Pharm: Nsaids/dmards/gout Quick Review

Front 1

Aspirin

Back 1

NSAID

*irreversibly acetylates COX
Uses/Adverse: see tables

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Diclofenac

Back 2

NSAID (non-selective COX inhibitors)

Front 3

Etodolac

Back 3

NSAID (non-selective COX inhibitors)

Front 4

Ibuprofen

Back 4

NSAID (non-selective COX inhibitors)

Front 5

Indomethacin

Back 5

NSAID (non-selective COX inhibitors)

Front 6

Ketoprofen

Back 6

NSAID (non-selective COX inhibitors)

Front 7

Ketorolac

Back 7

NSAID (non-selective COX inhibitors)

Front 8

Naprozen

Back 8

NSAID (non-selective COX inhibitors)

Front 9

Piroxicam

Back 9

NSAID (non-selective COX inhibitors)

Front 10

Tolmetin

Back 10

NSAID (non-selective COX inhibitors)

Front 11

Celecoxib

Back 11

NSAID (COX-2 Selective Inhibitors)

Uses: anti-inflam, anti-pyretic, analgesis, BUT no effect on platelet aggregation
Adverse: LESS GI effect, renal toxicity, CV thrombotic events (Rofe/Valdecoxib)

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Etoricoxib

Back 12

NSAID (COX-2 Selective Inhibitors)

*highest selectivity for COX2

Uses: anti-inflam, anti-pyretic, analgesis, BUT no effect on platelet aggregation
Adverse: LESS GI effect, renal toxicity, CV thrombotic events (Rofe/Valdecoxib)

Front 13

Meloxicam

Back 13

NSAID (COX-2 Selective Inhibitors)

*prefers COX2 but not selective

Uses: anti-inflam, anti-pyretic, analgesis, BUT no effect on platelet aggregation
Adverse: LESS GI effect, renal toxicity, CV thrombotic events (Rofe/Valdecoxib)

Front 14

Acetaminophen

Back 14

NOT an NSAID

*weak COX1/2 inhibitor, no anti-inflamm or anti-platelet effect
**ANALGESIC VIA COX3

Uses: mild moderate pain when there is no inflammation; DOC for osteoarthritis but not for RA, prefered in hemophilia and peptic ulcer
Adverse: safe but OD -> decrease liver fxn which is helped w/ ACETYLCYSTEINE

Front 15

Methotrexate

Back 15

DMARDS (1st choice demand)

*inhibits AICAR

Uses: anti-inflammatory; cancer chemotherapy
Adverse: nausea, mucosal ulcers, pseudolymphomatous rxn; Antifolate actions (help w/ leucovorine); NOT IN DESIRED PREGNANCY

Front 16

Cyclophoshamide

Back 16

DMARDS (cytotoxic agents)

*phosphoramide cross links DNA -> decrease replication -> decrease T/B cells

Uses: also for SLE
Adverse: infertility, bone marrow suppression, hemorrhagic cystitis, Bladder CA- from acrolein metabolite

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Azathioprine

Back 17

DMARDS (cytotoxic agents)

*+allopurinol to prevent increase uric acid
**decrease Ig/IL2 from B/T cells

Adverse: bone marrow suppresion, GI disturbances, increase infections, skin rash, hepatic dysfxn

Front 18

Leflunomide

Back 18

DMARDS (cytotoxic agents)

*only affects autoimmune T/B cells

Adverse: diarrhea, increase liver enzymes

Front 19

Mycophenolate mofetil

Back 19

DMARDS (cytotoxic agents)

*inhibits IMP DHG type II lymphocytes -> decrease T/B cells

Front 20

Chlorambucil

Back 20

DMARDS (cytotoxic agents)

*phenylacetic acid mustard cross-links DNA

Adverse: dose-related bone marrow suppression and infertility, increase risk of leukemia

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Cyclosporin

Back 21

DMARDS (Immunophilin ligands)

*decrease activation of NFAT ->increase TGF-B-> decrease antigen triggered signal transduction

Adverse: nephrotoxicity, tremor, HTN, hyperglycemia, hyperlipidemia, osteoporosis, hirsutism, gum hyperplasia, DECREASED bone marrow toxicity

Front 22

Hydroxychloroquine

Back 22

DMARDS (antimalarial drugs)

Uses: pts who did not respond to NSAIDs/salicylates
Adverse: retinopathy (scotomas, blurred vision, night blindness)

Front 23

Sulfazaline

Back 23

DMARDS

*reduces bone erosion

Uses: ulcerative colitis, juvenile arthritis, ankylosing spondylitis
Adverse: rash, nausea, vomit, dizziness, headaches, leucopenia

Front 24

Gold sodium thiomalate

Back 24

DMARDS (Gold compounds) (IM)

*inhibition of maturation of T cells/macrophages

Uses: decrease pain/joint swelling, decrease rheumatoid factor
Adverse: gi disturb, dermatitis, hephrotoxicity, thrombocytopenia, leukopenia, pancytopenia, encephalitis, exfoliative dermatitis

Front 25

Auranofin

Back 25

DMARDS (Gold compounds) (oral)

*inhibition of maturation of T cells/macrophages

Uses: decrease pain/joint swelling, decrease rheumatoid factor
Adverse: gi disturb, dermatitis, hephrotoxicity, thrombocytopenia, leukopenia, pancytopenia, encephalitis, exfoliative dermatitis

Front 26

Adalimumab

Back 26

DMARDS (anticytokine drugs - ANTI-TNF)

Uses: RA, ankylosing spondylitis, chrohn's, psoriatic arthritis

Front 27

Infliximab

Back 27

DMARDS (anticytokine drugs - ANTI-TNF)

Uses: RA, ankylosing spondylitis, chrohn's, psoriatic arthritis
Adverse: URT infections, nausea, headaches, drug-induced Lupus

Front 28

Etanercept

Back 28

DMARDS (anticytokine drugs - ANTI-TNF)

Adverse: erythema, local pain, swelling, itching

Front 29

Anakinra

Back 29

DMARDS (anticytokine drugs - ANTI-IL1)

Uses: decreases immunologic responses

Front 30

Glucocorticoids

Back 30

DMARDS / GOUT

*inhibit PLA2 -> decrease arachidonic acid -> decrease COX-2 selectively

Uses: polyarticular gout, pts w/ renal insufficiency
Adverse: fractures, infections, cataracts, patatherosclerotic heart disease

Front 31

Colchicine

Back 31

Drugs for Acute Gout

*binds to intracellular tubulin -> decrease neutrophil activation

Uses: gouty attack, Mediterranean fever, amyloidosis, pseudogout, biliary cirrhosis
Adverse: nausea, vomit, abdominal pain, bloody diarrhea, myelosuppression, nephrotoxicity

Front 32

Allopurinol

Back 32

Drugs for Chronic Gout

*non-compet. inhibitor of Xanthine Oxidase

Uses: hyperurecemia, gouty arthritis, NOT GOUTY attack
Adverse: Maculopapular rash, decrease metab. of mercaptopurine and azathioprone -> icnrease risk of gout attack in early phase treatment

Front 33

Probenecid

Back 33

Drugs for Chronic Gout

*inhibits anion exchanger in proximal tubule
Uses: hyperuricemia, gouty arthritis NOT attack
Adverse: inhibits tubular secretion of many weak acids: penicillins, cephalosporins, methotrexate, sulfonylureas, indomethacin; uric acid stones

Front 34

Sulfinpyrazone

Back 34

Drugs for Chronic Gout

*inhibits anion exchanger in proximal tubule

Adverse: ineffective in pts w/ renal insuff. GI irritation, depression of hematopoiesis, not used w/ underlying blood dyscrasias
***inhibits warfarin metabolism -> serious bleeding can occur

Front 35

Rasburicase

Back 35

Drugs for Chronic Gout

*reduce plasma urate levels
Uses: initial manag. of pediatric pts w/ leukemia, lymphoma, solid tumor malig.