Week 4 -Midterm Review Flashcards
Most appropriate treatment approach for OA - pharmalogical
- Topical NSAIDS
- Oral NSAIDS
- Tylenol
- US guided glucocorticoid injection
- Duloxetine
- Tramadol
Most appropriate treatment regimen for OA - non-pharmacological
- Exercise
- Balance exercises
- Weight loss
- Self-efficacy /self-management
Complications of untreated gout
- Tophi
- Joint damage
- Kidney stones & damage from crystal deposition
Patient education for colchicine
- Stop medication and inform the MD if GI symptoms including nausea, vomiting, diarrhea, or abdominal pain occur
Adverse effects of colchicine for gout
- GI side effects (N&V, D, abdo pain)
- GI toxicity
- Leukopenia
- Granulocytopenia
- Pancytopenia
- thrombocytopenia
What condition can be developed with long term use of allopurinol?
- Hypersensitivity syndrome includes rash, fever, eosinophilia, decreased liver and kidney function
What drugs interact with allopurinol?
- Warfarin
- Theophylline
- ampicillin
What should be co-administered with febuxostat?
- Colchicine or indomethacin to prevent gout attacks during the first 6 months of treatment
Black Box Warning for NSAIDS
- Increase risk of MI, stroke, other thrombolytic events
- Increase risk of dangers GI effects including bleeding and perforated ulceration
Drug interactions for NSAIDS
- Aspirin interacts with many other medications
NSAIDS mechanism of action
- 1st gen – inhibit Cox-1 and cox-2 enzymes (adverse effects
- 2nd gen- selectively inhibits cox-2 enzymes– produces analgesic and anti-inflammatory effects
Therapeutic action of NSAIDS
- Reduces inflammation and provides pain relief
Patient teaching for DMARDS
- Notifying about risk of infection
- Avoid communicable disease people
- Report s/s of infection to provider or evidence of bruising, bleeding, fatigue, fever, pallor, HF symptoms – SOB, orthopnea, fatigue
What baseline data/diagnostics are needed for all DMARDs
- Complete history and physical
- CBC with WBC diff
- s/s of infection
- TB and hepatitis
- Malignancies (skin exam)
- Rule out pregnancy
- Check ALT, AST, serum creat
- Chest x-ray
- Pulmonary status
- GI status
Therapeutic response of methotrexate
- Decreases immune reaction
Patient education for alendronate for osteoporosis
First line of treatment for osteoporosis
- Swallow tablet whole with a full glass of water while sitting or standing upright and remain upright for a minimum of 30 minutes
- Intake of food prevents absorption should take in the morning before taking anything except water do not take calcium, antacids, Iron, mg, coffee or juice for at least 30 minutes afterwards.
Which dietary supplement can interfere with absorption of ibandronate?
- Multivitamin with minerals
- Do not take with Mg, Ca or Fe
Adverse effects of densumaub
- Hypercalcemia
- Serious infections
- Skin reactions
- Osteonecrosis of the jaw
Raloxifene can cause…..
- Can cause DVT, PE, Stroke
Which RA drugs have highest risk vs which ones are the safest during pregnancy?
Safest
- NSAIDS
- Corticosteroids
- DMARDs (Sulfasalazine, Hydroxychloroquine)
Highest risk
- Methotrexate
- Leflunomide
- Biologics (rituximab and abatacept)
PRESCRIPTION WRITING:
Hydrocodone/Acetaminophen
- indication
- common doses
- directions for use
Indication
- moderate to severe pain
Common dose
– 2.5/325mg or 5/300 or 500mg
Directions for use
– 1 to 2 tablets every 4 to 6 hours as needed. May be taken with food or milk to minimize GI irritation.
PRESCRIPTION WRITING:
Lisinopril
- indication
- common doses
- directions for use
Indication
– hypertension, HF, MI, persistent albuminuria
Common dose
– 10mg PO daily (10-40mg up to max 80)
Directions for use
– take with/without food
PRESCRIPTION WRITING:
Amlodipine
- indication
- common doses
- directions for use
Indication
- Hypertension
Common dose
– 5mg PO daily (up to
10mg per day)
Directions for use
- May administer without regard to meals.
PRESCRIPTION WRITING:
Colchicine
- indication
- common doses
- directions for use
Indication
– prevention and treatment of gout flares, Mediterranean fever, pseudogout, pericarditis
Common dose
– 0.6mg PO once or 2x per day (max 1.2mg per day)
Directions for use
- Take without regard to meals. Administer with food to minimize gastric irritation.
