Rheumatology Flashcards
CNS toxicity
- Elderly at increased risk
- Headaches
- Drowsiness
- Dizziness
- Tinnitus
- Aseptic meningitis (seen in lupus with ibuprofen) Seen with naproxen, tolmetin, rofecoxib, sulindac.
NSAID photosensitivity
Common with naproxen, piroxicam, and ketoprofen
- Phototoxic reactions vs. photo allergic reactions
- Reported with All NSAIDS
NSAID dermatological reactions
- Urticaria
- Rashes
- Serious dermatologic reactions
- Benoxaprofen – withdrawn from the market
- Valdecoxib – withdrawn from the market
NSAID drug interactions
-Warfarin - increased bleeding
effects on platelets and gastric mucosa
hypoprothrombinemia
-Beta-blockers - loss of blood pressure control due to prostaglandin synthesis inhibition
monitor BP for dosage adjustment
-Loop diuretics - decreased sodium excretion, urine volume, increased BP due to prostaglandin synthesis inhibition
-Cyclosporine - renal impairment, thought to be related to renal prostaglandin synthesis inhibition
-SSRIS and SNRIs
-Lithium
-Methotrexate
-Salicylates
-Celecoxib (fluconazole can double celecoxib levels).
Corticosteroid mechanism of action
- inhibit the release of arachidonic acid from lipids by phospholipase
- immunosuprresive
- anti-inflammatory (RA)
Indications for oral corticosteroids
- Short term use
- Acute flares that are not responsive to other treatments.
- Progressive RA not responsive to DMARD drugs.
- elderly who cannot undergo aggressive tx. and intolerant to NSAIDs
- maintain lowest dose possible.
indications for intra-articular corticosteroids
- provide pain relief in single joints with significant inflamm. destruction
- adjunctive therapy for 1 or 2 joints not responsive to systemic treatment.
- pt’s intolerant or resistant to systemic therapy
- facilitate mobility
- bridging therapy for delayed onset drugs.
Dose of intra-articular corticosteroids
Dependent on the size of the joint.
Risks of intra-articular injection
- Infection
- Post-injection flares
- Avascular necrosis
- Cartilage damage
- Overuse of joint due to relief of pain
Rheumatoid arthritis
- Chronic dx of unknown etiology
- Inflammatory arthritis of the peripheral synovial joints
- Female:male 2-3:1
female: male ratio equalizes with age.
Etiology of RA
- Abnormality of immunoregulartory cells
- Genetic predisposition and environmental factors
Sequence of environmental factors in RA
Initiating agent activates immune response in a susceptible host of appropriate genetic makeup, resulting in inflamm. and destruction of joints.
Pharmacologic management of RA
- Higher doses of NSAIDs or salicylate
- Add DMARDs for moderate-severe active RA
- methotrexate is 1st choice
- TNF blockers, abatacept, tocilizumab, rituximab, tofactinib
almost all DMARDs are potent _______
immunosuppressants
-CBC monitoring required
ex- antimalarials & minocycline.
Infection Risk of DMARDs
- Limit exposure to sick people
- TB testing prior to biologic DMARDs
- Hep B/C infection status if risk factors present.
- Herpes zoster
