Pharma in rheumatic disease Flashcards
2 mechs in NSAIDs
COX-1 - prostaglandins for mucosal protection - thromboxane for hemostatis COX-2 - prostaglndins for pain and inflammation
4 As of NSAID effects
Anti-inflamm
Analgesic
Antipyretic
Antiplatelet
5 things that differentaite NSAIDs
- cost - COX2 is expensive
- antiplatelet effect - ASA more than others
- Duration of action
- Route - most oral
- GI tolerance - unpredicatable
6 adverse effects of all NSAIDs
- bleeds - ASA most
- interference with renal funct
- Na retention
- dyspep and ulceration
- inhib. uterine motility
- allergic hypersens. reactions
def. NSAID gastropathy
endoscopic erosions in 20-40% of ppl
presentation of gastropathy
- none for most
- dyspepsia
- bleeds
- ulcer complications
5 risk factors for dev. of gastropath
- > 60
- Hx of ulcer
- use of glucocorticoids
- high dose/ multi NSAIDs
- anticoag use
3 ways to help prevent
- rational drug choice
- try others or COX2 - acid supression
- prostagandin E1 analog
- misoprostol
5 rheum uses of NSAIDs
- acute crystalline
- acute.subacute polyarth
- alternative analgesic for non-inflammatory
- adjunct to DMARD in RA, SpA
- first line mgmt in axial SpA
adv. of glucocoorticoids
cheap and powerful
3 general mechs. of glucocort
- non-genomic activation
- DNA-dep regulation
- protein interference mechs.
3 effects of glucocort.
- inhib. leukocyte access to inflammed tissue
- interfere with cell processes involved in inflammation
- supress the production of humoral factors involved in inflamm. (cytokines etc.)
4 acute SE of glucos
- infection
- avasc. necrosis
- steroid psychosis
- steroid myopathy
what is effect on osteoporosis
- increase rate of bone loss
- effects are dose dependent
2 preps of glucos
oral - prednisone
IV
- doses based on prednisone and need to be adjusted
4 steroid sparing drugs
(all immunosuppressive)
- azathioprine
- methotrexate
- mycophenolate
- cyclophosphamide
2 general goals of gout treatment
- treat acute flares
2. prevent recurrent disease
how to reduce gout inflamm
- NSAIDS
- local injections
- RICE
specific drug for gout flares
colchicine - dirputs chemotaxis + phag of urate by neutrophils
cautions for colchicine
- toxicities
2. not well eliminated in people with renal disease
when to use
within 24 hours of attack
3 ways to prevent gout
- diet - esp alc
- avoid drugs that increase (ASA, diuetics)
- urate lowering therapy
2 types of urate lowering therapy
- increase excretion of uric acid
2. block xanthine oxidase (allopurinol)
SE of allopurinol
- flare of gout
- rash
- interstitial nephritis
