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3rd Semester Final > Rheumatology Pharmacotherapy Lecture PDF > Flashcards

Rheumatology Pharmacotherapy Lecture PDF Flashcards

1
Q

Acetaminophen function

A

Analgesic and antipirectic, does not possess anti-inflammatory activity (not an NSAID)

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2
Q

NSAIDs, Aspirin, and acetaminophen mech of action

A

-prostaglandin synthesis inhibitors by blocking COX 1 and/or 2 (1 helps with GI protection, platelet function, and kidney function while 2 is associated with inflammation, pain, and fever)

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3
Q

3 major actions of NSAIDS including ASA are….

A
  • anti-inflammation (
  • analgesia (raise threshold)
  • antipyretic (activation of macrophages that then release interleukins 1 and 2 which are pyrogens)
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4
Q

Methyl salicylate function (oil of wintergreen, bengay)

A

Poison when taken orally but topical prep in creams is counterirritant often for muscle pain in athletes by increasing blood flow and warmth at applicaiton site

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5
Q

Other effects of NSAIDS including ASA (3)

A
  • platelet inhibition (thromboxane enhances platelet aggregation and aspirin irreversibly inhibits production inhibiting platelet aggregation at low consistent*** levels)
  • migraine induced headache prophylaxis
  • antidysmenorrheal effect
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6
Q

NSAIDs long term use ADR’s (6)

A
  • dyspepsia
  • epigastric pain
  • peptic ulceration
  • renal side effects including failure
  • respiratory acidosis at very high dose
  • increase risk of thrombotic events (opposite of aspirin)
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7
Q

Gastric damage by NSAIDs can be mitaged by administering a ____ alongside

A

proton pump inhibitor

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8
Q

In contrast to aspirin, nonaspirin NSAIDS do not protect against ____ and ____

A

MI and stroke

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9
Q

Aspirin triad

A

Aspirin hypersensitivity
Asthma
Nasal polyps

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10
Q

Reyes syndrome

A

Primary childhood disorder with death rate of 25%, develops after apperent recovery from flu or chicken pox chracterized by vomiting, liver abnormalities, and encephalopathy progressing to delirium and coma, often due to aspirin use

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11
Q

NSAID use and pregnancy

A

Not recommended especially during lat trimester to cause premature closure of ductus arteriosus

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12
Q

Symptoms of salicylism from excess aspirin use (4)

A
  • tinnitus
  • headache
  • delirium
  • hyperventilation
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13
Q

Acetaminophen (tylenol) toxicity

A

At very high levels leads to production of macromolecules that are very hepatotoxic when daily dose is exceeded or individual with hepatitis

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14
Q

Nondrug therapies for RA treatment (remember RA cannot be cureD) (3)

A
  • physical therapy
  • occupaitonal therapy
  • surgery
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15
Q

3 categories of drugs for treatments of RA

A
  • NSAIDS (symptomatic relief doesn’t slow progression)
  • disease modyfing antirheumatic drugs (slow acting anti-rehumatic drugs inclduing nonbiologic and janus kinase inhibitors
  • glucocorticoids (great for flareups but chronic use has many neg side effects)
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16
Q

Current recommendations for treatment of rheumatoid arthritis

A

-start disease modifying antirheumatic drugs (DMARD) within 3 months of diagnosis (this hopes to delays joint degeneration)

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17
Q

Intraarticular injections

A

Use of something like methyrednisalone for relief of RA for several months as long as not used more than 2-3 times a year in cases where only 1 or 2 joints are affected

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18
Q

Corticosteroids ADRs (5)

A
  • adrenal suppression
  • cushings
  • osteoporosis
  • cataracts
  • glaucoma
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19
Q

Methotrexate function

A

fastest acting of DMARDs, PO in low dose decreases symptoms and improves long term outcome of RA, often used intially

20
Q

Methotrexate ADR’s (4)

A
  • hepatic fibrosis
  • bone marrow suppression
  • immunosuppressive
  • teratogenic in pregnancy
21
Q

Hydroxychloroquine (plaquenil) function

A

Antimalerial drug that is moderately effective for mild rheumatoid arthritis and can produce remission of RA, reserved for those not responding to NSAIDS, takes up to 3-6 months to develop effects

22
Q

Hydroxychloroquine (plaquenil ADR’s (2)

A
  • retinal damage

- hemolysis in G6PD deficiency

23
Q

Sulfasalazine (azulfidine) function

A

Drug used to treat inflammatory bowel disease and RA

24
Q

Azathioprine (imuran), cyclosporine, and gold salts function

A

Approved by FDA for rheumatoid arthritis treatment but used infrequently due to serious adverse side effects, may still be used in refractory cases

25
Q

When are biologic DMARDs and janus kinase inhibitor used?

A

In those that need moderate or high disease treatment of RA or who do not respond

26
Q

Etanercept (enbrel) drug class and function

A

TNF inhibitor, used for RA in combo with methotrexate in those who do not respond to first line treatments alone

27
Q

Etanercept (enbrel) contraindication (1)

A

-septic patients or those with hypersensitivity

28
Q

Infliximab (remicade) drug class and function

A

TNF inhibitor, first approved for treatment of crohn’s now approved for use in combo with methotrexate to treat RA in patients who do not respond to methotrexate alone, also to treat ankylosing spondylitis, psoriasis

29
Q

Adalimumab (humira) function

A

Similar immunosuppressant function as infliximab but easier to administer as it is only used every 2 weeks

30
Q

Rituximab (rituxan) drug class and fucntion

A

B lymphocyte depleting agent, selectively depletes B cells which play role in autoimmune response and in the chronic synovitis associated with RA

31
Q

T cell activation inhibitor example, function

A

Abatacept (orencia), reduces RA symptoms and decreases disease progression

32
Q

3 examples of drugs that are interleukin receptor antagonists preventing the cytokines being overproduced in patients with RA that contribute to joint destruction

A
  • tocilizumab
  • sarilumab
  • anakinra
33
Q

Tofacitinab (xeljanz) drug class and function

A

Janus kinase inhibitors, used for treatment of adults with moderate to severe active RA who have not had adequate response or who are intolerant of methotrexate

34
Q

Gouty arthritis is associated with hyperuricemia which is uric acid level greater than ___mg/dL

A

6-7

35
Q

Drugs to relieve acute gouty attacks (2)

A
  • NSAIDS

- colchicine

36
Q

Drugs used to lower long term levels of uric acid in patients with chronic gout (2)

A
  • allopurinol and febuxostat

- probenecid and lesinurad

37
Q

If a patient is not on uric acid lowering therapy at time of gout attack, then…..

A

It is not time to intiiate therapy. If patient is on uric acid lowering therapy at time of attack, should not be discontinued

38
Q

Common NSAID agents used for treatment of gout (4)

A
  • indomethacin
  • naproxen
  • diclofenac
  • ibuprofen
39
Q

Causes of elevated uric acid levels

A
  • decreased clearance of uric acid from kidney (90%)

- overproduction of uric acid

40
Q

Lifestyle changes for gout (3)

A
  • diet not huge influence
  • decrease obesity
  • decrease alcohol consumption
41
Q

Whenever starting a uric acid lowering treatment, there is risk of preciptating a ___, therefore this is avoided by coadministration of ___ alongside uric acid lowering therapy

A

gout flare, steroids/colchicine/nsaid

42
Q

Colchicine function

A

Antinflammatory whose effects are specific for gout, ineffective for other inflammatory disorders, use has declined because of better alternatives

43
Q

Colchicine ADR’s (3)

A
  • GI issues
  • drug interactions with statins
  • myelosuppression
44
Q

Allopurinol drug class and function

A

Xanthine oxidase inhbitor, used to reduce blood levels of uric acid, indicated for primary hyperuricemia of gout, as well as 2ndary hyperuricemia due to blood dyscrasias such as polycythemia vera and leukemia, can increase risk of incidence of attacks in intial months of treatment hence need concurrent treatment with colchicine or NSAID

45
Q

Febuxostat (uloric) function

A

Identical to allopurinol in treatment of reduction of uric acid levels in blood for primary hyperuricemia of gout

46
Q

Pegloticase (krystexxa) drug class and function

A

Recombinant form of uric acid oxidase IV agent for highly symptomatic patients with severe tophaceous gout who have not responded to other agents, very expensive and has many infusion reactions (urticaria, dyspepsia, chest discomfort, erythema)

47
Q

Pseudogout

A

Results when calcium pyrophosphae dihydrate crystals deposited into bone and cartilage are released into synovial fluid inducing acute inflammation, may present as acute monarthritis or oligoarthritis, usually affecting knee, treated via NSAIDs, colchicine, glucocorticoids

3rd Semester Final (248 decks)

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