Pharm 1-Liners: Nsaids And Dmards

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MOA of NSAIDS

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inhibit prostaglandin synthesis by inhibiting cyclo-oxygenase (cox)

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Difference between aspirin and other NSAIDS

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Aspirin irreversibly inhibits cyclooxygenase

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Four main actions of NSAIDS

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Anti-inflammatory, analgesia, antipyretic and antiplatelet activity

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Agent used for closure of patent ductus arteriosus

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Indomethacin

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Aspirin is contraindicated in children with viral infection

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Potential for development of Reye's syndrome

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SE of salicylates

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Tinnitus, GI bleeding

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NSAID also available as an ophthalmic preparation

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Diclofenac, ketoralac

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NSAID available orally, IM and ophthalmically

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Ketoralac

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NSAID that is used for acute condition, such as preop anesthesia and has limited duration (<5 days) of use due to nephrotoxicity

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Ketoralac

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Newer NSAID that selectively inhibits COX-2

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Celecoxib

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COX 2 inhibitors may have reduced risk of

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Gastric ulcers and GI Bleeding

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COX 2 inhibitors should be used cautiously in pts with

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Pre-existing cardiac or renal disease

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Acetaminophen only has

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Antipyretic and analgesic activity

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SE of acetaminophen

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Hepatotoxicity

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Antidote for acetaminophen toxicity

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N-acetylcysteine

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Drugs-Modifying Anti-Rheumatic Agents

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DMARDS

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DMARDs are slow acting drugs for

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Rheumatic disease

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Initial DMARD of choice for patients with RA

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Methotrexate

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Drug ofter used in combination with TNF – alpha inhitors for RA

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Methotrexate

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Causes bone marrow suppression

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Methotrexate

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SE of penicillamine

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Aplastic anemia and renal toxicity

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Interferes with activity of T-lymphocytes

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Hydroxychloroquine

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Anti-malarial drug used in rheumatoid arthritis (RA)

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Hydroxychloroquine

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SE of hydroxychloroquine

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Retinal destruction and dermatitis

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MOA of Leflunomide (newer agent)

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Inhibiting dihydroorotate dehydrogenase which leads to decreased pyrimidine synthesis, decreased T cell proliferation and decreased antibody production by B cells

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Proteins that prevent action of tumor necrosis factor alpha (TNF-alpha)

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Adalimumab, infliximab and etanercept

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Anti-rheumatic agent also used for ulcerative colitis

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Sulfasalazine

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Anti-rheumatic agent also used for Chron's disease

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Infliximab

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NSAID used in gout

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Indomethacin

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NSAID contraindicated in gout

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Aspirin

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MOA of colchicine (used in acute gout)

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Selective inhibitor of microtubule assembly

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SE of colchicine

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Kidney and liver toxicity, diarrhea

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Agent used to treat chronic gout by increasing uric acid secretion and excretion

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Probenecid and sulfinpyrazone

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Allopurinol treats chronic gout by decreasing uric acid production by inhibiting

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Xanthine oxidase