Rheumatologic Drugs Flashcards
Increase in uric acid (product in purine metabolism) and inflammation of joints
Gouty Arthritis
Inflammation (Cardinal Signs)
1. Rubor -
2. Calor -
3. Tumor -
4. Dolor -
5. Functio laesa -
- Rubor - Redness
- Calor - Heat
- Tumor - Swelling
- Dolor - Pain
- Functio laesa - loss of function
What disease is stated below:
▪️non-inflammatory: No Rubor & Calor
▪️morning joint stiffness (5 mins.)
Osteoarthritis (OA)
Drugs for Rheumatics
Analgesic
DMARDs
Glucocorticoids
Antigout Agents
- 1st line: Osteoarthritis
- Better than analgesic
- Even @ high doses
- Analgesic
- Antipyretic
- Anti-inflammatory
What is the Uric Acid level for Gouty Arthritis
M:
F:
M: > 7 mg/dL
F: > 6 mg/dL
What treatment is given for acute gouty arthritis if:
▪️If unable to tolerate NSAIDs
▪️If pain is severe
▪️Short course only
Glucocorticoids
What Disease is stated below:
▪️ASA + child w/ viral infection
▪️Fatal: hepatic failure encephalopathy
Reye’s Syndrome
▪️Power anti-inflammatory and analgesic
▪️Withdrawn due to T/E
Pyralazone derivatives
(Phenylbutazone, Dipyrone, Oxyphenbutazone)
What drug is it:
▪️Indole Derivatives
▪️(-) COX ↓ PG=closes the ductus arteriosis
▪️Mgt. of Patent Ductus Arteriosis
▪️Tx. pain in acute gout, mgt. of Bartter’s Syndrome
Indomethacin
What drug is it:
▪️Propionic Acid Derivatives
▪️Anti-inflammatory, antipyretic, analgesic
Ibuprofen
Naproxen
Ketoprofen
Flubiprofen
What drug is it:
Added antipyretic
Ibuprofen & Naproxen
What drug is it:
Analgesic, Anti-inflammatory
Ibuprofen & Flubiprofen
What drug is safest NSAID in children
Ibuprofen
What drug is use for fever of malignancy
Naproxen - kapag yung lagnat gumaling lang sa Naproxen my cancer
What drug is it:
Phenylacetic Derivatives
- True Phenylacetates
- Sulindac (sulfonamide like), Alclofenac, Diclofenac - Acetic Acid Derivatives
- Ketorolac, Etidolac, Nabumetone (prod drug)
What drug is it:
▪️Fenamates/Fenamic Acid Der.
▪️Used as analgesic only
▪️NOT given in children
Mefenamic Acid
- 250mg (OTC)
- 500mg (Rx)
Meclofenamic Acid
What drug is it:
▪️Oxicam Derivatives
▪️Greates Risk: GI Effects
▪️longest t1/2 (half-life)
▪️Under Non-Selective NSAIDs
Piroxicam
What drug is it:
▪️Selective NSAIDs
▪️COX-2 Inh.
▪️Highly Selective/ Specific
-coxib
Celecoxib, Etoricoxib, Rofecoxib
What drug is it:
Papaver Somniferum
Morphine
What drug is it:
Papaver bracteatum
Thebaine
What are the 3 activation of opiod receptors (MKD)
- Mu (u) - majority
- Kappa (K) - additional analgesia in women
- Delta (δ) - spinal analgesia
What drug is stated below:
Use: Tx of pain (visceral pain)
Narcotics (such as Morphine, Thebain)
What drug is used for the ff:
- Somatic pain
- Visceral pain (laman loob)
- NSAIDs
- Narcotics
What drug used for Visceral Pain Types:
- Mild Pain
- Moderate
- Severe
- Tramadol
- Codeine
- Morphine & Friends
What drug is it:
Mgt. of Acute Pulmonary Edema
Morphine
What drug is it:
▪️Anesthetic adjuncts
▪️General Anesthesia
IV: Fentanyl
What drug is it:
Derivative of Codeine
Tramadol
What type of Opiates is stated below:
Reference Standard: Analgesic
Morphine
What type of Opiates is stated below:
▪️Reference Standard: Antitussive
▪️Less efficacy vs Morphine
Codeine
What type of Opiates is stated below:
Precursor in the synthesis of Naloxone
Thebaine
What type of Opiods-Semi-synthesis is stated below:
▪️Diacetylmorphine/Diamorphine
▪️Equal efficacy vs Morphine
▪️Drug of abuse
Heroin
What type of Opiods-Semi-synthesis is stated below:
▪️Not analgesic (no affinity at u)
▪️D2 agonist reuptake Inh.
▪️↑DA=Mgt. of Parkinsonism
Apomorphine
What drug is it:
▪️Opiods: Synthetic
▪️Same efficacy w/Morphine
▪️Good oral BA & longer DOA=Less rapid dvplmt. of tolerance
▪️Use: To wean off Morphine/Heroin addicts
Methadone
What drug is it:
Use: To wean off Morphine/Heroin addicts
Methadone
What drug is it:
▪️Opiods: Synthetic
▪️5-7x more potent than Morphine
▪️D-isomer: Dextromethorphan-antitussive
Levorphanol
What drug is it:
▪️Opiods: Synthetic
▪️Partial Kappa agonist
Pentazocine
Full Antagonists: Antidotes for Narcotic Poisoning
Naloxone
Naltrexone
Nalorphine
Nalmefene
Levallorphan
Nal-
DMARDs (Non-Biological)
▪️1st line DMARD
▪️MOA: (-) ALCAR transformylace & Thimidylate synthase
▪️Use: For CA (100mg/day) For RA (7.5-20mg)
Methotrexate (MTX)
What is the Rescue Drug for Methotrexate T/E Hepatotoxicity (dose-dependent)
Folinic Acid (Leucovorin)
DMARDs (Non-Biological)
▪️2nd line DMARDs
▪️MOA: (-) T cell response to mitogens chemotaxis DNA & RNA synthesis
Chloroquine
Hydroxychloroquine (Plaquenil)
DMARDs (Non-Biological)
▪️prodrug -> A77-1726 (active)
Leflunomide
DMARDs (Non-Biological)
▪️Gold cmpds.
1. Parenteral: (?)
2. Oral: (?)
- Aurothiomalate, Aurothioglucose
- Auranofin
DMARDs (Biologicals)
What drug is it:
Target: T cell activation Inh.
Abatacept
DMARDs (Biologicals)
What drug is it:
Target: B cell Depeleting Agent
Rituximab
DMARDs (Biologicals)
What drug is it:
Target: IL-6 Inh.
Tocilizumab
DMARDs (Biologicals)
What drug is it:
Target: IL-1 neutralizing Inh.
Anakinra
DMARDs (Biologicals)
What drug is it:
Target: TNF-alpha Inh.
Adalimumab
Infliximab
Etanercept
What drug is it:
▪️Glucocorticoids
▪️For life-threatening SLE
▪️BN: Solu-Medrol
Methylprednisone IV
Antigout Agents
What drug is it:
▪️ MOA: (-) tubulin polymerization, target microtubules
▪️1st line: Acute Gout
▪️T/E: Watery Diarrhea, Bloody Biarrhea
Colchicine
What type of Gouty Arthritis is stated below:
▪️Big Toe is affected: Podagra of Gout
Acute Gout
What type of Gouty Arthritis is stated below:
▪️Gouty Neuropathy
▪️Chronic Tophaceous Gout= inflammatory bumps, SQ deposits of MSU crystals
Chronic Gout
Drugs in Acute Gout
- Colchicine
- NSAIDs (Indomethacin, Etoricoxib)
- Glucocorticoids (use NMT 5 days)
Steps Tx. for Chronic Gout
- Colchicine only (1st 2-3 weeks)
- Colchicine + Hypouricemic Agents - xanthine oxidase inh.
What drug is it:
▪️MOA: (-) xanthine oxidase
▪️1st line: Chronic tophaceous Gout
▪️Purine analogue
▪️Irreversible
Allopurinol
What drug is it:
▪️MOA: (-) xanthine oxidase
▪️Non-Purine
▪️Alternative
Febuxostat
What drug is it:
▪️MOA: enhance urine excretion of UA
▪️Uricosuric Agent
- Penicillamine
- Sulfinpyrazone
- Probenecid