Week 11 - Arthritis drugs Flashcards
Acetaminophen: indications
Mild to moderate OA
Acetaminophen: MOA
Exerts action on CNS which results in decreased prostaglandin synthesis
- Does NOT affect COX, so does not affect platelet aggregating or cause GI irritation
Active as analgesic and antipyretic
- Reduces fevers by direct actions on the hypothalamic heat-regulating centers
Acetaminophen: caution and contraindications
- Avoid in severe hepatic impairment and severe active liver disease
- D/c if skin reaction develops
Acetaminophen: ADR
- Skin rash
- Dizziness
- Hypersensitivity reactions (rare)
NSAIDs: examples
- Ibuprofen
- Naproxen
- Voltaren gel
NSAIDs: indications
Mild to moderate OA, RA
NSAIDs: MOA
Exerts anti-inflammatory action by inhibiting conversion of arachiconic acid to prostaglandin, prostacyclin, and thromboxanes (all mediators of pain and inflammation)
NSAIDs: caution and contraindications
- Caution in cardiovascular disease
- Avoid in pregnancy
- Caution in elderly patients
- Caution in renal and hepatic impairment
- Avoid use if GFR <30 mL/minute
NSAIDs: ADR
Peripheral edema, dizziness, skin rash, GI disturbances, elevated transaminases, dyspepsia, HTN, bleeding d/t reversibly impacting platelet aggregation
“Coffee ground” emesis
Tramadol: indications
Considered when pain associated w/ OA progresses past responsiveness to acetaminophen and NSAIDs
Tramadol: MOA
Mu opioid receptor agonist that when binds, ascending pain pathways are inhibited
Inhibits reuptake of serotonin and norepinephrine
Tramadol: caution and contraindications
- Caution in patients w/ substance abuse history
- Avoid in patients w/ history of seizures d/t lowering of seizure threshold
- Caution in renal and hepatic impairment
- Caution in pediatrics, elderly
- Caution using w/ other CNS depressants
Tramadol: ADR
- Dizziness, nausea, drowsiness, sweating
- Constipation, dependecy, euphoria, respiratory depression
- Risk of serotonin syndrome when combined with other serotonergic agents
Methotrexate: indications
Antirheumatic
Methotrexate: MOA
Folic acid antagonist
Thought to affect leukocyte suppression, decreasing the inflammation that results from immunologic by products
Methotrexate: ADR
N/D, arthralgias, oral ulcers, alopecia, photosensitivity, skin rash, dizziness, increased serum transaminases
Methotrexate: caution and contraindications
- Avoid in pregnancy and lactation
- Avoid in patients w/ blood dyscrasias
- Caution in renal and hepatic impairment
Black box warning
- Risk of hepatotoxicity, renal impairment, pneumonitis, bone marrow suppression, GI toxicity, active stomatitis, dermatology reactions, opportunistic infections
TNF inhibitors: examples
Rituximab (Rituxan)
Abatacept (Orencia)
TNF inhibitors: MOA
Binds to circulating TNF-alpha making it inactive
Reduces chemotactic effect of TNF-alpha by reducing IL-6 and CRP –> reduced infiltation of inflammatory cells into joint
Cell lysis
TNF inhibitors: caution and contraindications
Caution in patients w/ new/recurrent infections
TNF inhibitors: patient educations
Must be up to date on immunizations before initiation
TNF inhibitors: ADR
Injection site reactions, infusion reaction, infections, dizziness, HA, nausea
Acetaminophen: pharmacokinetics
- Metabolized by the liver
- When taken regularly or in large doses, stores of glutathione become depleted –> hepatic necrosis
Indomethacin (NSAID): ADR
May aggravate depression or other psychiatric disturbances
