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Nurp 423 Exam 2 > Week 6 > Flashcards

Week 6 Flashcards

1
Q

OA pain lasts how long in the morning?

A

Less than an hour

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2
Q

First line therapy for OA:

A

Tylenol

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3
Q

Tylenol is hard on what organ?

A

Liver

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4
Q

Second line therapy in OA:

A

NSAIDS

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5
Q

NSAIDS are hard on what organ?

A

Kidneys

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6
Q

NSAIDS MOA:

A

Inhibits the conversion of arachidonic acid to prostaglandin, prostacyclin, and thromboxanes- all of which are mediators of pain and inflammation

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7
Q

Which NSAID is Cox2 selective?

A

Celebrex

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8
Q

Contraindications for NSAIDS:

A

Allergy to Asa, alcohol dependence, pregnancy

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9
Q

Do not use Celebrex with:

A

Sulfa allergy and CV disease

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10
Q

NSAIDs have a black box warning for:

A

An increase in CV adverse events and is contraindicated for perioperative pain treatment in patients undergoing CABG

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11
Q

Adverse events of NSAIDs:

A

Visual changes, weight gain, ha, dizziness, nervousness, photosensitivity, fluid retention

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12
Q

First line therapy for rheumatoid arthritis?

A

NSAIDs and start DMARDS ASAP

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13
Q

Most common DMARD:

A

Methotrexate

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14
Q

Methotrexate MOA:

A

A folic acid antagonist, thought to affect leukocyte suppression, decreasing the inflammation that results from immunologic by products

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15
Q

Starting dose of methotrexate?

A

7.5 mg PO weekly up to a max of 25-30 mg weekly

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16
Q

Methotrexate contraindicated in:

A

Pregnancy (cat x), lactation, leukopenia (wbc less than 3000), AIDS, renal impairment, or liver disease

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17
Q

Adverse events of methotrexate:

A

Nausea and abdominal pain- most common
Oral ulcers, leukopenia, anemia
*take 1mg folic acid daily to minimize

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18
Q

Baseline labs with methotrexate:

A

CBC, LFTs, BUN, serum creatinine

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19
Q

Monitoring with methotrexate:

A

CBC every 4 weeks

BUN, creatinine, and liver function every 3 months

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20
Q

DMARDS other than methotrexate:

A

Sulfasalazine (azulfidine)
Hydroxychloroquine (plaquenil)
Leflunimide (Arava)

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21
Q

How long to see improvement with methotrexate?

A

3-8 weeks

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22
Q

What should be taken with methotrexate?

A

1 mg of folic acid daily

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23
Q

Sulfasalazine indicated in:

A

Patients with significant synovitis but no poor prognostic factors.

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24
Q

Sulfasalazine dosage:

A

1000mg/d initial and increase to 2000 mg over 2 weeks. Max is 3000 mg

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25
Q

Time to see effect with sulfasalazine?

A

May notice changes in 1 month with full results in 4 months

26
Q

Sulfasalazine is contraindicated in:

A

Sulfa allergy, G6PD, GI/GU tract obstruction, porphyria

27
Q

Adverse events of sulfasalazine:

A

N/D, dizziness, oral ulcers, Orange-yellow pigment of the skin, HA, depression

28
Q

Anti malarial agent that cannot limit the progression of RA- indicated for patients as adjunct to methotrexate or as a single agent therapy in early/mild RA without bone erosion.

A

Hydroxychloroquine (plaquenil)

29
Q

Dosage of plaquenil:

A

200 mg BID or 400mg daily

30
Q

When to see an effect with plaquenil:

A

2-6 months

31
Q

Plaquenil is contraindicated in:

A

Retinal field changes due to ocular effects of long-term therapy

32
Q

Adverse events of plaquenil:

A

N/V/D, skin pigmentation changes, rash

33
Q

Exerts anti inflammatory and anti proliferative actions, retarding erosions and joint space narrowing.

A

Leflunomide (arava)

34
Q

Arava is:

A

Usually mono therapy and a last resort

35
Q

Arava is contraindicated in:

A

Pregnancy, lactation, alcoholism, and liver disease

36
Q

First targeted synthetic DMARD available

A

Togacitinib (xelinjax)

37
Q

TNF alpha inhibitors:

A

Humira, Enbrel, Remicade

38
Q

These agents bind to the circulating TNF alpha and render it inactive. This results in reduced infiltration of inflammatory cells into joints

A

TNF alpha inhibitors

39
Q

How quickly do TNF alpha inhibitors work?

A

May take days to weeks to see results (2-4 weeks)

40
Q

Contraindications of TNF alpha inhibitors:

A

Untreated hepatitis B, class 3-4 HF patients, patients at risk of infections. Not recommended for patients with a treated solid malignancy in 5 years.

41
Q

Adverse events of TNF alpha inhibitors:

A

Increased risk of infection, HF, and skin cancer

42
Q

Indicated for the treatment of moderate to sever RA as monotherapy or incombo with csDMARDs. Blocks t-cell and TNF.

A

Abatcept (Orencia)

43
Q

Contraindications of Orencia:

A

Use in caution in patients with a history of infections or COPD.

44
Q

First line therapy for chronic gout?

A

Allopurinol and febuxostat (Uloric)

45
Q

Allopurinol MOA:

A

Acts directly on purine metabolism

46
Q

Adverse events of allopurinol:

A

N/V/D, rash

47
Q

Monitoring with allopurinol:

A

Draw Utica acid levels every 2-5 weeks during titration until desired level is reached, which may take up to 6 months

48
Q

Used for chronic gout when at least one XOI is contraindicated or not tolerated

A

Probenecid

49
Q

MOA of probenecid:

A

Increases the excretion of serum Utica acid

50
Q

How long to see effect of probenecid?

A

Serum uric acid levels will begin to decrease within 2 weeks but may take up to 6 months to see full effect

51
Q

Contraindications for probenecid:

A

Do not give during acute gout attacks, blood dyscrasias, uric acid kidney stones, or children less than 2

52
Q

Drink 2 liters or more of water a day with:

A

Probenecid

53
Q

Last line therapy for patients with chronic gout that had not been successfully treated with either an XOI or probenecid

A

Pegloticase (krystexxa)

54
Q

Used for acute gout attack:

A

Colchicine

55
Q

Colchicine MOA:

A

Decreases the inflammation and pain associated with a gout attack.

56
Q

Colchicine dosing:

A

Take 1.2 mg at first sign of gout flare followed by 0.6 mg 1 hour later

57
Q

How long to see effect with colchicine?

A

Will provide pain relief in 18-24 hours with full anti inflammatory effect in 48 hours

58
Q

Adverse events with colchicine?

A

GI effects particularly diarrhea

59
Q

Nonselective NSAID used in gout. Take 3 times a day with food.

A

Indomethacin

60
Q

Which chronic gout med can increase gout flares on initiation?

A

Febuxostat

Nurp 423 Exam 2 (4 decks)

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