RA and Gout Flashcards
How do side effects of nonselective and cox-2 selective NSAIDs differ?
Nonselective: GI effects, edema, acute renal failure
Selective: increased activation of platelets
How does methotrexate treat rheumatoid disease?
Folate antagonist that interferes with thymidylate synthesis
What side effects exist for methotrexate use?
Bone marrow depression (causing anemia)
GI disturbances
Dose-related liver toxicity
Pneumonitis
How does sulfasalazine treat rheumatoid disease?
Salicylic acid moiety is released in the colon and absorbed, which has anti-inflammatory effects
What side effects are there for sulfasalazine treatment?
Nausea
Vomiting
Headaches
Rashes
Many patients discontinue use due to prevalence of effects
How does leflunomide treat rheumatoid disease?
Inhibition of dihydroorotate dehydrogenase, resulting in inhibition of T-cell proliferation and production of autoantibodies by B cells
What side effects are associated with leflunomide use?
Diarrhea (25% of patients)
Increased blood pressure
Weight gain
How do tofacitinib and baricitinib treat rheumatoid disease?
Inhibition of JAK
Apremilast is used to treaet what condition?
Psoriatic arthritis
How does apremilast work against rheumatoid disease?
Inhibition of PDE4 and spontaneous production of TNF-alpha from human rheumatoid synovial cells
What conditions are infliximab and adalimumab used to treat?
When other therapy hasn’t worked:
Rheumatoid arthritis (with methotrexate)
Ankylosing spondylitis
Psoriatic arthritis
What side effects are associated with infliximab and adalimumab use?
Nausea
Vomiting
Headache
Upper respiratory tract infections with cough
What is colchicine used to treat?
Gout
How does colchicine work?
Inhibition of proinflammatory mechanisms and increasing levels of anti-inflammatory mediators, specifically inhibition of microtubule polymerization by binding tubulin
What are some complications with colchicine?
Cannot be used in patients with renal failure
Narrow therapeutic window
What side effects are seen with colchicine?
Diarrhea (virtually guaranteed)
Bone marrow suppression
Myopathy
Neuropathy
How do probenecid and sulfinpyrazone work to treat gout?
Medication is reabsorbed by the proximal tubule instead of uric acid
What contraindications exist for treatment using probenecid/sulfinpyrazone?
Renal insufficiency
Urolithiasis
Peptic ulcers
What side effects can be seen when using probenecid/sulfinpyrazone?
Mild GI upset
Allergic reactions (2-4% of patients)
How do allopurinol and febuxostat work to treat gout?
Inhibition of xanthine oxidase, which creates uric acid
What side effects are seen with allopurinol treatment?
Skin reactions
Epidermal necrolysis or Stevens-Johnson syndrome (rare)
Liver reactions
Renal insufficiency
What side effects are seen with febuxostat treatment?
Increased risk of MI, stroke, and cardiovascular death
