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Pharmacology (Dale Turley) > Tx of Bone and Joint Disorders (Part II) > Flashcards

Tx of Bone and Joint Disorders (Part II) Flashcards

1
Q

NSAID’s – Naproxen Sodium: sub class ?

A

propionic acid

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2
Q

Naproxen Sodium trade ?

A

Naprosyn

Alieve

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3
Q

Naproxen Sodium indications ?

A

Anti-inflammatory

Osteoarthritis
Rheumatoid arthritis
Acute gout
Mild – Moderate Pain
Dysmenorrhea
Fever
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4
Q

Naproxen Sodium adult dosing ?

A

220, 275, 550 mg naproxen sodium = 200, 250, 500 mg naproxen

Special Ped’s dosing 11-22 mg/kg/day
Divided dose q8-12 hrs

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5
Q

Naproxen Sodium BBW / caution ?

A

CABG / CAD / CHF / PUD

  • *Watch its with NSAIDS if they are post CABG
  • *
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6
Q

Naproxen Sodium preg. cat ?

A

C

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7
Q

IR(Imed release) doses expressed as ?

A

naproxen sodium

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8
Q

ER (extended release) doses expressed as ?

A

naproxen equivalents

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9
Q

NSAID Combo Cytoprotective example ?

A

Diclofenac/misoprostol

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10
Q

Diclofenac/misoprostol trade ?

A

Arthrotec

Cytotec)

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11
Q

Diclofenac/misoprostol (Arthrotec, Cytotec) MOA ?

A

Acts upon gastricparietal cells inhibiting the secretion ofgastric acid

Stimulate increased secretion of the protective mucus that lines theGI tractand increase mucosal blood flow, thereby increasing mucosal integrity

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12
Q

Misoprostol trade ?

A

Arthrotec, Cytotec

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13
Q

Misoprostol indicated ?

A

Indicated NSAID induced ulcer or protection

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14
Q

Misoprostol inhibits ____________ secretion and mucosal __________ ?

A

Inhibits gastric acid secretion and mucosal protections

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15
Q

Misoprostol used with ?

A

NSAID’s / ASA

Used in early pregnancy termination

**long standing NSAIDS use you want to use these protection agents

the proactive agents are used to stimulate contractions or bleeding after delivery for uterine bleeding agent **

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16
Q

Misoprostol BBW ?

A

Black Box warning with pregnancy / miscarriage, induce labor, uterine rupture

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17
Q

NSAID that has been discontinued in the US because of renal disease ?

A

Nabumetone (Relafen)

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18
Q

Muscle Relaxants examples ?

A

Metaxalone

Cyclobenzaprine

Baclofen

Tizanidine

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19
Q

Metaxalone trade ?

A

Skelaxin

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20
Q

Metaxalone (Skelaxin)

MOA ?

A

exact mechanism of action unknown; depresses CNS activity (centrally-acting muscle relaxant)

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21
Q

Metaxalone (Skelaxin)

indication ?

A

MS pain / Spasm

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22
Q

Metaxalone (Skelaxin) caution in ?

A

renal / Liver Dz

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23
Q

Metaxalone (Skelaxin) dosed ?

A

Dosed 800 mg tid/qid

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24
Q

Metaxalone (Skelaxin) is give on ______ stomach ?

A

empty

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25
Q

Metaxalone (Skelaxin) preg cat ?

A

C

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26
Q

Metaxalone (Skelaxin) peds ?

A

12 years old

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27
Q

Metaxalone (Skelaxin)

common reactions ? low incidence ?

A

drowsiness

dizziness

headache

nervousness

nausea

vomiting

dyspepsia

low incidence

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28
Q

Cyclobenzaprine trade ?

A

Flexeril

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29
Q

Cyclobenzaprine (Flexeril)

MOA ?

A

potentiates norepinephrine and binds to serotonin receptors, reducing spasticity (centrally-acting muscle relaxant)

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30
Q

Cyclobenzaprine (Flexeril)

indications ?

A

Muscle Spasm

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31
Q

Cyclobenzaprine (Flexeril)

dosing ?

A

Dosing 5-10 mg tid up to three weeks

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32
Q

Cyclobenzaprine (Flexeril)

pregnancy category ?

A

B

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33
Q

Cyclobenzaprine (Flexeril)

cautions ?

A

anticholinergic effects

CNS depression

lowers seizure threshold

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34
Q

Cyclobenzaprine (Flexeril)

can cause serotonergic effect which include what sxs ?

A

Increased heart rate, shivering, sweating, dilated pupils, myoclonus (intermittent jerking or twitching)

Hyper-reflexia

Hyperactive bowel sounds, high blood pressure

Hyperthermia - temperature as high as 40°C (104°F).

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35
Q

Baclofen trade ?

A

Lioresal

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36
Q

Baclofen (Lioresal)

class ?

A

GABA receptor Stimulant (agonist)

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37
Q

_____________ is an amino acid which acts as a neurotransmitter in the central nervous system.

A

Gamma-Amino Butyric acid(GABA-b)

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38
Q

Baclofen (Lioresal)

inhibits _____ ___________ in the brain, calming nervous activity

A

nerve transmission

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39
Q

Baclofen (Lioresal)

: “ Think of it as a ___ depressant “

A

CNS

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40
Q

Baclofen have what effects ?

A

Sedative effects (anxiolytics)

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41
Q

Baclofen MOA ?

A

Inhibits monosynaptic and polysynaptic spinal reflexes (centrally-acting muscle relaxant)

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42
Q

Baclofen indication ?

A

Spacity

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43
Q

A beneficial property of ________ is thattoleranceto its muscle-related therapeutic benefits

A

baclofen

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44
Q

Baclofen retains its therapeutic anti-spasmodic effects even after ?

A

many years of continued use

  • *can be on these for a while and you dont become resistance - continuously same dose (no tolerance)
  • *
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45
Q

Discontinuation of baclofen can be associated with a ?

A

withdrawal syndrome

** you can get WD sxs. - taper it cause we dont want spastic sxs. **

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46
Q

Resemblesbenzodiazepine or alcohol withdrawal ?

A

Baclofen WD

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47
Q

Baclofen route ?

A

PO / Intrathecal

Baclofen pump

**intrathecal cath. into L2 or L3 that is not a dispensing

it is set at a standard dose and they can get an extra dose by hitting the button

the port underneath the skin and they go in a fill back up the port depending on the dosage depends on how frequently you need to refill **

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48
Q

Tizanidine trade ?

A

Zanaflex

**non-narcotic narcotic **

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49
Q

Tizanidine (Zanaflex)

MOA ?

A

Centrally acting alpha-2 adrenergic receptor agonist (centrally-acting muscle relaxant)

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50
Q

Tizanidine (Zanaflex)

indication ?

A

spasticity

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51
Q

Tizanidine (Zanaflex)

dosing ?

A

Start at 2mg PO q6-8hr

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52
Q

Goal of Drugs Used to Treat Gout are used because they ?

A

End painful attacks of gout

Prevent the formation of uric stones in the kidney

Prevent complications from uric stone formation in the joints

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53
Q

Drugs Used to Treat Gout examples NSAID ?

A

Indomethacin or Indometacin (Indocin)

54
Q

Indomethacin sub class?

A

Acetic acid

55
Q

Indomethacin inhibits ?

A

production of prostaglandins

56
Q

Indomethacin indication ?

A

Acute Gout

OA / RA

Bursitis / Tendonitis

Dysmennorrhea

Peds IV dosing for patient ductus arteriosus

57
Q

Indomethacin (Indocin)

side effects same as ?

A

non-selective COX inhibitors / NSAIDS

58
Q

Indomethacin (Indocin)

side effects ?

A

mostly renal

Edema from fluid retention

Hyperkalemia

Hypernatremia

HTN

59
Q

Indomethacin cautions ?

A

HTN / CAD / CHF / Renal Dz / PUD

60
Q

Indomethacin preg cat ?

61
Q

Indomethacin dosing ?

A

25-50mg TID

62
Q

Drugs Used to Treat Gout: Allopurinol trade ?

63
Q

Allopurinol (Zyloprim)

MOA ?

A

Inhibits the enzyme xanthine oxidase in purine metabolism

64
Q

Allopurinol (Zyloprim)

blocks ?

A

formation of uric acid

65
Q

Allopurinol (Zyloprim)

reduces ?

A

serum uric acid

66
Q

Allopurinol (Zyloprim)

clinical uses ?

A

Chronic gouty arthritis (prophylaxis)

Prevention of uric acid calculi (common kidney stones)

Hyperuricemia (excess serum uric acid)

Calcium oxalate calculi (most common kidney stone)

Tumor Lysis Syndrome from chemotherapy (generates large quantities of nucleic acids, the purines )

67
Q

Allopurinol (Zyloprim)

indication ?

A

Chronic gouty arthritis (prophylaxis)

NEVER in acute attack

68
Q

Allopurinol (Zyloprim)

dosing ?

A

200-600 mg/day divided qd-qid

69
Q

Allopurinol (Zyloprim)

preg cat ?

70
Q

Drugs Used to Treat Gout: Cholchicine trade ?

A

Colcrys

Generic

71
Q

Cholchicine: Toxic natural plant alkaloid extracted from Colchium plant believed to interfere with ?

A

WBC function, affecting the inflammatory response

72
Q

Colchicine does not affect ______ levels in the serum ?

A

uric acid

Hyperuricemia

73
Q

Colchicine (Generic)

clinical uses ?

A

treatment of acute gout attacks

74
Q

Colchicine (Colcrys) side effects ?

A

GI at high doses

Diarrhea and stomach upset

Neutropenia

Damage bone nmarrow – anemia

Corneal clouding

Peripheral neuropathy

75
Q

Colchicine (Colcrys)

facts ?

A

Generic production halted

Trade $$$$

76
Q

Colchicine (Colcrys) route ?

77
Q

Colchicine (Colcrys) dosing ?

A

1.6 mg PO x1 then, 0.6 mg (30ea): $220.57

prevention is 0.6 bid

78
Q

Colchicine (Colcrys) preg cat ?

79
Q

Colchicine (Generic)

extreme caution in ?

A

renal patients

80
Q

Drugs Used to Treat Gout : Probenecid trade ?

81
Q

Probenecid (Probalan)

MOA ?

A

Lowers serum levels of urate (hyperuricemia) by competitive inhibition of reabsorption in the renal tubules

increases uric acid excretion in the urine

82
Q

Probenecid (Probalan)

clinical uses ?

A

Chronic gout

Hyperuricemia

Gonorrhea or neurosyphillis by delaying the excretion of penicillin

83
Q

Drugs Used to Treat Gout : Sulfinpyrazone trade ?

84
Q

Sulfinpyrazone (Anturane)

MOA ?

A

Inhibits reabsorption of urates at the proximal tubule

Similar to probenecid

Increases uric acid excretion

85
Q

COX-2 example ?

A

Celecoxib (Celebrex)

86
Q

Only remaining COX-2 on the market ?

A

Celecoxib (Celebrex)

87
Q

Celecoxib (Celebrex)

MOA ?

A

Inhibits prostaglandin synthesis by decreasing the activity of the COX-2 enzyme

88
Q

Celecoxib (Celebrex)

does NOT exhibit ?

A

antiplatelet activity

89
Q

Celecoxib (Celebrex)

clinical uses ?

A

Rheumatoid arthritis

Osteoarthritis

  • Most common joint disorder in the United States
  • Increased incidence of self-medication
  • Degree of joint pain and dysfunction guides intervention

Dysmenorrhea

90
Q

Systemic oral corticosteroids

are ?

A

Anti-inflammatory agents

91
Q

Systemic oral corticosteroids

clinical uses ?

A

RA / OA

Acute Gout

Asthma: short-term burst therapy

COPD

Replacement therapy in adrenal insufficiency

Crohn’s disease

people who cant tolerate GOUT medications ( b/c kidney disease) then steroids are good for them

92
Q

Systemic oral corticosteroids

examples ?

A

Hydrocortisone (Solu-Cortef)

Prednisone (Deltasone)

Methylprednisolone (Solu-Medrol)

93
Q

Systemic oral corticosteroids contraindications ?

A

serious fungal, viral, or tubercle skin infection

Diabetes

94
Q

Hydrocortisone trade ?

A

Solu-Cortef

95
Q

Hydrocortisone (Solu-Cortef) route ?

A

IV / IM / PO

96
Q

Hydrocortisone (Solu-Cortef) example doses ?

A 
Solumedrol
Medrol Dose Pack
Prednisone Taper Dose
Prednisone
Decadron
Prelone elixir
97
Q

Hydrocortisone (Solu-Cortef) dosing ?

A

100-500 mg IM / IV

98
Q

DMARDs Influence the disease process of rheumatoid arthritis by ?

A

preventing bone loss and cartilage erosion

99
Q

DMARDs Are prescribed in combination with ?

A

biologic modifiers (such as etanercept, inflixamab) or in multiple drug regimens with :
NSAIDs
other DMARDs
w or w/o CCS

100
Q

DMARDs examples ?

A

Methotrexate

101
Q

Methotrexate trade ?

A

Rheumatrex, Trexall)

102
Q

Methotrexate MOA ?

A

immunosuppressant

inhibits dihydrofolate reductase

inhibits lymphocyte proliferation (folate antagonist)

Folate antimetabolite that inhibits DNA synthesis

103
Q

Methotrexate Appears to act as a _____________ with multiple effects when used to treat arthritis

A

cell anti-proliferative

for CA and mitochondrial proliferation

104
Q

Methotrexate indications ?

A 
RA
Severe psoriasis
ALL
Osteosarcoma
Ectopic Pregnancy
SLE
105
Q

Methotrexate BBW ?

A

Fetal death

Hepato-toxicity

Pulmonary toxicity – fibrosis

Tumor Lysis Syndrome

GI Toxicity

106
Q

Methotrexate route ?

A

IV / PO form

107
Q

Methotrexate side effects ?

A

Pulmonary Fibrosis
for these people on it long term they need serial CXRs

Blurred vision / transient blindness

Alopecia

N/V diarrhea

Anemia, Thrombocytopenia
bone marrow supression

Neuropathy

Hyperuricemia
make GOUT worse

**respiratory sxs. with this medication - pulmonary fibrosis **

108
Q

Leflunomide is a ?

109
Q

Leflunomide trade ?

110
Q

Leflunomide (Arava) facts ?

A

1998 minimal use today

Indicated for RA, Crohns, Sarcoidosis

Immunomodulator

It is apyrimidine synthesis inhibitor (mitochondrial enzyme) reduction lymphocytes

Reduces signs and symptoms of rheumatoid arthritis and slows the progression of its associated joint damage

111
Q

DMARDs:Hydroxychloroquine trade ?

112
Q

Hydroxychloroquine (Plaquenil)

suspected to decrease ?

A

T-cell response

113
Q

Hydroxychloroquine (Plaquenil)

clinical uses ?

A

Used for years for treatment of malaria

Severe RA

Systemic lupus erythematous

114
Q

Hydroxychloroquine (Plaquenil)

can cause ___________________ w/ resultant _________

A

irreversible retinopathy with resultant blindness;

ensure patient undergoes frequent eye examinations

Vomiting, Headache common

Used more so when others have failed

115
Q

Gold Salts are ?

A

Ionic chemical compounds of gold

116
Q

Gold Salts are used primarily to ?

A

reduce inflammation and to slow disease progression in patients with rheumatoid arthritis

Mechanism by which gold drugs affect arthritis is unknown

Slow acting
Toxic
Agents of last resort

117
Q

Gold Compounds examples ?

A

Aurothioglucose suspension (Solganal)

Gold sodium aurothiomalate (Myochrysine)

Auranofin (Ridaura)

118
Q

Auranofin trade ?

119
Q

Auranofin (Ridaura)

is _____ acting and can be ____

A

slow

toxic

Rarely used today due to the advent of TNF

like last resort options for RA

120
Q

Auranofin (Ridaura)

administered ?

A

IM

PO (lower efficacy)

121
Q

Immune Modifying Agents or Biologicals

are used when ?

A

When corticosteroids fail or require long term therapy

122
Q

Immune Modifying Agents or Biologicals not used in ?

A

acute flare-ups

123
Q

__________ therapy that targets the rheumatoid process

A

Anticytokine

124
Q

Tumor Necrosis Factor Inhibitors examples ?

A

Etanercept (Enbrel)

Infliximab (Remicade):

Adalimumab (Humira)

Anakinra (Kineret)

125
Q

Etanercept (Enbrel): TNF receptor joined to a ______ ___ molecule

126
Q

Infliximab (Remicade): _____________ monoclonal antibody

A

mouse/human

127
Q

Adalimumab (Humira): TNF-inhibiting ___________?

A

anti-inflamatory

128
Q

Anakinra (Kineret) blocks ?

A

interleukin-1

129
Q

Class: Tumor Necrosis Factor (TNF) Inhibitors

examples ?

A

infliximab (Remicade)

etanercept (Embrel)

Adalimumab (Humira)

**use in OA, RA and crohns **

130
Q

TNF inhibitors BBW ?

A

Chronic or recurrent infection

Pulmonary and extrapulmonary tuberculosis (TB)

Invasive fungal infections and other opportunistic infections incl. Legionella and Listeria

Consider all patients to be immunosuppressed! - if respiratory sxs.

131
Q

TNF indications ?

A

Rheumatoid Arthritis

Ankylosing Spondylitis

Paoriasis

Crohns

Ulcerative Colitis

132
Q

TNF reactions

A

serum sickness

infection, sepsis, pneumonia, opportunistic infection, tuberculosis, malignancy, lymphoma, hepatosplenic T-cell lymphoma (peds pts), leukemia, HBV reactivation, hepatotoxicity, CHF

anaphylactoid rxn
hypersensitivity rxn

**can cause malignancies to be exacerbated and CHF and patients will retain water **

Pharmacology (Dale Turley) (31 decks)

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