• Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

A key: Read text to speech.a key

image

Play button

image

Play button

image

Progress

1/114

Click to flip

114 Cards in this Set

  • Front
  • Back
folic acid
vitamin, hematologic agent; synthesis of pyrimidine/purine bases/AA and prevents/tx megaloblastic anemia, prevents neural tube defects and CAD
diet of organ meat, beans veggies
dec in alcoholics, preg, poor diet
homocysteine inc w/ deficiency
MTX, trimethoprim, pyrimethamine, phenytoin
iron dextran
IM/IV is ferric hydroxid and dextran (glucose); poss anaphylactic rxn in children and 10 tablets can be lethal
tx: iron deficiency
deferoxamine
iron chelator to treat iron overdose and also a whole bowel irrigation; overload poss caused by hemochormatosis, excess storage, genetic, many RBC transfusions
ferrous sulfate
tx: iron deficiency orally 3x/day
food dec absorption but poss necessary b/c gastric distress
intake from meat and vitamin C enhances; reduced form is ferrous that can bind to O2 w/ Hb and is oxidized as stored ferric; absorbed in duodenum and porx jejunum and bound to tranferrin; stored as ferritin; lasts 120 days adn degraded by reticuloendothelial cells; iron is recycled
newborns, preg, menstration, female athlets, surgery, disease can cause iron def
ferrous gluconate
tx: iron deficiency orally 3x/day
food dec absorption but poss necessary b/c gastric distress
intake from meat and vitamin C enhances; reduced form is ferrous that can bind to O2 w/ Hb and is oxidized as stored ferric; absorbed in duodenum and porx jejunum and bound to tranferrin; stored as ferritin; lasts 120 days adn degraded by reticuloendothelial cells; iron is recycled
newborns, preg, menstration, female athlets, surgery, disease can cause iron def
ferrous fumarate
tx: iron deficiency orally 3x/day
food dec absorption but poss necessary b/c gastric distress
intake from meat and vitamin C enhances; reduced form is ferrous that can bind to O2 w/ Hb and is oxidized as stored ferric; absorbed in duodenum and porx jejunum and bound to tranferrin; stored as ferritin; lasts 120 days adn degraded by reticuloendothelial cells; iron is recycled
newborns, preg, menstration, female athlets, surgery, disease can cause iron def
cyanocobalamin
inactive B12 (from meat and dairy); IF binds pareital cells to absorb
w/ B12 def inc methymalony-CoA and homocystine and dec succinyl coa
- nasal spray less preferred
hydroxocobalamin
for pernicious anemia defective IF give B12 parenterally IM daily for 2 wks then 1/mo for life if malabsortion;
-stays longer in circulation b/c highly bound to palsma proteins


inactive B12 (from meat and dairy); IF binds pareital cells to absorb
w/ B12 def inc methymalony-CoA and homocystine and dec succinyl coa
deoxyadenosylcobalamin
active forms of B12
methycobalamin
active forms of B12
epoietin a
SE: HTN

poss dec need for transfusion and inc QOL; inc Hct or Hb dec EPO except in renal disease which a dec in EPO is concurrent w/ anemia
tx: hematologic malignancies like lymphoma, HF, chemo, HIV therapy, chronic RF (add folate and iron)
--recombanent human EPO
darbepoetin alfa
3x longer HL b/c of inc in sialic acid content!!!!
SE HTN

poss dec need for transfusion and inc QOL; inc Hct or Hb dec EPO except in renal disease which a dec in EPO is concurrent w/ anemia
tx: hematologic malignancies like lymphoma, HF, chemo, HIV therapy, chronic RF (add folate and iron)
epoetin beta
SE: HTN

poss dec need for transfusion and inc QOL; inc Hct or Hb dec EPO except in renal disease which a dec in EPO is concurrent w/ anemia
tx: hematologic malignancies like lymphoma, HF, chemo, HIV therapy, chronic RF (add folate and iron)
filgrastim
hematopoietic GF; recombinant human granulocyte CSF
--by E coli dec infections esp after chemo
SE: bone pain
tx neutropenia assoc w/ cancer chemo and BM transplant
pegfilgrastim
filgrastin + polyethylene glycol which inc HL to 42 hrs b/c inc size for renal clearance;

hematopoietic GF; recombinant human granulocyte CSF

SE: bone pain
tx neutropenia assoc w/ cancer chemo and BM transplant
sargramostim
HL is 4; lymphoma pts; GM-CSF

SE: bone pain
tx neutropenia assoc w/ cancer chemo and BM transplant
erythropoietin in renal disease
dec w/ anemia (dec of hb and Hct)
also needs folate and iron
warfarin
oral; delayed 3-5 days; inhib synthesis of 2, 7, 9, 10 by blocking vit K reductase; monitor w/ PT
NOT IN PREG;
tx: articifical heart valve, log term prophylaxis, stroke/MI prevention; prevents embolism
SE: bleeding poss hemorrhage, fetal warfarin syndrome (hemorrhage in fetus), chrondrodysplasia punctata (abnl bone formation)
extrinsic pathway
coumarin
warfain and dicumarol comes form it
dicumarol
warfarin but causes GI distress
phytonadione
antitode to warfarin toxicity; basically vit K1
tx warfarin toxicity
phytonadione, FFP, factor 9 conc
side effects of warfarin
SE: bleeding poss hemorrhage, fetal warfarin syndrome (hemorrhage in fetus), chrondrodysplasia punctata (abnl bone formation)
warfarin drug interations
inc PT (inc effects)- cimetidine, aspirin, cephalosproin, heaprin, sulfa, hepatic disease
dec PT- barbituates, fifampin, diruetic, vit k , hereditary resistance
heparin
yes preg
antithrombotic agent
active in vitro; not absorbed from gut (acidic) so parenteral IV/subQ; NOT IM; immediate effect
inhibits thrombin and Xa slowly to prevent clotting
SE: hemorrage in elderly/RF, TP hyperK (dec aldosterone), osteoporosis if chronic admin
Tx: A-fib, STEMI, acute TE, acute therpay, DVt; pregnant woman, embolism, CV surgery, renal dialysis, blood transfusions, blood sampling **venous thromboembolism
monitor w/ aPPT
overdose-protamine sulfate
effect inc by other thormbotic agents
enoxaparin
yes preg

LMWH inact factor Xa (more bioavailable but less effective than HMW fractions)
-prevent DVT, embolism, thormbosis in unstable angina, MI
more predictable effects than heparin; no need to monitor w/ aPTT
SE: bleeding TP (sufonated)
dalteparin
yes preg
GI irritaiton; inact Factor Xa
MWH (more bioavailable but less effective than HMW fractions)
-prevent DVT, embolism, thormbosis in unstable angina, MI
more predictable effects than heparin; no need to monitor w/ aPTT
SE: bleeding TP (sufonated)
fondaprinux
yes preg
heparin synthetic pentasaccharide
inact Factor Xa
MWH (more bioavailable but less effective than HMW fractions)
-prevent DVT, embolism, thormbosis in unstable angina, MI
more predictable effects than heparin; no need to monitor w/ aPTT
SE: bleeding TP (sufonated)
bivalirudin
hirudin analogue (leeches); direct thrombin inhib binds catalytic substract recognition sites; disrupt binding of fibirongen to thrombin
**no TP
TX: acute coronary sydnrome an dheparine-induced TP
lepirudin used over bivalirudin

NOT used in active bleed
preg yes
tx heparin toxicity
protamine sulfate b/c highly alkaline or FFP
protamine sulfate
tx heparin toxicity
lepirudin
hirudin analogue (leeches); direct thrombin inhib binds catalytic substract recognition sites; disrupt binding of fibirongen to thrombin
**no TP
TX: acute coronary sydnrome an dheparine-induced TP
lepirudin used over bivalirudin

NOT used in active bleed
preg yes
aspirin
inhibits COX-1 in plts; acetylates serine on plt irrev
dec TXA2 less effect on PGI2; prevent plt agg
TX: unstable angina, TIA, stroke prevention, AMI, prevent rhombisis or dec enlargement, artificial heart valve, acute; low doses
high doses: inflammatory disroders, pain, fever
SE: GI bleed, heart burn, nausea, allegic, anaphylaxis; overdose=tinnitis, resp alkalosis and met acidosis
inc effect by anticoag, thormbolytics, exretion inc by alkalinzing urine; ibuprofen can negate antiplt effect

antiplt drugs
clopidogrel
block ADP receptors (which induces GP2b/3a for fibrinogen); inhib plt agg


Tx: prophylactic for ischemia; esp if person is allergic to aspirin
additive effective w/ aspirin

antiplt drugs
ticlodipine
block ADP receptors (which induces GP2b/3a for fibrinogen); inhib plt agg
additive effects w/ aspirin

MORE LIKELY TO CAUSE NEUTORPENIA; food intereferes w/ absorption

Tx: prophylactic for ischemia; esp if person is allergic to aspirin

antiplt drugs
abciximab
plt GP receptor antag to 2b/3a;
mAb to GP Rc; irrev bind to GP2b3a; no agg; percutaneous coronary interventions for procedures

-poss TP,bleeding; antiplt drugs
tiriofiban
block Gp2b/3a R competitative rev fibirongen atag; minic fibriongen (analog)
tx: acute coronary syndrome (unstable angina and MI)

antiplt drugs
eptifibatide
block Gp2b/3a R competitative rev fibirongen atag; minic fibriongen (analog)
tx: acute coronary syndrome (unstable angina and MI)

antiplt drugs
alteplast
recombinant tPA- tissue palsminogen activatory- act fibirn bound plasinogen to palsmin
preferentioally act plaminogen
tx: acute AMI, ischemia thrombotic stroke, pulm embosim, STEMI, hemipariesis, HA, blurred vision

CI: active bleed; hemorrhagic stroke, sever HTN, intracrainial surgery/trauma, aneurysm, tumor
SE: bleeding, reperfusion arrhythmias
Inx: inc effect by antithormbotic agents
reteplase
recombinant tPA- tissue palsminogen activatory- act fibirn bound plasinogen to palsmin
preferentioally act plaminogen
tx: acute AMI, ischemia thrombotic stroke, pulm embosim, STEMI, hemipariesis, HA, blurred vision

CI: active bleed; hemorrhagic stroke, sever HTN, intracrainial surgery/trauma, aneurysm, tumor
SE: bleeding, reperfusion arrhythmias
Inx: inc effect by antithormbotic agents
tenecteplase
recombinant tPA- tissue palsminogen activatory- act fibirn bound plasinogen to palsmin
preferentioally act plaminogen
tx: acute AMI, ischemia thrombotic stroke, pulm embosim, STEMI, hemipariesis, HA, blurred vision

CI: active bleed; hemorrhagic stroke, sever HTN, intracrainial surgery/trauma, aneurysm, tumor
SE: bleeding, reperfusion arrhythmias
Inx: inc effect by antithormbotic agents
plasmin
endogenous anti-plamsins preclude the use of palsmin...drugs are activated w/in clot ("protected")
streptokinase
indirect fibrionlytic drug; joins plsainogen to palsmin; lacks fibirn specificity; not enzymatic;
antistreplase=stretokinase +plasminogen

activater-->thormbolysis


INDICATED FOR PULMONARY EMBOLISM
urokinase
catalytic; from human urine
plasminogen activater-->thormbolysis


INDICATED FOR PULMONARY EMBOLISM
antiplasmins
inactivates plasmin before it can become bound to fibirn;
so create clots
aminocaproid acid
inhibits plasminogen for fibrinolytic drugs; tx toxicity
ex: anistreplase, reteplase, streptokinase, tencteplase, urokinase, alteplase
atorvastatin
can take daily anytime, flourine #2 drug
- inhibit acetyl-Coa by blocking HMG-CoA reductase which prevents CH from being made; inc LDL Rc expression in liver; inc LDL remvoal form paslma; dec hepatic CH synthesis; inc clearance of cH;
-act in GI tract
dec mevalonic acid (CH precursor)
inhibits rate-limiting enzyme in CH biosynthesis
Tx: hypercholesterolemia 2a and atherosclerosis
can combine w/ ezetimibe and bile acid-binding agents
SE: myalgia, myositis, rhabodomyolysis; liver tox (hepatitis: GI distress; monitor urin and CK levels
effects inc by cyclosporine, gemfibrozil, niacin, azole, antifungals, erythromycin, grafuit juice; inc warfarin
inc HDL and dec TGs too
**most have short HL 2-3 hrs w/ noctural peak
CYP3A
fluvastatin
active fluorine; least myopathy
- inhibit acetyl-Coa by blocking HMG-CoA reductase which prevents CH from being made; inc LDL Rc expression in liver; inc LDL remvoal form paslma; dec hepatic CH synthesis; inc clearance of cH;
-act in GI tract
dec mevalonic acid (CH precursor)
inhibits rate-limiting enzyme in CH biosynthesis
Tx: hypercholesterolemia 2a and atherosclerosis
can combine w/ ezetimibe and bile acid-binding agents
SE: myalgia, myositis, rhabodomyolysis; liver tox (hepatitis: GI distress; monitor urin and CK levels
effects inc by cyclosporine, gemfibrozil, niacin, azole, antifungals, erythromycin, grafuit juice; inc warfarin
inc HDL and dec TGs too
**most have short HL 2-3 hrs w/ noctural peak
CYP3A
lovastatin
food inc absorption; (do NOT give if have GI probs); BBB cross-->sleep disturbances; Mevacor; inactive lactone prodrug (act in GI tract)

- inhibit acetyl-Coa by blocking HMG-CoA reductase which prevents CH from being made; inc LDL Rc expression in liver; inc LDL remvoal form paslma; dec hepatic CH synthesis; inc clearance of cH;
-act in GI tract
dec mevalonic acid (CH precursor)
inhibits rate-limiting enzyme in CH biosynthesis
Tx: hypercholesterolemia 2a and atherosclerosis
can combine w/ ezetimibe and bile acid-binding agents
SE: myalgia, myositis, rhabodomyolysis; liver tox (hepatitis: GI distress; monitor urin and CK levels
effects inc by cyclosporine, gemfibrozil, niacin, azole, antifungals, erythromycin, grafuit juice; inc warfarin
inc HDL and dec TGs too
**most have short HL 2-3 hrs w/ noctural peak
CYP3A
pravastatin
pravachol; no drug intx!!!!

- inhibit acetyl-Coa by blocking HMG-CoA reductase which prevents CH from being made; inc LDL Rc expression in liver; inc LDL remvoal form paslma; dec hepatic CH synthesis; inc clearance of cH;
-act in GI tract
dec mevalonic acid (CH precursor)
inhibits rate-limiting enzyme in CH biosynthesis
Tx: hypercholesterolemia 2a and atherosclerosis
can combine w/ ezetimibe and bile acid-binding agents
SE: myalgia, myositis, rhabodomyolysis; liver tox (hepatitis: GI distress; monitor urin and CK levels
effects inc by cyclosporine, gemfibrozil, niacin, azole, antifungals, erythromycin, grafuit juice; inc warfarin
inc HDL and dec TGs too
**most have short HL 2-3 hrs w/ noctural peak
CYP3A
rosuvastatin
crestor #1 drug; active fluourine; can take daily

- inhibit acetyl-Coa by blocking HMG-CoA reductase which prevents CH from being made; inc LDL Rc expression in liver; inc LDL remvoal form paslma; dec hepatic CH synthesis; inc clearance of cH;
-act in GI tract
dec mevalonic acid (CH precursor)
inhibits rate-limiting enzyme in CH biosynthesis
Tx: hypercholesterolemia 2a and atherosclerosis
can combine w/ ezetimibe and bile acid-binding agents
SE: myalgia, myositis, rhabodomyolysis; liver tox (hepatitis: GI distress; monitor urin and CK levels
effects inc by cyclosporine, gemfibrozil, niacin, azole, antifungals, erythromycin, grafuit juice; inc warfarin
inc HDL and dec TGs too
**most have short HL 2-3 hrs w/ noctural peak
CYP3A
simvastatin
zocor; inactive lactone; GI probs; food inc absorption; BBB-sleep disturbances; must give food

- inhibit acetyl-Coa by blocking HMG-CoA reductase which prevents CH from being made; inc LDL Rc expression in liver; inc LDL remvoal form paslma; dec hepatic CH synthesis; inc clearance of cH;
-act in GI tract
dec mevalonic acid (CH precursor)
inhibits rate-limiting enzyme in CH biosynthesis
Tx: hypercholesterolemia 2a and atherosclerosis
can combine w/ ezetimibe and bile acid-binding agents
SE: myalgia, myositis, rhabodomyolysis; liver tox (hepatitis: GI distress; monitor urin and CK levels
effects inc by cyclosporine, gemfibrozil, niacin, azole, antifungals, erythromycin, grafuit juice; inc warfarin
inc HDL and dec TGs too
**most have short HL 2-3 hrs w/ noctural peak
CYP3A
bile acid bind resins
colestipol, cholestyramine, colesevelam
colesevelam
bile acid binding resin
bile acids made from CH; bind and inhibit bile acid reabsorption form gut in jejunm an dileum which inc CH utilization; inc LDL Rc expression; these inhibit entero-hepatic cycling of bile
almost no SE; poss constipation
dec CH mainly
Tx: hypercholesterolemia in persons not tolerating other drugs; additive esp w/ statins; NOT effective in homozygous familiar hypercholesterolemia b/c they lack LDL Rc!!!
CI: inhib absroption of digoxin, TH, fat soluble vitamins, gemfibrozil, steroids
colestipol
bile acid binding resin
bile acids made from CH; bind and inhibit bile acid reabsorption form gut in jejunm an dileum which inc CH utilization; inc LDL Rc expression; these inhibit entero-hepatic cycling of bile
almost no SE; poss constipation
dec CH mainly
Tx: hypercholesterolemia in persons not tolerating other drugs; additive esp w/ statins; NOT effective in homozygous familiar hypercholesterolemia b/c they lack LDL Rc!!!
CI: inhib absroption of digoxin, TH, fat soluble vitamins, gemfibrozil, steroids
cholestryamine
bile acid binding resin
bile acids made from CH; bind and inhibit bile acid reabsorption form gut in jejunm an dileum which inc CH utilization; inc LDL Rc expression; these inhibit entero-hepatic cycling of bile
almost no SE; poss constipation
dec CH mainly
Tx: hypercholesterolemia in persons not tolerating other drugs; additive esp w/ statins; NOT effective in homozygous familiar hypercholesterolemia b/c they lack LDL Rc!!!
CI: inhib absroption of digoxin, TH, fat soluble vitamins, gemfibrozil, steroids
ezetimibe
in brush border of SI; inhib absorption of CH; 50% even w/o CH in diet; dec LDL, TG, inc HDL; tx: multiple lipid disorders but mainly hyperCHOL; DISRUPTS ANNEXIN-CAVEOLIN COMPLEX; HL 20hr; metab by conj w/ glucoronate
SE: very few
mostly dec LDL
additive w/ statins (vytorin)
fenofibrate
inc absorption w/ food; HL 20 hrs

fibric acid drug; inc; PPAR-a ligand binds promoter region of gene to transcriptional induct of LPL...inc; FFA into fat tissue to become TG
dec VLDL secertion inc clearance
***dec TG levels; blocks secretin
Tx: hypertriglercidemia and low HDL levels
CI: statins NO! same MOA and SE
SE: myopathy, rhabdomyolysis, BM suppresion, exfoliative dermatitis, fibrates potentiate warfarin
**monitor LFTs
gemfibrozil
fibric acid drug; inc; PPAR-a ligand binds promoter region of gene to transcriptional induct of LPL...inc; FFA into fat tissue to become TG
dec VLDL secertion inc clearance
***dec TG levels; blocks secretin
Tx: hypertriglercidemia and low HDL levels
CI: statins NO! same MOA and SE
SE: myopathy, rhabdomyolysis, BM suppresion, exfoliative dermatitis, fibrates potentiate warfarin
**monitor LFTs
niacin
B3 is incorporated into NAD in oxidation rxn; GPCR ligand inhibits lipolysis in adipose tissue and release of FA; dec TG syn and dec VLDL
B3 prevents atherosclerotic damage by inc ABCA1 w/ HDL
act LPL
best effect on CH dec CV mortality
tx: hypercholesterolemai, hyperTG, low HDL
SE: flusing, VD, GI distress; inc blood glc; aggrevate peptic ulcer (CI PUD); myopathy, rhabdomyolysis (do NOT combo w/ statin)
asprin pretx reduces VD and flushing
tx hyperCH
statin (HMG coa reductase inhib); bile acid binding resins (combo w/ statin), niacin (GCPR B3), ezetimibe (combo w/ statin; on brush border disrupts annexin-caveolin complex)
hyperTG and low HDL
gemfibrozil-fibrate blocks PPAR-a RE on gene inc LPL); Niacin- in NAD
tx high levels of both TG/CH
niacin
inc LDL, dec HDL, inc TG and has T1DM
use gemfibrozil NOT niacin
SE using gemfibrozil and statin
rhabdomyalysis
inc TG, nl HDL, high B band electorphoresis, fam hx MI w/ itraconazole
hyperlipproteiniemia so no LDLR can't use statins b/c of itraconazole and not bile acid b/c of no LDLRc so use niacin
adult male w/ inc VLDL, TG, LDL norm and dec HDL
niacin
NSAIDS tx:
inhib COX
tx: inflammation, pain, fever
Cox-1 is
consitutive (always there in kidneys, plt, GI tract); inability to form stomach protecting PG; dec TxA2
Cox-2 is
inducible and assoc w/ inflammation, less GI distress
aspirin
acetysalicylic acid ASA absorb in stomach, low gastric pH so in non-ionized form which enhances absorption can irritate mucosal lining; buffering can dec irritation by slowing absorption rate
Phase 1 metab- hydrolyzed acetic acid and salicylate by esterase in tissues and blood
Phase 2: conjugate w/ glycine; water-soluble
inhib TxA2 more than PGI2
tx: pain and fever at low dose and inflammation at high dose
NSAID;
tx: MI TIA, stroke
SE: GI bleed, epigastric distress, heartburn, nausea, allgery, overedose=tinnitus and resp alk
intx: inc by anticoags; inc excretion by alkalinizing urin; ibuprofen can negate antiplt effect
15 mins; 1-2 hrs as salycylate
high dose 15hrs
sat at phase 2 becomes zero order and subsequrent small dose inc result to build up serum salicylate
irrevercsible COX inhibitor
salicylate
rev COX inhibtor;
aspirin SE
low dose-GI distress w/ inc BT
high dose- tinnitis; resp depression as resp alkylosis to met acidosis
tx aspirin toxicity
gstric lavage; sodium bicarb alkalinizes
ibuprofen
2 hr HL NSAID; tx pain/inflammation assoc w/ trauma/infection; potency 3
inhib COX1/2 nonselective; synthesis of PG causing pain, fever and inflammation
tx: mild to mod pain or dysmenorrhea; infalmmatory disorders; osteoarthritis and RA
reduces risk of colon, breast, lung, prostate cancer
SE: GI bleed, N/V, dyspepsia, allergic rxn poss hepatitis, RF
Inx: NOT w/ GI probs inc renal tox; dec effect of antiHTNs; inc lithium; aspirin dec effects
diclofenac
approx 2 hr NSAID; pain/inflammation assoc w/ trauma/infection; potency 3
inhib COX1/2 nonselective; synthesis of PG causing pain, fever and inflammation
tx: mild to mod pain or dysmenorrhea; infalmmatory disorders; osteoarthritis and RA
reduces risk of colon, breast, lung, prostate cancer
SE: GI bleed, N/V, dyspepsia, allergic rxn poss hepatitis, RF
Inx: NOT w/ GI probs inc renal tox; dec effect of antiHTNs; inc lithium; aspirin dec effects
etodolac
approx 2 hr NSAID; pain/inflammation assoc w/ trauma/infection; potency 3
inhib COX1/2 nonselective; synthesis of PG causing pain, fever and inflammation
tx: mild to mod pain or dysmenorrhea; infalmmatory disorders; osteoarthritis and RA
reduces risk of colon, breast, lung, prostate cancer
SE: GI bleed, N/V, dyspepsia, allergic rxn poss hepatitis, RF
Inx: NOT w/ GI probs inc renal tox; dec effect of antiHTNs; inc lithium; aspirin dec effects
fenoprofen
NSAID; pain/inflammation assoc w/ trauma/infection; potency 3
inhib COX1/2 nonselective; synthesis of PG causing pain, fever and inflammation
tx: mild to mod pain or dysmenorrhea; infalmmatory disorders; osteoarthritis and RA
reduces risk of colon, breast, lung, prostate cancer
SE: GI bleed, N/V, dyspepsia, allergic rxn poss hepatitis, RF
Inx: NOT w/ GI probs inc renal tox; dec effect of antiHTNs; inc lithium; aspirin dec effects
flubiprofen
NSAID; pain/inflammation assoc w/ trauma/infection; potency 3
inhib COX1/2 nonselective; synthesis of PG causing pain, fever and inflammation
tx: mild to mod pain or dysmenorrhea; infalmmatory disorders; osteoarthritis and RA
reduces risk of colon, breast, lung, prostate cancer
SE: GI bleed, N/V, dyspepsia, allergic rxn poss hepatitis, RF
Inx: NOT w/ GI probs inc renal tox; dec effect of antiHTNs; inc lithium; aspirin dec effects
meloxicam
approx 2 hr NSAID; pain/inflammation assoc w/ trauma/infection; potency 3
inhib COX1/2 nonselective; synthesis of PG causing pain, fever and inflammation
tx: mild to mod pain or dysmenorrhea; infalmmatory disorders; osteoarthritis and RA
reduces risk of colon, breast, lung, prostate cancer
SE: GI bleed, N/V, dyspepsia, allergic rxn poss hepatitis, RF
Inx: NOT w/ GI probs inc renal tox; dec effect of antiHTNs; inc lithium; aspirin dec effects
ketoprofen
2 hr HL; pain/ inflammation assoc w/ traum/infection
NSAID; pain/inflammation assoc w/ trauma/infection; potency 3
inhib COX1/2 nonselective; synthesis of PG causing pain, fever and inflammation
tx: mild to mod pain or dysmenorrhea; infalmmatory disorders; osteoarthritis and RA
reduces risk of colon, breast, lung, prostate cancer
SE: GI bleed, N/V, dyspepsia, allergic rxn poss hepatitis, RF
Inx: NOT w/ GI probs inc renal tox; dec effect of antiHTNs; inc lithium; aspirin dec effects
nabumetone
approx 2 hr NSAID; pain/inflammation assoc w/ trauma/infection; potency 3
inhib COX1/2 nonselective; synthesis of PG causing pain, fever and inflammation
tx: mild to mod pain or dysmenorrhea; infalmmatory disorders; osteoarthritis and RA
reduces risk of colon, breast, lung, prostate cancer
SE: GI bleed, N/V, dyspepsia, allergic rxn poss hepatitis, RF
Inx: NOT w/ GI probs inc renal tox; dec effect of antiHTNs; inc lithium; aspirin dec effects
naproxen
****14 hr HL potency is 4

NSAID; pain/inflammation assoc w/ trauma/infection; potency 3
inhib COX1/2 nonselective; synthesis of PG causing pain, fever and inflammation
tx: mild to mod pain or dysmenorrhea; infalmmatory disorders; osteoarthritis and RA
reduces risk of colon, breast, lung, prostate cancer
SE: GI bleed, N/V, dyspepsia, allergic rxn poss hepatitis, RF
Inx: NOT w/ GI probs inc renal tox; dec effect of antiHTNs; inc lithium; aspirin dec effects
oxaprozin
approx 2 hr

NSAID; pain/inflammation assoc w/ trauma/infection; potency 3
inhib COX1/2 nonselective; synthesis of PG causing pain, fever and inflammation
tx: mild to mod pain or dysmenorrhea; infalmmatory disorders; osteoarthritis and RA
reduces risk of colon, breast, lung, prostate cancer
SE: GI bleed, N/V, dyspepsia, allergic rxn poss hepatitis, RF
Inx: NOT w/ GI probs inc renal tox; dec effect of antiHTNs; inc lithium; aspirin dec effects
piroxicam
57 HL used to Tx RA b/c of its long HL; potency 200
NSAID;

tx: mild to mod pain or dysmenorrhea; infalmmatory disorders; osteoarthritis and RA
reduces risk of colon, breast, lung, prostate cancer
SE: GI bleed, N/V, dyspepsia, allergic rxn poss hepatitis, RF
Inx: NOT w/ GI probs inc renal tox; dec effect of antiHTNs; inc lithium; aspirin dec effects
sulindac
approx 2 hr HL
NSAID; pain/inflammation assoc w/ trauma/infection; potency 3
inhib COX1/2 nonselective; synthesis of PG causing pain, fever and inflammation
tx: mild to mod pain or dysmenorrhea; infalmmatory disorders; osteoarthritis and RA
reduces risk of colon, breast, lung, prostate cancer
SE: GI bleed, N/V, dyspepsia, allergic rxn poss hepatitis, RF
Inx: NOT w/ GI probs inc renal tox; dec effect of antiHTNs; inc lithium; aspirin dec effects
tolmetin
approx 2 hr HL
NSAID; pain/inflammation assoc w/ trauma/infection; potency 3
inhib COX1/2 nonselective; synthesis of PG causing pain, fever and inflammation
tx: mild to mod pain or dysmenorrhea; infalmmatory disorders; osteoarthritis and RA
reduces risk of colon, breast, lung, prostate cancer
SE: GI bleed, N/V, dyspepsia, allergic rxn poss hepatitis, RF
Inx: NOT w/ GI probs inc renal tox; dec effect of antiHTNs; inc lithium; aspirin dec effects
indomethacin
5 hr HL; toxic, short term in severe cond; tx serious infection (gouty arthritis, osteoarthritis, RA, ankylosing spondylitis); used in closure of PDA in infants
more GI and CNS SE
nonselective NSAID
reserved for pts not responding to less toxic drugs
SE: GI bleed, N/V, dyspepsia, allergic, dizzy, drowsy, HA
adverse effect inc by other NSAIDs; acetaminophen inc renal tox; dec effect of antihtn; inc lithium; aspirin dec effects of both; hyperK w/ K sparking diruetics
ketorolac
4-10 hr HL; post-op pain, similar analgesis effect as morphine but w/o N/V; IV or IM SHORT TERM
TX: MIGRAINS AND GLAUCOMA
MORE HEMOLYTIC TOX
nonselective NSAID; inc BT limit to <5 days
SE: inc risk allergic rxn w/ asthma; nasal polyps
adverse GI effect inc by NSAIDs, use w/ acetaminophen inc renal tox; dec effect of antiHTN agens; inc lithium; aspirin dec effets of both; inc risk of bleed w/ thormbolytics
celecoxib
inhib COX-2 NSAID; and PG
Tx: osteoarthritic RA
easily absorbed; 3 hrs; p-450;
SE: abdominal pain, dyspepsia, diarrhea; GI ulcers; inc stroke an dMI
intx: P450 dec effects of ACEi and diuetics and inc lithium
acetaminophen
tylenol; inhib COX3; inhib synthesis of PG causing pain and fever; NOT affect inflammation; inhib by peroxides so only in CNS not periphery
tx: mild to mod pain; fever
SE: overdose fatal hepatic fialure
glutitione clears
inx: inc hepatotoxicity w/ alcohol use; add salicylates an dNSAID additive renal toxicity
man has peptic ulcers, mm pain and family hx of AMI
tx w/ acetaminophen NOT COX nonsp b/c GI distress; no COX2 due to family hx
fever, aching mm tx w/
acetaminophen
twisten ankle, HA, fever tx w/ acetamiophen what happens?
still swollen b/c periphery peroxides degrade
acetycysteine
tx acetaminophen toxicity which inc GSH
RA first choice for pain relief
Gluycocorticoids and maybe prednisone (lipocortin) and NSAIDS
methotrexate
immunosuppressant; inhibits AICAR in purine synthesis; thymidylate synthetase in DNA synthesis; can be long term; dose lower than that in cancer chemo
folate reductase inhibitor
tx: RA
SE: N/V, hepatotox, anemia, leukopenia, TP, nephropathy
itx: sufas, Trimethoprim
chlorambucil
inhibtis cell replication; immunosuppresant; cross links DNA
tx: RA
SE: N/V, anorexia, hemorrhage, TP, leukopenia, anemia
intx: rifampin, doxorubicin
cyclophosphamide
inhibtis cell replication; immunosuppresant; cross links DNA
tx: RA
SE: N/V, anorexia, hemorrhage, TP, leukopenia, anemia
intx: rifampin, doxorubicin
cyclosporine
immunosuppresent; inhibitos IL-2; disrupts T cell
Tx: RA
SE: nephrotixic, HTN, GI distress, gingival hyperplasia
intx: CYP450 drugs
infliximab
disease mod antirheumatic durg; monoclonal Ab to TNFa
inac TNFa and dec joint inflammation pain destruction
Tx: RA and crohns
IV every 4 wks sometimes combine w/ MTX- 8 wks so don't intx w// mouth Ab
SE: n/v, fatique, URT infection
adalimumab
give subQ every 2 wks

disease mod antirheumatic durg; monoclonal Ab to TNFa
inac TNFa and dec joint inflammation pain destruction
Tx: RA and crohns

SE: n/v, fatique, URT infection
etanercept
recombinant fusion protein TNFa Rc-IgG binds TNFa; recetpor for cytokines; expencive
dec joint inflammation an dpain; slows RA
sub Q twice wkly
SE: URT infeciton, HA
can dec Ab response to live virus vaccines
Leflunomide
inhib ribonucleotide synthesis; inhib T cell prliv
act in intestine/plasma; inhibits dihydro dehydrogenase

disease mod antirheumatic durg; monoclonal Ab to TNFa
inac TNFa and dec joint inflammation pain destruction
Tx: RA and crohns

SE: n/v, fatique, URT infection
anakinra
recombinant IL-1B Rc antag; locks cytokine induced inflammaiton given subQ
TNF a blocking agent
Tx: RA
arthrocentesis
remove fluid form joint for inspection of crystals
allopurinal
stops production of uric acid; inhib xanthine oxidase which catabolizes purines
prevent hyperuricemia
NOT for acute attaks of gout
SE: rask
intx: inhibtis metab of mercaptopurine and inc mercaptopurine BM suppresion; inc effects of warfarin and hypoglycemic agents; ampicillin inc risk of rash
probenecid
highdose salicyclate inc uric acid clearance
antigout; uricosuric agent
tx: and prevents gouty arhtritis; inhibits renal tubular secretion of penicillins an dused to inc penicillin serum levels
SE: diarrhea, n/v poss agranulocytosis, aplstic anemia
inx: colchicine additive bm suppresion
combo colchicine prevents leukocyte respones to urate cystals
sulfinpyrazone
highdose salicyclate inc uric acid clearance
antigout; uricosuric agent
tx: and prevents gouty arhtritis; inhibits renal tubular secretion of penicillins an dused to inc penicillin serum levels
SE: diarrhea, n/v poss agranulocytosis, aplstic anemia
diretics and low-dose salicylates do what to uric acid
uric acid rtn
colchicine
used for acute attacts and prophylacxis; prevents plymerizaiton of tubulin into MT; inhib leukocyte migration into affected area; inhib synthesis an drlease of leuktirenes
combine w/ probenecid for gout
pripionic acid derivative in GOUT
ibuprofen, naproxen, kepprofen all given in first acute gout attack due to toxicity of colchicines NOT aspirin
probenecid or allopurionol
observe 24 hr uric acid excretion rate less than 800 mg too little excretion; give probenecid
gtrs than 800 mg give allopurinol
F w/ RA, NSAIDS then MTX given drug Sub Q
TNFa ineffective is adalimumab???