1. 1st line: Osteoarthritis 2. Better than analgesic 3. Even @ high doses

1. Analgesic 2. Antipyretic 3. Anti-inflammatory

Rheumatologic Drugs Flashcards by Mark Agustin

Increase in uric acid (product in purine metabolism) and inflammation of joints

Gouty Arthritis

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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

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What disease is stated below:

▪️non-inflammatory: No Rubor & Calor
▪️morning joint stiffness (5 mins.)

Osteoarthritis (OA)

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Drugs for Rheumatics

Analgesic
DMARDs
Glucocorticoids
Antigout Agents

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1st line: Osteoarthritis
Better than analgesic
Even @ high doses

Analgesic
Antipyretic
Anti-inflammatory

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What is the Uric Acid level for Gouty Arthritis

M:
F:

M: > 7 mg/dL
F: > 6 mg/dL

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What treatment is given for acute gouty arthritis if:

▪️If unable to tolerate NSAIDs
▪️If pain is severe
▪️Short course only

Glucocorticoids

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What Disease is stated below:

▪️ASA + child w/ viral infection
▪️Fatal: hepatic failure encephalopathy

Reye’s Syndrome

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▪️Power anti-inflammatory and analgesic
▪️Withdrawn due to T/E

Pyralazone derivatives
(Phenylbutazone, Dipyrone, Oxyphenbutazone)

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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

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What drug is it:

▪️Propionic Acid Derivatives
▪️Anti-inflammatory, antipyretic, analgesic

Ibuprofen
Naproxen
Ketoprofen
Flubiprofen

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What drug is it:

Added antipyretic

Ibuprofen & Naproxen

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What drug is it:

Analgesic, Anti-inflammatory

Ibuprofen & Flubiprofen

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What drug is safest NSAID in children

Ibuprofen

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What drug is use for fever of malignancy

Naproxen - kapag yung lagnat gumaling lang sa Naproxen my cancer

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What drug is it:

Phenylacetic Derivatives

True Phenylacetates
- Sulindac (sulfonamide like), Alclofenac, Diclofenac
Acetic Acid Derivatives
- Ketorolac, Etidolac, Nabumetone (prod drug)

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What drug is it:

▪️Fenamates/Fenamic Acid Der.
▪️Used as analgesic only
▪️NOT given in children

Mefenamic Acid
- 250mg (OTC)
- 500mg (Rx)
Meclofenamic Acid

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What drug is it:

▪️Oxicam Derivatives
▪️Greates Risk: GI Effects
▪️longest t1/2 (half-life)
▪️Under Non-Selective NSAIDs

Piroxicam

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What drug is it:

▪️Selective NSAIDs
▪️COX-2 Inh.
▪️Highly Selective/ Specific

-coxib
Celecoxib, Etoricoxib, Rofecoxib

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What drug is it:

Papaver Somniferum

Morphine

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What drug is it:

Papaver bracteatum

Thebaine

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What are the 3 activation of opiod receptors (MKD)

Mu (u) - majority
Kappa (K) - additional analgesia in women
Delta (δ) - spinal analgesia

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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: 1. Mild Pain 2. Moderate 3. Severe

1. Tramadol 2. Codeine 3. 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: (?)

1. Aurothiomalate, Aurothioglucose 2. 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

1. Colchicine 2. NSAIDs (Indomethacin, Etoricoxib) 3. Glucocorticoids (use NMT 5 days)

Steps Tx. for Chronic Gout

1. Colchicine only (1st 2-3 weeks) 2. 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

1. Penicillamine 2. Sulfinpyrazone 3. Probenecid