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Pharmacotherapeutics > NSAIDs, RA & OA Management > Flashcards

NSAIDs, RA & OA Management Flashcards

1
Q

In order to be considered an NSAID, a drug must be able to…

A

Decrease inflammation
Relieve mild-moderate pain
Reduce fever
Decrease risk of blood clotting (inhibit platelet aggregation)

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2
Q

Is acetaminophen an NSAID?

A

NO! It does NOT have anti-inflammatory properties or anticoagulant properties

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3
Q

How do NSAIDs work?

A

Interfere with synthesis of prostaglandins (increase in the presence of inflammation, pain & fever) by inhibiting the COX enzyme

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4
Q

COX-1 vs COX-2

A

Cox-1 produces prostaglandins that regulate normal cell activity and maintain cell homeostasis. Beneficial prostaglandin creation

Cox-2 enzyme is produced in injured cells and create harmful prostaglandins

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5
Q

Inhibiting which COX enzyme is the best clinically?

A

COX-2 - Inhibit COX-2 to decrease pain/inflammation and spare COX-1

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6
Q

Are Aspirin & traditional NSAIDs selective?

A

No, they are not selective in COX inhibition

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7
Q

Benefits of Aspirin (Acetylsalicyclic acid)

A

Manage pain in musculoskeletal and joint disorders, s/p surgery pain, prevention of clots, treatment of adult fever, and some cancer prevention (prevent tumor growth)

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8
Q

Side Effects of NSAIDs

A

Gastrointestinal damage (hemorrhage, ulceration)
Cardiovascular (decreased platelets, increased BP)
Impaired hepatic & kidney function
Aspirin intoxication/poisoning
Reye Syndrome
Inhibition of bone healing

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9
Q

What population will Aspirin cause kidney impairments in?

A

Those with already impaired kidney function, diabetes mellitus, heart failure or those with decreased body water

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10
Q

Signs of Aspirin Intoxication/Poisoning

A

Headache, tinnitus, difficulty hearing, confusion, GI distress, and metabolic acidosis

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11
Q

What is Reye syndrome?

A

Occurs in children/teenagers that take aspirin. Signs include high fever, vomiting, liver dysfunction, increased unresponsiveness, delirium, coma and even death

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12
Q

COX-2 Selective Drugs

A

Celebrex - Less gastric irritation but increased respiratory tract infections and risk of heart attack/stroke

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13
Q

What is Acetaminophen?

A

Tylenol
Equal to NSAIDs in terms of pain relief/fever reduction in children/teens
No upper GI irritation
Used for treating non-inflammatory conditions with mild-moderate pain
Used in early stages of OA

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14
Q

Mechanism of Action - Acetaminophen

A

Inhibit COX enzyme

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15
Q

What is the toxic level of Acetaminophen for the liver?

A

15 g - Can be fatal

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16
Q

What are the two main goals of RA treatment?

A

Decrease joint inflammation & stop the progression of the disease

17
Q

What are the three categories of drugs for RA?

A
  1. NSAIDs
  2. Glucocorticoids
  3. Disease-Modifying Antirheumatic Drugs (DMARDs)
18
Q

Glucocorticoids (Corticosteroids)

A

Provide symptomatic relief by decreasing joint inflammation and pain. Effective anti-inflammatory agents. Early use can decrease joint erosion and slow progression of RA
Example: Prednisone

19
Q

How are Glucocorticoids administered?

A

2-3 injections per joint per year
Used for acute flare-ups or exacerbations

20
Q

Mechanism of Action - Glucocorticoids

A

Bind to receptor in cytoplasm of certain cells and form glucocorticoid-receptor complex. This complex moves and binds to genes that regulate inflammatory process - Inhibits production of inflammatory substances

21
Q

Adverse effects of Glucocorticoids

A

Osteoporosis
Muscle wasting/weakness
HTN
Aggravation of DM
Glaucoma
Cataracts
Increased risk of infection

22
Q

DMARDs

A

Slow or halt the progression of RA in early stages
Promote remission before joints become too damaged

23
Q

Types of DMARDs (5)

A
  1. Antimalarials
  2. Gold Compounds
  3. Nonbiological DMARDs
  4. Biological DMARDs (TNF)
  5. Others
24
Q

Antimalarials

A

Non-biological traditional DMARD
Affect immune cell responses
Very safe compared to other DMARDs - Can cause irreversible retinal damage, HA, GI distress though
Example: Hydroxychloroquine

25
Q

Gold Therapy

A

Cease progression of RA disease by binding to enzymes in immune cells that suppress ability for autoimmune responses

Side effects: GI distress, oral mucosa irritation, rashes/itchy skin, proteinuria, conjunctivitis, thrombocytopenia, leukopenia

26
Q

What is Methotrexate used for?

A

Treatment of cancer and RA
Rapid onset (2-3 weeks)

Side effects: TOXICITY, Gi issues, pulmonary problems, hematological disorders, liver dysfunction, hair loss

27
Q

Tumor Necrosis Factor Inhibitors

A

Inhibits the erosion and inflammation of joints
Good for initial stages of RA
Side effects: URI, sepsis, malignancy, liver disease, heart failure, lupus-like disease, demyelinating diseases

28
Q

TNF inhibitors are contraindicated in…

A

People who have infections

29
Q

Which drug is considered the cornerstone drug for RA?

A

Methotrexate - Other DMARDs are added to this (TNF-a) for optimal benefits

30
Q

Relationship between RA and Diet

A

Good - Diets high in fish oil & omega-3 fatty acids
Bad - Diets high in meat & protein

31
Q

What should the primary focus for OA be?

A

Nonpharmacological intervention - PT, weight loss, joint replacement

32
Q

What is the goal of OA drug treatment?

A

Manage pain & maintain active lifestyle

33
Q

Types of OA medications

A

Acetaminophen, NSAIDs, Disease-modifying OA drugs (DMOADs)

34
Q

What is the first drug of choice for OA?

A

Acetaminophen

35
Q

Example of Viscosupplementation for OA

A

Hyaluronan (Hyaluronic Acid) - 3-5 injections that last 6 mo -1 year

Restore lubricating properties of synovial fluid and limit joint destruction. Improves pain and function as well

36
Q

Dietary supplements for OA treatment

A

Glucosamine & Chondroitin Sulfate (supplements)
Protect articular cartilage or reverse joint deterioration
Key ingredients for the production of synovial fluid/cartilage

37
Q

Rehab Implications for RA

A

Monitor for skin breakdown and damaged bone, tendon, or muscle - Focus on ROM and strengthening to prevent injury/fractures
Infection control is essential with DMARDs

Pharmacotherapeutics (13 decks)

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