Pharm 36 Nsaids, Dmards & Drugs Used In Gout

Front 1

advantages and disadvantages of celecoxib, rofecoxib, valdecoxib?

Back 1

(COX 2 selective)
Less GI effects
Increased risk of MI and stroke

Front 2

difference between aspirin and other NSAIDs?

Back 2

aspirin is irreversible, longer duration of antiplatelet effect

Front 3

MOA of NSAIDs?

Back 3

inhibit cyclooxygenase which converts arachidonic acid into prostaglandins (inflammation)

Front 4

What cells express cox 1 and cox 2?

Back 4

cox 1: noninflammatory cells

cox 2: activated lymphocytes, pmns, other inflammatory cells

Front 5

antipyretic effect of NSAIDs?

Back 5

inhibits prostaglandin synthesis in CNS that is stimulated by pyrogens

Front 6

MOA of typical NSAIDs

Back 6

inhibit COX1/2 which suppresses PG synthesis (antipyretic and inhibition of peripheral pain sensors)

Front 7

effects of dose ranges of aspirin?

Back 7

<300mg/d: antiplt

300-2400mg/d: antipyretic and analgesic

2400-4000mg/d: anti-inflammatory

Front 8

indications for non-aspirin NSAIDs?

Back 8

moderate pain, esp MS inflammation from arthritis, gout

Front 9

long term use of NSAIDs is associated with what?

Back 9

reduced risk of colon cancer

Front 10

toxic effects of aspirin

Back 10

GI upset
upper GI bleeding
acute renal flr, interstitial nephritis
inc PT/PTT
asthma (in hypersensitive pts)
Reye's syndrome (children)

high dose: tinnitus, vertigo, hyperventilation, resp alkalosis.

very high dose: met acidosis, dehydration, hyperthermia, collapse, coma, death

Front 11

what is Reye's syndrome?

Back 11

rare syndrome of rapid liver degeneration and encephalopathy in children with viral infxn who are tx with aspirin

Front 12

toxic effects of nonselective NSAIDs

Back 12

GI upset
renal damage

Front 13

which NSAID is associated with serious hematologic reactions?

Back 13

indomethacin

Front 14

MOA of acetaminophen

Back 14

unclear -- but weak COX1&2 inhibitor in peripheral tissues, may inhibit COX3 in CNS

no anti-inflammatory effect

Front 15

indications for acetaminophen?

Back 15

fever, pain

Front 16

DOC for children with viral infection?

Back 16

Acetaminophen (to avoid Reye's)

Front 17

toxic effects of acetaminophen?

Back 17

in OD and alcoholics, hepatotoxicity

(oxidation by phase I P450 enzymes when phase II enzymes are lacking leads to buildup of toxic metabolite)

Front 18

DOC for acetaminophen OD?

Back 18

acetylcysteine

Front 19

MOA of methotrexate

Back 19

reduces number of immune cells available to maintain inflammatory response in RA

Front 20

DMARDs that interfere with T-cell activity?

Back 20

sulfasalazine, hydroxychloroquine, cyclosporine, leflunomide, mycophenolate mofetil, abatacept

Front 21

DMARDs that interfere with B cell activity?

Back 21

rituximab

Front 22

DMARDs that inhibit TNF-alpha?

Back 22

infliximab, adalimumab, etanercept

Front 23

MOA of colchicine?

Back 23

selective inhib of microtubule assembly, reduces leukocyte migration and phagocytosis

inhib leukotriene B4 synthesis

decr free radical formation

Front 24

anti-inflammatory drugs used for gout?

Back 24

potent NSAIDs (indomethacin)
Colchicine

Front 25

DOC for acute gouty arthritis?

Back 25

indomethacin or glucocorticoid

Front 26

toxicity of indomethacin?

Back 26

bone marrow suppression, renal damage

Front 27

drugs used in gout?

Back 27

anti-inflammatory drugs
uricosuric drugs
xanthine oxidase inhibitors

Front 28

uricosuric agents?

Back 28

probenecid, sulfinpyrazone

Front 29

MOA of probenecid?

Back 29

increase uric acid excretion by competing with uric acid for reabs by transporters in PCT

Front 30

uses of uricosuric agents?

Back 30

chronic gout

used to inhibit secretion of penicillins, methotrexate

Front 31

main side effect of uricosuric drugs?

Back 31

can precipitate acute gout attack during early phase of action (avoid by also giving colchicine or indomethacin)

Front 32

MOA of allopurinol?

Back 32

irreversible suicide inhibitor of xanthine oxidase
(converts hypoxanthine to xanthine to uric acid)

Front 33

MOA of febuxostat?

Back 33

non-purine inhibitor of xanthine oxidase, more selective than allopurinol/alloxanthine

Front 34

use of xanthine oxidase inhibitors?

Back 34

given orally in tx of chronic gout, also used as adjunct to cancer chemotherapy (uric acid released in death of neoplastic cells)

Front 35

toxic effects of xanthine oxidase inhibitors?

Back 35

can precipitate acute gout attack (dose with colchicine or NSAID to avoid), GI upset

Allopurinol: rash, periph neuritis/vasculitis/BM dysfxn (rare), inhibits metab of mercaptopurine and azathioprine

Febuxostat: abnml liver fxn, HA

Front 36

NSAID that is relatively safe, inexpensive, moderate effectiveness, 2 h half life?

Back 36

ibuprofen

Front 37

NSAID with moderate effectiveness, but long half-life?

Back 37

naproxen

Front 38

strong NSAID with greater anti-inflammatory effectiveness and greater toxic effects

Back 38

indomethacin

Front 39

parenteral NSAID with greater analgesic effectiveness

Back 39

ketorolac

Front 40

pts with nasal polyps are predisposed what effect of NSAIDs?

Back 40

aspirin hypersensitivity asthma

Front 41

DMARDs also used in IBD?

Back 41

sulfasalazine, anti TNF drugs (infliximab, etanercept, adalimumab)

Front 42

DMARDs also used as antimalarial?

Back 42

hydroxychloroquine