Fa: Msk, Derm, And Connective Tissue Pharm

Front 1

Aspirin
Mechanism

Back 1

Irreversibly inhibits cyclooxygenase (COX-1 & COX-2) by covalent acetylation, which decreases synthesis of Thromboxane A2 (TXA2) and prostaglandins.
Increase bleeding time until new platelets are produced (about 7 days)
No effect on PT, or PTT
A type of NSAID

Front 2

Aspirin
Clinical Use

Back 2

Low dose (<300 mg/day): Decrease platelet aggregation

Intermediate dose (300-2400 mg/day): Antipyretic and analgesic

High dose (2400-4000 mg/day): Anti-inflammatory

Front 3

Aspirin
Toxicity

Back 3

Gastric ulceration
Tinnitus (CN VIII)
Chronic use can lead to acute renal failure, interstitial nephritis, and upper GI bleeding.
Risk of Reye syndrome in children treated with aspirin for viral infection
Also stimulates respiratory centers, causing hyperventilation and respiratory alkalosis

Front 4

Ibuprofen
what type of drug is it?

Back 4

NSAIDs

Front 5

Naproxen
what type of drug is it?

Back 5

NSAIDs

Front 6

Indomethacin
what type of drug is it?

Back 6

NSAIDs

Front 7

Ketorolac (Toradol)
what type of drug is it?

Back 7

NSAIDs

Front 8

Diclofenac
what type of drug is it?

Back 8

NSAIDs

Front 9

NSAIDs
Mechanism

Back 9

Reversibly inhibit cyclooxygenase (COX-1 and COX-2)
Block PG synthesis

Front 10

NSAIDs
Clinical use

Back 10

Antipyretic
Analgesic
Anti-inflammatory

Indomethacin is used to close a PDA

Front 11

NSAIDs
Toxicity

Back 11

Interstitial nephritis
Gastric ulcer (PGs protect gastric mucosa)
Renal ischemia (PGs vasodilate afferent arteriole)

Front 12

Celecoxib
What type of drug is it?

Back 12

COX-2 inhibitor

Front 13

Meloxicam
What type of drug is it?

Back 13

COX-2 inhibitor

Front 14

COX-2 inhibitor
Mechanism

Back 14

Reversibly inhibit COX-2, which is found in inflammatory cells and vascular endothelium and mediates inflammation and pain

Spares COX-1, which helps maintain the gastric mucosa (no gastric ulcers) and also spares TXA2

Front 15

COX-2 inhibitor
Clinical Use

Back 15

Rheumatoid arthritis
Osteoarthritis

Use in pts with gastritis or ulcers

Front 16

COX-2 inhibitor
Toxicity

Back 16

Increase risk of thrombosis
Sulfa allergy

Front 17

Acetaminophen
Mechanism

Back 17

Reversibly inhibitis cyclooxygenase, mostly in CNS
Inactivated peripherally

Front 18

Acetaminophen
Clinical use

Back 18

Antipyretic
Analgesic, but not anti-inflammatory
Used instead of aspirin to avoid Reye syndrome in children with viral infection

Front 19

Acetaminophen
Toxicity

Back 19

Overdose produces hepatic necrosis
- Acetaminophen metabolite (NAPQI) depletes glutathione and forms toxic tissue adducts in liver
- N- Acetylcysteine is antidote -> Regenerates glutathione

Front 20

Bisphosphonates. Alendronate, other -dronates
Mechanism

Back 20

Pyrophosphate analogs
Bind hydroxyapatite in bone, inhibiting osteoclast activity

Front 21

Bisphosphonates. Alendronate, other -dronates
Clinical Use

Back 21

Osteoporosis
Hypercalcemia
Paget disease of bone

Front 22

Bisphosphonates. Alendronate, other -dronates
Toxicity

Back 22

Corrosive esophagitis (pts are advise to take with water and remain upright for 30 min)
Osteonecrosis of the jaw

Front 23

Chronic gout drugs (preventive) are...

Back 23

Allopurinol
Febuxostat
Probenecid

Front 24

Allopurinol
Mechanism

Back 24

Inhibits xanthine oxidase: Decrease conversion of xanthine to uric acid.
Also use in lymphoma and leukemia to prevent tumor lysis-associated urate nephropathy

All but the highest doses depress uric acid clearance. Even high doses (5-6g/day) have only minor uricosuric activity

Front 25

Allopurinol
Side effects

Back 25

Increase concentrations of Azathioprine and 6-MP (both metabolized by xanthine oxidase)

Do not give salicylates

Front 26

Febuxostat
Mechanism

Back 26

Inhibits xanthine oxidase

Front 27

Probenecid
Mechanism

Back 27

Inhibits reabsorption of uric acid in PCT (also inhibits secretion of PCN -> It will stay longer in the serum)

Front 28

Acute gout drugs are...

Back 28

NSAIDs: Naproxen or Indomethacin
Glucocorticoids: Oral or intraarticular
Colchicine

Front 29

Colchicine
Mechanism
Side effects

Back 29

Binds and stabilizes tubulin to inhibit microtuble polymerization, impairing leukocyte chemotaxis and degranulation

GI Side effects

Acute and prophylactic value

Front 30

TNF-Alpha inhibitors
Side effects

Back 30

Predispose to infection, including reactivation of latent TB

TNF blockade prevents activation of macrophages and destruction of phagocytosed microbes

Front 31

Etanercept
What type of drug is it?

Back 31

TNF-Alpha inhibitor

Front 32

Etanercept
Mechanism

Back 32

Fusion protein (receptor for TNF-alpha and IgG-Fc), produced by recombinant DNA

Front 33

Etanercept
Clinical use

Back 33

Rheumatoid arthritis
Psoriasis
Ankylosing spondylitis

Front 34

Infliximab
What type of drug is it?

Back 34

TNF- alpha

Front 35

Adalimumab
What type of drug is it?

Back 35

TNF-alpha

Front 36

Infliximab, adalimumab
Mechanism

Back 36

Anti-TNF-alpha monocloncal antibody

Front 37

Infliximab, adalimumab
Clinical Use

Back 37

IBD
Rheumatoid Arthritis
Ankylosing Spondylitis
Psoriasis

Front 38

Back 38