Term
| Bisphosphonates are useful in the treatment of: |
|
Definition
hypercalcemia
osteoporosis
Paget's disease
multiple myeloma
bone metastases |
|
|
Term
| Bisphosphonates inhibit _____________ activity. (MOA) |
|
Definition
|
|
Term
| Bisphosphonates end in what? |
|
Definition
|
|
Term
| Which drugs are bisphosphonates? |
|
Definition
Alendronate (fosamax)
Risedronate (Actonel)
Ibandronate (boniva)
Etidronate
Pamidronate
Zoledronate (Reclast) IV
Tiludronate |
|
|
Term
| Which bisphosphonate is taken PO once a month? |
|
Definition
|
|
Term
| Which bisphosphonate is taken by IV once a year? |
|
Definition
|
|
Term
| Which bisphosphonates are used in the prevention of osteoporosis and vertebral fractures? |
|
Definition
Alendronate (Fosamax)
Ibandronate (Boniva)
Risedronate (Actonel) |
|
|
Term
| Besides vertebral fractures and osteoporosis, what else do Alendronate and Risedronate help prevent? |
|
Definition
|
|
Term
| who are bisphosphonates frequently prescribed to? |
|
Definition
postmenopausal women
and
those using steroid meds |
|
|
Term
| What MUST you tell a patient before they take bisphosphonates? |
|
Definition
1. Take first thing in the morning with a full glass of water, 30 mins before ingesting anything
2. stay upright; do not recline |
|
|
Term
| Why is it important for someone on bisphosphonates to stay upright after they take them? |
|
Definition
| because of the high incidence of esophageal erosion |
|
|
Term
| What percentage of bisphosphonates are absorbed? |
|
Definition
|
|
Term
| What is the HL of a bisphosphonate? |
|
Definition
| ranges from ~1 to 10 years |
|
|
Term
| List the SEs of bisphosphonates. |
|
Definition
GI: nausea, abd pain, loose stools
small risk of esophageal ulcers
BONE NECROSIS |
|
|
Term
| The bone necrosis that can occur with bisphosphonate use usually manifests where? |
|
Definition
|
|
Term
| How often do you administer Alendronate and Risedronate? |
|
Definition
|
|
Term
| Which bisphosphonate is for Paget's disease only? |
|
Definition
|
|
Term
| Which bisphosphonates are used IV to treat hypercalcemia of malignancy, Multiple Myeloma and renal cancer? |
|
Definition
Etidronate
Ibandronate
Pamidronate
Zoledronate |
|
|
Term
| Hyperuricemia is due to... |
|
Definition
| overproduction or underexcretion of uric acid -- sometimes both |
|
|
Term
| What can cause secondary gout? |
|
Definition
medications
myeloproliferative diseases
chronic renal disease
alcoholism |
|
|
Term
| What is the difference between how you treat primary and secondary gout? |
|
Definition
|
|
Term
| What are the possible lab findings of gout? |
|
Definition
elevated serum uric acid -- doesn't have to be elevated
elevated ESR and WBC
Joint aspirates show Na urate crystals |
|
|
Term
| What is the treatment of choice for Gout? |
|
Definition
|
|
Term
| Which NSAIDs do you normally use to treat gout? |
|
Definition
Indomethacin (can cause frontal HAs)
Naproxen and Ibuprofen |
|
|
Term
| Colchicine is used specifically for the treatment of what? |
|
Definition
|
|
Term
| How is colchicine usually administered in the US? |
|
Definition
|
|
Term
| How do you use colchicine is the prophylaxis of gout? |
|
Definition
|
|
Term
| When using Colchine for prophylaxis, how do you change the dosage to abort an impending gouty attack? |
|
Definition
increase dosage at first prodromal signs
2 tabs initially followed by 1-2 tabs every 1-2 hours until pain is relieved or until toxicity occurs
|
|
|
Term
| Are NSAIDs used in the prophylaxis of gout? |
|
Definition
|
|
Term
| List the AEs of colchicine. |
|
Definition
Nausea, vomiting, diarrhea (can be terrible)
D/C immediately |
|
|
Term
| What is the max dose of colchicine? |
|
Definition
|
|
Term
| When should stop Colchicine use? |
|
Definition
1. when the pain is relieved
2. when the SEs are too awful to continue
3. when you've taken 8 mg |
|
|
Term
| What drugs can be used to treat gout? |
|
Definition
NSAIDs
Colchicine
Corticosteroids
Uricosuric agents (Probenecid)
Allopurinol |
|
|
Term
| When should you use corticosteroids to treat gout? |
|
Definition
| when pts are unable to take oral NSAIDs or colchicine |
|
|
Term
| What do you need to R/O before you administer corticosteroids for gout? |
|
Definition
|
|
Term
| Which 2 classes of drugs are used to reduce serum uric acid levels long term? |
|
Definition
uricosuric agents (Probenecid)
Allopurinol |
|
|
Term
| Which drug used to treat gout decreases the production of uric acid? |
|
Definition
|
|
Term
| Which drug used to treat gout increases the elimination of uric acid? |
|
Definition
| Uricosuric agents - Probenecid |
|
|
Term
| How can you tell if a patient is an underexcretor of uric acid or an overproducer? |
|
Definition
24 hr urine test
>800 mg overproducers
<800 mg underexcretors |
|
|
Term
| Uricosuric agents block tubular _________ of filtered urate and thus increase the ___________ of uric acid. (MOA) |
|
Definition
|
|
Term
| What should you avoid when using Probenecid? |
|
Definition
ASA and other salicylates
high doses of salicylates inhibit uric acid reabsorption, low doses inhibit uric acid secretion |
|
|
Term
| Which drug should not be initiated during an acute gouty attack? |
|
Definition
|
|
Term
| Do you have to stop the use of Allopurinol if an acute gouty attack occurs? |
|
Definition
once started you do not have to stop for a gouty attack
however, do not initiate the drug during an acute gouty attack |
|
|
Term
| What is the active metabolite of Allopurinol? |
|
Definition
| Oxipurinol (Alloxanthine) |
|
|
Term
| Allopurinol and its _____________ decrease the production of ____________ by inhibiting xanthine oxidase, the enzyme that converts hypoxanthine to xanthine to __________. (MOA) |
|
Definition
active metabolite
uric acid
uric acid |
|
|
Term
| How is Allopurinol administered? |
|
Definition
|
|
Term
| What percentage of patients cannot tolerate Allopurinol because of its SEs? |
|
Definition
|
|
Term
| List the SEs of Allopurinol. |
|
Definition
N/V
Hepatitis
Skin rashes
Other forms of hypersensitivity |
|
|
Term
| What is a real concern with Allopurinol? |
|
Definition
a hypersensitivity reaction can occur at ANY POINT DURING ITS USE
it progresses very rapidly and is often missed |
|
|
Term
|
Definition
| inhibits the breakdown of azathioprine and mercaptopurine, these drug's doses should be decreased |
|
|
Term
| ______________ and _____________ can be used to treat Psoriasis. |
|
Definition
| UV light and corticosteroids topical preparations |
|
|
Term
| What can you use to treat allergic contact dermatitis? |
|
Definition
| corticosteroid preparations (only need for a short time) |
|
|
Term
| When you have seborrheic dermatitis of the scalp, what do you use to treat it? |
|
Definition
salicylic acid
selenium sulfide - Selsun blue
Zinc pyrithione - head and shoulders
coal tar - Neutrogena T/Gel |
|
|
Term
| Seborrheic dermatitis of the skin responds well to ____________________. |
|
Definition
|
|
Term
| Babies with cradle cap often respond well to __________________. |
|
Definition
|
|
Term
|
Definition
| steroid creams or ointments |
|
|
Term
| Warts are caused by viruses in the _____ family. |
|
Definition
|
|
Term
| What can you use to treat skin warts? |
|
Definition
salicylic acid (compound W), plaster
cantharidin cryotherapy - liquid nitrogen |
|
|
Term
| _______________ is used to treat genital warts in those ______ years old and over. |
|
Definition
|
|
Term
| Imiquimod should be used not longer than __________. |
|
Definition
|
|
Term
| Fungal and bacterial infections of the skin are treated with _____________ and ______________ respectively. |
|
Definition
antifungals (topical or systemic)
antibiotics (topical or systemic) |
|
|
Term
| Topical retinoids used to treat acne are related to ___________. |
|
Definition
|
|
Term
| List the Topical Retinoids |
|
Definition
Tretinoin (Retin A)
Adapalene (Differin)
Tazarotene (Tazorac) |
|
|
Term
| Which drug is a systemic retinoid? |
|
Definition
|
|
Term
| How long should you take Accutane? |
|
Definition
|
|
Term
| Accutane works by reducing the secretion of ___________________ in addition to altering DNA trascription. (MOA) |
|
Definition
|
|
Term
| Accutane/Isotretinoin is recommended ONLY for _______________. |
|
Definition
|
|
Term
| List the SEs of Isotretinoin (Accutane) |
|
Definition
Extremely Tetratogenic
Dry skin and mucous membranes
HA
depression
hypertriglyceridemia, hypercholesterolemia
reduced HDL
elevation of LFTs |
|
|
Term
| What is the program used to monitor proper control and use of Isotretinoin (accutane)? |
|
Definition
|
|
