducer - NO ANTI INFLAMMATORY PROPERTIES -ESP IN CHILDREN AND THE OLD
44
Acetaminophen | -adverse effects:
1) liver toxicity at high doses a) Narrow therapeutic index = -15mg/kg=ok - 150mg/kg=centrilobular liver necrosis - 350mg/kg=liver failure
45
Acetaminophen interacts with what other major drug?
EtOH
46
Gout | -what is?
1) acute arthritis due to the deposit of monosodium urate (uric acid crystals) a) increased production - metabolic imbalance - diet intake of purine rich foods - inc tissue destruction b) decreased excretion by kidney 2) associated with hyperuricemia
47
Therapeutic goals for gout tx:
- stop gout attack - CONTROL PAIN AND INFLAMMATION - prevent future attacks
48
First line treatment for gout?
NSAID-->indomethacin | aspirin would NOT be used - causes renal retention of uric acid at low dose
49
Tx options for gout?
- NSAID - corticosteroids - if cant tolerate NSAID - intra-articular steroid injection-benefits one of2 large joints
50
Acute gout tx drug
Colchicine
51
Colchicine - uses? - MOA?
- reduces pain and inflammation of gout | - inh leukocyte migration and phagocytosis (inh microtubule aggregation)
52
Colchicine | -AE?
DIARRHEA!
53
Gout prophylaxis:
1) use xanthine oxidase inh drugs to prevent production of uric acid - --> febuxostat & allopurinol 2) inc renal excretion by blocking tubular reabsorption --> probenecid or sulfinpyrazone
54
Allopurinol - use? - type? - MOA?
- gout prophylaxis - xanthine oxidase inh - blocks conversion of xanthine to uric acid
55
Febuxostat - use? - type? - MOA?
-gout prophylaxis -new xanthine oxidase inh (more selective and well tolerated if cant use allopurinol) -blocks conversion of xanthine to uric acid
56
Probenecid/ Sulfinpyrazone - use? - type? - MOA? - AE?
- gout prophylaxis - uricosuric drug - inc renal clearance of uric acid by inh tubular absorption - kidny and GI stones - not for acute attacks
57
Stages of RA?
- initiation --> nonspecific inflammation - amplification --> t-cell activation - FINAL STAGE: CHRONIC INFLAMMATION AND TISSUE INJURY
58
First line tX for RA?
NSAIDs--> aspirin, acetominophen, indomethacin, ibuprophen, .... REDUCE INFLAMMATION AND PAIN
59
Tx options for RA?
1) NSAIDs-REDUCE INFLAMMATION AND PAIN (does not cahnge progression) 2) glucocorticoids-reduce inflammation and cause improvement (does not cahnge progression) 3) Disease modifying antirheumatic drugs (DMARDs) - reduce inflammation and slow bone damage == improve prognosis!
60
issue with DMARDs?
- SLow onset of therapeutic effects! could take 6weeks to 6months - more toxic!
61
First line DMARD for RA tx?
methotrexate
62
Methotrexate - drug type and what for? - MOA?
- SYNTHETIC DMARD for RA - inhibits AICAR transformylase --> inc extracellular adenosine and *inh T-cell activation*, cytotoxic to proliferating lymphocytes following antigen exposure FIRST LINE RA TX
63
Lefunomide - drug type and what for? - MOA?
- Synthetic DMARD for RA | - nih ribonucleotide synthesis and causes cell cycle arrest
64
Chloroquine and hydroxychloroquine - drug type and what for? - MOA?
- antimalarial drug for RA | - MOA UNK
65
first agent for RA for both symptomatic improvement and retardation of structural joint damage?
leflunomide -synth DMARD
66
Etanercept - drug type and what for? - MOA?
- Anti-TNF-alpha agent for RA | - cytokine receptor fusion protein -binds to receptor so TNF-a cant
67
Infliximab - drug type and what for? - MOA?
- Anti-TNF-alpha agent for RA - anti-TNF-alpha chimeric monoclonal antibody - binds TNF-a and marks it for destruction/elimination
68
Anakinra - drug type and what for? - MOA?
- IL1 inhibitor for RA | - IL1 cytokine receptor decoy - so IL1 cant bind
69
*Pathophys of migranes?
1) originates deep in brain 2) electrical impulse spread to other regions of brain 3) changes in nerve cell activity and blood flow = visual disturbance, numbness, tingling, dizziness 4) chemicals in brain cause blood vessel dilation and inflammation of surrounding tissue 5) inflammation irritates the trigeminal nerve = severe/throbbing pain
70
Migrane Tx - non-pharm? - pharmacological?
1) Avoid triggers=regular **SLEEP**/meals/exercise 2) a) preventative therapy - prevent frequency and severity b) acute migrane management - nonspecific pain meds = aspirin, acetaminophen, NSAIDs, opiates - speicific migrane drugs= ergotamine, dihydroergotamine, triptans
71
Specific migrane drugs:
ergotamine dihydroergotamine triptans
72
beta-blockers - what for? - drugs? - contraindication?
1) preventative therapy of migranes 2) propranolol (B1&2) metoprolol (B1) 3) not to be used in asthmatics
73
**tx of choice for migrane prevention?
metoprolol
74
Antidepressants - what for? - drugs? - AE?
- preventative therapy of migranes - amitriptyline - drowsiness
75
Anticonvulsants - what for - drugs?
- -preventative therapy of migranes - divalproex (varproic acid) - topiramate
76
- Acute tx of migriane attacks - non-specific - drugs: | - what should be avoided with these gys?
- aspirin - Naproxen (NSAID) - ibuprophen (NSAID) - acetaminophen -avoid OVERUSE ---> might transform migriane into a more severe chronic disorder
77
metoclopramide - what kind of drug? - what for? - how used to tx? - MOA?
- antiemetic - for acute migrane attacks * -adjunct therapy to combat nasuea and vomiting due to migraine or ergot alkaloid tx - central D2 antagonist - weak 5-HT3 antagonist
78
Chlorpormazine - what kind of drug? - what for? - how used to tx? - MOA?
- antiemetic - for acute migrane attacks * -adjunct therapy to combat nasuea and vomiting due to migraine or ergot alkaloid tx -central D2 antagonist
79
Prochlorperazine - what kind of drug? - what for? - how used to tx? - MOA?
- antiemetic - for acute migrane attacks * -adjunct therapy to combat nasuea and vomiting due to migraine or ergot alkaloid tx -central D2 antagonist
80
Ergotamine - what kind of drug? - what for? - MOA?
- migrane specific drug - ergot derivative - acute migrate attacks - VASOCONSTRICTION due to stimulation of alpha and 5-HT receptors VASODILATION IS THE PROBLEM
81
Dihydroergotamine + derivs - what kind of drug? - what for? - MOA?
- migrane specific drug - ergot derivative - acute migrate attacks - VASOCONSTRICTION due to stimulation of alpha and 5-HT receptors
82
Ergot derivative - pros/cons
Pros: effective, used for a long time, and low cost Cons: GI disturbance - complex pharmacology and kinetics - variable absorption, metabolism, and shit - inc risk of vascular effects due to vasoconstriction
83
SumaTRIPTAN - what kind of drug? - what for? - MOA?
1) migraine specific - Triptan drug 2) for acute migraine attacks 3) MOA: - selective 5-HT1D and 5-HT1B agonist = VASOCONSTRICTION - inh activation of trigeminal affarent nociceptors
84
triptan adv/disadv over ergots:
- selective pharmacology - established and safe - fewer adverse effects - expensive - cant use if cardiovascular disease
85
Triptans - safety?
- safe but 5HT1B constricts coronary arteries = anginal pain | - irritating adverse effects -- tingling, warm feeling, dizzy...
86
Triptans - contraindications:
-ischemic heart disease -HTN cerebrovascular disase

Pharm Exam 4 (10 decks)

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