Pain Management Drugs

Front 1

NSAIDs

Back 1

Nonsteriodal Antiinflammatory Drugs

Front 2

DMARDs

Back 2

Disease-Modifying Antirheumatic Drugs

Front 3

Antigout

Back 3

Drugs for the prevention of management of gout

Front 4

Anti-inflammatory drugs

Back 4

-Salicylates, corticosteroids, NSAIDs
- Release of chemical mediators: Histamine, Prostaglandins, Kinins

Front 5

Aspirin

Back 5

FIRST NSAIDs

⦁ Blocks both Cox 1 and Cox 2
⦁ Platelet inhibition (good for cardiac patients, but increased risk of bleeding)
*** GI irritation—try enteric coated
***Take with food
⦁ Interaction with other NSAIDS—blocks their action
⦁ Hypersensitivities—tinnitis, dizziness, bronchospasm—require discontinuation of ASA

Front 6

ibuprofen (Motrin)

Back 6

NSAIDs

⦁ Block Cox 1 and Cox 2 to variable degrees
⦁ Used for chronic inflammatory conditions (i.e. arthritis)
⦁ GI irritation and bleeding risk, in varying degrees
⦁ Variable half-lives, protein-binding, time-to-effect, and other side effects
Heart attack, stroke, life-threatening skin reactions have led to removal of some NSAIDs

Front 7

meclofenamate (Meclomen)

Back 7

NSAIDs

⦁ Block Cox 1 and Cox 2 to variable degrees
⦁ Used for chronic inflammatory conditions (i.e. arthritis)
⦁ GI irritation and bleeding risk, in varying degrees
⦁ Variable half-lives, protein-binding, time-to-effect, and other side effects
Heart attack, stroke, life-threatening skin reactions have led to removal of some NSAIDs

Front 8

meloxicam (Mobic)

Back 8

NSAIDs

⦁ Block Cox 1 and Cox 2 to variable degrees
⦁ Used for chronic inflammatory conditions (i.e. arthritis)
⦁ GI irritation and bleeding risk, in varying degrees
⦁ Variable half-lives, protein-binding, time-to-effect, and other side effects
Heart attack, stroke, life-threatening skin reactions have led to removal of some NSAIDs

Front 9

indomethacin (Indocin)

Back 9

NSAIDs

⦁ Block Cox 1 and Cox 2 to variable degrees
⦁ Used for chronic inflammatory conditions (i.e. arthritis)
⦁ GI irritation and bleeding risk, in varying degrees
⦁ Variable half-lives, protein-binding, time-to-effect, and other side effects
Heart attack, stroke, life-threatening skin reactions have led to removal of some NSAIDs

Front 10

ketorolac (Toradol)

Back 10

NSAIDs

⦁ Block Cox 1 and Cox 2 to variable degrees
⦁ Used for chronic inflammatory conditions (i.e. arthritis)
⦁ GI irritation and bleeding risk, in varying degrees
⦁ Variable half-lives, protein-binding, time-to-effect, and other side effects
Heart attack, stroke, life-threatening skin reactions have led to removal of some NSAIDs

Front 11

celecoxib (Celebrex)

Back 11

⦁ Better GI protection
⦁ Less impact on platelet function

-Well absorbed from GI tract
*Should not be taken with anticoagulant medications
*Require caution with liver or kidney dysfunction
Keep well hydrated
*Should be taken with food
*Should be stopped for GI irritation, bleeding, sensitivity

Front 12

methotrexate (Mexate)

Back 12

Immunosuppressive Agents

-Low dose cancer suppressing agents
⦁ NSAID-Refractory RA
⦁ Suppress inflammation/immune reaction in the joint—slowing joint destruction
⦁ Can take several weeks for full therapeutic effect
**Serious side effects include increased risk of infections, liver failure, inflammation of GI tract, depression

OTHERS: azathioprine (Imuran), cyclophosphamide (Cytoxan)

Front 13

ethanercept (Enbrel)

Back 13

Immunomodulators
- Target immune cell activity in the joints to slow disease progression
- For moderate to severe symptoms refractory to NSAIDs and other DMARDs
⦁ EXTREMELY expensive, “designer” drugs
** Can take weeks to obtain full therapeutic effect.
⦁ Examples: adilimumab (Humira). Both are injectables. Leflonomide (Arava) and tofacitinib (Xeljanz) are oral. Infliximab (Remicade) is given IV.
** High risk of acquiring infections while on therapy
** Pre-treatment vaccines and testing required