Term
| NSAID method of action and uses |
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Definition
1st line for inflammation and pain, chronic pain requires more dosage
MoA: Anti inflammatory, REVERSIBLY inhibit cyclooxygenase (COX)
Analgesic by inhibiting peripheral PG production inhibiting pain stimuli
Antipyretic by inhibiting PG synthesis in thermoregulatory center of hypothalamus
Uses: Inflammatory disease, mild-moderate pain, fever |
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Term
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Definition
SE: GI most common
Nausea, dyspepsia, ab pain, Ulcerations To minimize ulcers in people over 65 or comorbid med conditions and on anticoagulant use COX 2 selective and helps to take with food
Other: Renal dysfunction, hypersensitivity reactions, rash, CNS, avoid late in pregnancy because closes off ductus arteriosus
Skin affected for SJS, TENs caution with aspirin, decrease liver function and stop use before operation |
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Term
| Drug interactions of NSAIDS |
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Definition
Drug Interactions: Anticoagulants and antiplatelets- higher bleeding risk
Corticosteroids, bisphsphonates- GI effect so high risk for ulcer
Renal mech/excretion- Methotrexate, lithium
Renal toxicity- cyclosporine, antibiotics like vancomycin
Antihypertensives- decrease antihypertensive effects, increase vascular volume and salt retention |
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Term
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Definition
| increase in MI, CVA, HTN, also GI irritation and ulcers. Watch if concurrently using aspirin, anticoagulants, corticosteroids, smoking, alcohol, and elderly |
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Term
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Definition
Irreversible inhibitors of Cox
MoA: Act like NSAID’s but for the entire life of the platelet. |
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Term
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Definition
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Term
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Definition
Uses: Reduce risk of TIA, stroke, MI, unstable and chronic stable angina
Low dose= analgesic and 1st order High dose= anti-inflammatory and zero order
Metabolism: rapidly cleared by kidney and converted in liver. Low dose decreases uric acid and high dose increases uric acid. |
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Term
| Aspirin Contraindications |
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Definition
| Contraindications: Children w/ fever because risk of Reye’s syndrome which is fatal hepatitis w/ cerebral edema |
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Term
| Nonacetylated Salicylates actin and drugs |
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Definition
less effect on platelets than acetylated
Salsalate, diflunisal, choline salicylate, main one is magnesium salicylate (Doan’s) |
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Term
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Definition
| Ketoprolac, Etldolac,Diclofenac, Indocin |
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Term
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Definition
| Ketorolac (toradol) indicated for short term relief of moderate to severe pain for up to 5 days after 1st dose. Can cause fatal peptic ulcers, Gi bleeding and or perforation of stomach or intestines |
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Term
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Definition
| is used for PDA, inflammatory/ bursitis and tendonitis, and acute gouty arthritis. Taken orally or injected |
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Term
| NSAIDs propionic acids drugs |
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Definition
| Fenoprofen, flurbiprofen (ansaid), Ibuprofen (motrin, Advil) Ketoprofen (orudis) Naproxen sodium (Aleve, naprosyn) Oxaprozin (daypro) |
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Term
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Definition
Meclofenamate (melomen)- inflammatory disorder, mild pain, primary dysmenorrheal
Mefenamic Acid (ponstel)- mild pain and primary dysmenorrheal- used more often |
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Term
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Definition
| Piroxicam (feldene) rheumatoid and osteoarthritis |
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Term
| Preferential Cox-2 inhibitor |
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Definition
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Term
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Definition
Celcoxib (celebrex)
Rofefcoxib (vioxx), valdecoxib (bextra) removed from market |
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Term
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Definition
| MoA: Inhibits PG synthesis in CNS so analgesic and antipyretic. Weak inhibitor of COX in periphery but not anti-inflammatory and doesn’t inhibit platelet function |
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Term
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Definition
| Uses: analgesic/antipyretic for children with viral or chicken pox, pts w/ gastric disorders and does not antagonize uricosuric agents |
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Term
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Definition
| Kinetics: 1st pass affect, metabolized and can be dangerous reaction w/sulfhydryl groups. At normal doses this is non toxic |
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Term
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Definition
| SE: within normal doses not many. High doeses reaction with sufhydryl groups and get hepatic necrosis and renal tubular necrosis, If overdose N-acetylcystein can be life saving |
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Term
| Disease Modifying Antirheumatic Agents (DMARDs) |
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Definition
Slow progress of disease and induce remission preventing further destruction of the joints. Most patients on multiple drugs not one that is effective in every pt.
NSAIDs, COX 2 inhibitors, corticosteroids in addition to DMARDs
Methotrexate, Leflunomide (Arava), hydroxychloroquine (Plaquenil), sulfasalazine, D-Penicillamine, Gold salts, etanercept (Enbrel), Infliximab (Remicade), Adalimumab (Humira), Anakinra (Kineret), abatacept (Orencia), rituximab (Rituxin) |
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Term
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Definition
| : inhibits dihydrofolic acid reductase stopping synthesis of purine nucleotides, interferes with DNA synthesis, repair and replication, slows appearance of new erosions but can take 3-6 weeks. Much smaller dose than for chemo and only once per week |
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Term
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Definition
SE: GI- mucosoal ulcerations and nausea
Black box: bone marrow depression, hepatotoxicity, fibrosis and cirrhosis, lung lesions, diarrhea, ulcerative stomatitis, hemorrhages, fetal death or abnormalities, fatal infections, skin reactions, malignant lymphomas, reduction in dosage and careful monitoring for renal use |
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Term
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Definition
MoA: cause cell arrest of autoimmune lymphocytes action on DHODH which is necessary for pyrmidine synthesis, after metabolism it becomes an irreversible inhibitor of DHODH
Kinetics: absorbed well and bound to albumin, very long half life of 14-18 days, excreted in urine and feces |
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Term
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Definition
| SE: headache, diarrhea, nausea, wt loss, allergies, rashes, alopecia, hyokalemia, don’t use in pregnancy and careful if hepatic and renal impairment, possible infection so watch CBC’s |
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Term
| Hydroxychoroquine use and MoA |
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Definition
Used for early to mild RA but doesn’t slow joint damage, very small SE
MoA: inhibit phospholipase A2 and platelet aggregation but watch for renal toxicity |
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Term
| Biologic Therapies for RA |
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Definition
| Interleukins 1b and TNF-alpha are proinflammatory cytokines. They stimulate synovial cells to proliferate and make collagenase which will degrade the cartilage. TNF-a inhibitors decrease S and Sx of RA. Improvement seen in 2 weeks, Standard care is becoming TNF-a inhibitor and Methotrexate. Cannot give with a 1L-1 receptor antagonist like anakinra |
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Term
| TNF-alpha inhibitors MoA and Drugs |
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Definition
| Inhibit TNF-A which is a proinflammatory cytokine w/ RA Entancerept, infliximab, adalimumab, Abatacept, Rituximab |
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Term
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Definition
| SQ injection, binds to TNF-a, tolerated with local injection site |
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Term
| SE of TNF alpha inhibitors |
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Definition
| Increases risk for infection, especially fungal, risk of pancytopenia, do not give live vaccinations while on this, careful when pt has CHF. |
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Term
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Definition
IV Chimeric monoclonal antidbody of human and murine regions and binds to human TNF-a
Uses: combo with MTX in RA, psoriases, psoriatic arthritis, ulcerative colitis, ankylosing and spondylitis and Crohn’s disease
Not used as stand alone therapy |
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Term
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Definition
| : infusion reactions, infections, leucopenia, neutropenia, thrombocytopenia and pancytopenia |
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Term
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Definition
Indicated for severe RA w/ or w/o MTX, psoriasis, psoriatic arthritis, ankylosing spondylitis and Crohn’s disease
SQ and binds to TNF alpha and low AE, HA/n/rash at injection site, for sever RA |
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Term
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Definition
| Recombinant fusion protein of human CTLA4 and competes w/ CD28 for binding on CD80 which prevents full T-cell activation |
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Term
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Definition
SE: HA, URI, nasopharyngitis and nausea
Do not use concurrent with TNF inhibitors because risk of infection |
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Term
| Rituximab action and uses |
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Definition
IV genetically engineered antibody resulting in B cell depletion.
Uses: reduces joint erosion and use when inadequate response to 1 or more TNF inhibitors |
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Term
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Definition
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Term
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Definition
Prevent sever immune response to transplanted organs (rejection)
Sever cases of inflammatory diseases like rheumatoid arthritis, inflammatory bowel disease and other autoimmune conditions |
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Term
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Definition
Drugs:
Cyclosprine and Tacrolimus- Inhibit T-Cells
Azathioprine- inhibit DNA, RNA, and protein synthesis
Lymphocyte immune globulin- alter decrease formation of T-cells
Methotrexate- Block metabolism of folic acid
Muromonab- CD3- used for treatment of kidney transplant rejection
Myocophenolate mofetil- inhibits T-cells, B-cells, and antibody formation |
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Term
| Pharmacological treatment of Gout drugs |
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Definition
NSAIDS: indomethacin
Colchicine
Glucocorticoids: prednisone, triamcinolone
Uricosuric Agents: probenecid, sulfinpyrazone
Xanthine Oxidase Inhibitor: Allopurinol (Zyloprim®) |
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Term
| Dietary treatment for gout |
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Definition
| Avoid alcohol, high purine foods like anchovies, liver, herring, game meets, gravy, Only eat moderate purine food like asparagus, lentils, beef, pork and seafood in moderation and good hydration to excrete uric acid |
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Term
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Definition
| Anti-inflammatory/Anti Gout decreases leukocyte mobility, decrease phagocytosis in joints, decrease deposition of urate crystals. Anti-inflammatory, anti-gout |
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Term
| SE of Colchine and caution |
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Definition
Caution: serious renal, GI, liver, hematoligic, and pregnancy
SE: GI: N/V/D, ab pain and anorexia
Alopecia and hematologic abnormalities
DI: Cyp 450 so toxic with CYP inhibitors, decrease effects with acidic agents and increase effects with alkaline agents |
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Term
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Definition
NSAID
inhibits prostaglandin synthesis by inhibiting cyclooxygenase |
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Term
| Contraindication and SE for Indomethacin w/ Gout |
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Definition
NSAID or aspirin allergy, PUD, renal problems, CHF, HTN, thrombocytopenia
SE: CNS- headache, dizziness, tinnitus
GI: N/v, dyspepsia, ab pain, GI bleed
Hematologic: inhibition of plately aggregation
Black Box for GI ulcerations |
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Term
| Uricosuric Medications MoA |
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Definition
MoA: increase excretion of uric acid inhibiting renal tubular reabsorption
Administration: start w/ low dose and increase over several weeks. Keep hydrated, alkalinize urine |
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Term
| Caution of uricosuric medications |
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Definition
| Contraindicated in renal impairment (CrCl < 50mL/min) |
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Term
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Definition
| Probenecid, sulfinpyrazone |
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Term
| Probenecid (Benemid)MoA and use |
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Definition
Uricorsuric agent
MoA: competitively inhibits reabsorption of uric acid at PCT increasing it’s excretion
Use: prevent gouty arthritis, hyperuricemia, also for prolongation of antibiotic effects |
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Term
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Definition
SE: HA, dizziness, flushing, rash, pruritis, N/V. anorexia,gingival sores, dysuria, renal caliculi and may cause acute gout attack
DI: increase effects of methotrexate, guinolones, beta-lactams, NSAIDs |
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Term
| Sulfinpyrazone use and MoA |
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Definition
Uricosuric, anti-gout
MoA: increase urinary excretion of uric acid
Use: chronic gouty arthritis, intermittent |
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Term
| Allopurinol (zyloprim) MoA |
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Definition
| Inhibits xanthine oxidase (the enzyme that converts xanthine to uric acid), reduces production of uric acid |
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Term
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Definition
| Use: Prevents acute gout, DoC if history of urinary stones or renal function. Pretreatment in cytotoxic therapy to prevent uric acid nephrophathy |
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Term
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Definition
SE: Skin rash, N/V, leukopenia
DI: increase rash w/ certain antibiotics, increase bone marrow suppression with immunosuppressants, increase anticoagulants, decrease effect w/ ethanol |
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Term
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Definition
| Pegloticase and Febuxostat |
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Term
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Definition
| uricase and breaks down urate, lowers uric acid and gouty deposits, use for treatment resistant gout, sever infusion and allergic reaction and gout flare, very very expensive, more than 20,000/year |
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Term
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Definition
| Xanthine oxidase inhibitor like allopurinol, and is used for people who can’t take allopurinol or high doses, cost under 2,000 per year |
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