RA and Gout Flashcards
Drugs used for initial treatment of RA
NSAIDs
need high doses- more SE- kidney + stomach
Used to slow the progression of RA
DMARDs
Type of NSAID used for RA
Celecoxib- COX2 inhibitor
Methotrexate
MTX
#1 DMARD small, daily doses for RA large, cyclic doses for cancer
MOA of Methotrexate (MTX)
inhibits dihydrofolate reductase, so dihydrofolate is not converted to tetrafolate
cells cannot make DNA
SE of Methotrexate (MTX)
hepatotoxicity with long term use
Hydroxychloroquine
Plaquenil
backup to MTX for initial RA treatment
SE of Hydroxychloroquine
cinchonism
accommodation defects, corneal deposits, blurred vision, scotomas, night blindness
Sulfasalazine MOA
prodrug- 5-ASA-SP broken up by gut bacteria
SP treats RA
ASA for Crohn’s / ulcerative colitits
Sulfasalazine
backup to MTX for initial RA treatment
SE of Sulfasalazine
nausea, vomiting, diarrhea
Tofacitinib
used for severe RA when MTX has failed
MOA of Tofacitinib
JAK inhibitor- stops inflammatory cytokine activity
Infliximab and Adalimumab
for severe RA when MTX has failed
MOA of Infliximab and Adalimumab
anti-TNF antibody drugs
SE of Infliximab and Adalimumab and Tofacitinib
suppresses immune system so must test for TB before use
Used for acute Gout attacks
NSAIDs
Types of NSAIDs used for Gout
Indomethacin #1
naproxen
Corticosteroids
for short term acute gout
Colchicine MOA
binds to tubulin and blocks microtubular polymerization
treat gout attacks
Allopurinol and Febuxostat MOA
inhibits xanthine oxidase- decreases uric acid production
Drug interactions of Allopurinol
blocks metabolism of 6-mercaptopurine (cancer drug) which increases toxicity of 6-MP
Probenecid MOA
inhibit proximal tubular reabsorption of uric acid- more uric acid excreted
SE of Probenecid
renal stones
Pegloticase MOA
is a urate oxidase enzyme- metabolizes uric acid into allantoin- easily excreted
SE of Pegloticase
given IV over 2 hours
pretreat with antihistamines and corticosteroids to avoid histamine reaction
