Rheumatoid and Gout Flashcards
Indomethicin
Mech
Tx
Side eff
NSAID- reduce pain and inflammation
Tx: RA and gout symptoms
Gastric and duodenal ulcers
Naproxen (aleve)
Mech
Tx
Side eff
NSAID- reduce pain and inflammation
Tx: RA and gout symptoms
Gastric and duodenal ulcers
COX-2 Inhibitors
Mech
Tx
Side eff
Selective NSAID (asprin)
Tx: RA and gout symptoms
Fewer Gastric and duodenal ulcers than indomethicin and naproxen
Qinolones (Hydroxydcholoroquine)
Mech
Tx
Side eff
(Hyroxycholoroquine)
DMARD
Reduces T-Cell activation and chemotaxis
Tx: RA and SLE
Retinal damage, Hemolysis in G6PD defficient Pts
Glucocorticoids
Mech
Tx
Side eff
- Inhibit phospoholipase A2 (inhibition of Arachadonic acid release and thus, prostaglandin formation)
- Inhibit cytokine production (prevents COX-2 induction)
Tx: RA, Gout
Cushingoid symtoms
Sulfasalazine
Mech
Tx
Side eff
inhibit IL-1 and TNF-a release
Tx: RA
skin rashes and neutropenia
Methotrexate
Mech
Tx
Side eff
DMARD
(ChemoTheraputic Folate analog)
Inhibits AICAR transformylase and thymidilate synthetase, 2* effects on PMN chemotaxis
Causes adenosine accumulation, which inhibits inflammation
Tx: RA
Nausea, stomatitis, hepatotoxicity
Leflunomide
Mech
Tx
Side eff
DMARD
inhibits DHODH –> impaired T-cell response to stimuli
Tx: RA
diarrhea, heptotoxic
Etanercept
Mech
Tx
Side eff
Biologic response modifier
TNF-a receptors bound by Fc of Ig bind TNF-a
Blocks TNF-a Binding to TNF Receptors
Tx: RA
Infliximab
Mech
Tx
Side eff
Biologic response modifier
MAb against TNF-a
Blocks TNF-a Binding to TNF Receptors
Tx: RA
Ag response to Murine Ab
Adalimumab
Mech
Tx
Side eff
Biologic response modifier
human MAb against TNF-a
Blocks TNF-a Binding to TNF Receptors
Tx: RA
Not antiogenic like infliximab
Golimumab
Mech
Tx
Side eff
Biologic response modifier
Human MAb vs TNF-a
Blocks TNF-a Binding to TNF Receptors
Tx: RA
Certolizumab
Mech
Tx
Side eff
Biologic response modifier
Conjugated to PEG for increased T 1/2
Blocks TNF-a Binding to TNF Receptors
Tx: RA
Anakinra
Mech
Tx
Side eff
IL-1 Receptor antagonist
Tx: RA
short half life, daily high dose Tx
Infections
Tocilizumab
Mech
Tx
Side eff
IL-6 receptor
Tx: RA
Infections
Rituximab
Mech
Tx
Side eff
Anti-CD20 Mab
Reduces circulating B-cells
Tx: RA refractory to TNF-a inhibitors
infections, hypersensitivity rxns
Abatercept
Mech
Tx
Side eff
Inhibits T-cell activation
Induces T-cell apoptosis
Tx: RA refractory to TNF-a inhibitors
Infections and headaches
Colchicine
Mech
Tx
Side eff
Inhibits microtubule depolymerization, thus inhibiting leukocyte migration, phagocytosis, and cytokine release (like vinca alkyloids vincristine and vinblastine)
Tx: pain and inflammation of acute gouty arthritis
diarrhea due to inhibited epitheilial cell proliferation
perihperal neuropathy
Low Theraputic Index
Probenecid
Mech
Tx
Side eff
increases excretion of urate in the proximal tubule
Tx: Chronic gout
inhibits excretion of weak acid drugs (eg penicillin)
Allopurinol
Mech
Tx
Side eff
Suicide inhibitor of Xanthine Oxidase
–> inhibition of purine synthesis
Tx: Chronic Gout
prevents hydrolysis of 6-MP, increasing T1/2
Febuxostat
Mech
Tx
Side eff
Non-purin, non-competitive XO inhibitor
Tx: Chronic Gout
Nausea, rash, arthralgias
Expensive
Pegloticase
Mech
Tx
Side eff
stabilized uricase
converts uric acid to allantoin
Tx: Chronic gout