Study your flashcards anywhere!

Download the official Cram app for free >

  • 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

1/48

Click to flip

48 Cards in this Set

  • Front
  • Back
Nonsteroidal Antiinflammatory Drugs (NSAIDs)
Salicylates
Magnesium Salicylate (Magan; Mobidin)

• Salsalate (Disalcid; generic)

• Difunisal (Dolobid; generic)
Newer NSAIDs
Ibuprofen (Motrin; Advil; Nuprin; etc.)
Naproxen (Naprosyn; Aleve)
Ketoprofen (Orudis; Oruvail)
Meclofenamate (Meclomen; generic)
Piroxicam (Feldene; generic)
Indomethacin (Indocin; generic)
Sulindac (Clinoril; generic)
Nabumetone (Relafen)
Diclofenac (Voltaren; generic)
Celecoxib (Celebrex)
Disease – Modifying Antirheumetic Drugs(DMARD)
Hydrochloroquine (Plaquenil)

Gold Compounds
-Aurothiglucose (Solganal)
-Auranofin (Ridaura) – oral

Immunosuppressive Agents:
-Methotrexate (Rheumatrex)
-Leflunomide (Arava)

Sulfasalazine (Azulfidine, generic)

Tumor necrosis factor (TNF) inhibitors;
-Infliximab (Remicade)
-Etanercept (Enbrel)

Interleukin–1 (IL-1) receptor antagonist:
-Anakinra (Kineret)

Coticosteroids; e.g., Prendisone
drawbacks to salicylates for initial therapy
requires frequent dosing & GI side effects
alternative salicylates that have less GI irritation but are more expensive
Salsalate (Disalcid; generic)
Diflunisal (Dolobid)- BID
No NSAID is consistently more EFFECTIVE than any other in large-scale trials. T/F
T
___________ is associated with a high incidence of diarrhea.
Meclofenamate (Meclomen)
This prostaglandin analog may decrease GI toxicity caused by NSAIDs
misoprostol (Cytotec)
This can result from chronic use of high doses of NSAIDs in individuals at risk, e.g., elderly patients and pts with renal impairment, CHF, or volume depletion.
Renal toxicity
MOA of NSAID associated renal toxicity
changes in renal haemodynamics (bloodflow), ordinarily mediated by prostaglandins, which are affected by NSAIDs.
Indomethacin (Indocin)
uses: moderate to severe RA,OA, & ankylosing sponylitis &
SE: high incidence
GI side effects
CNS: headache, dizziness, confusion
ductus arteriosus
Sulindac (Clinoril):
related to indomethacin
lower incidence of AEs but lower efficacy
Prodrug
1/2 life -12 hrs
piroxicam (Feldene)—
very long half life -- 50 hrs
severe GI side effects 20%
avoid in elderly
Nabumetone (Relafen)
prodrug
long-acting
less GI irritation & ulceration
Celecoxib (Celebrex)MOA
inhibits COX-2 only
PGs produced by cox 1 available to protect GI mucosa
Celecoxib (Celebrex) effects
1) anti-inflammatory, analgesic, & antipyretic effects
2) does not inhibit platelet aggregation and causes fewer GI ulcers
3) may be pro-thrombotic: Rofecoxib was withdrawn from markit in 2004 due to increase CV complications
Celecoxib (Celebrex)clinical uses

side effects it does not have that COX 1 & 2 inhibitors have
RA, OA, primary dysmenorrhea, dental, surgical pain

low risk of GI side effects, no edema or renal toxicity
DISEASE-MODIFYING ANTIRHEUMATIC DRUGS (DMARDs): “Slow-Acting Antirheumatic Drugs (SAARDs):
What is their advantange?

How long do they take to start working (generally)?
modify progression of disease

take a long time to start working (weeks to months)
Hydroxychloroquine (Plaquenil)
Antimalarial Drug

Use:
mild RA unresponsive to NSAIDS

Toxicity: Visual disturbances (retinopathy; corneal deposits);epigastric pain; skin rash; etc

Monitor closely for visual
changes--EVERY 6-12 MONTH

HEMOLYSIS IN PTS WITH G-6-PD DEFICIENCY
Aurothioglucose (Solganal)
Gold Compound
IM
Clinical uses: mild to moderate RA
May take 3-6 months to start working

Most common toxic effects:
• Pruritus, erythema, skin rash; stomatitis, glossitis--IM
• Exfoliative dermatitis – rare

b. Blood dyscrasias: Rare, but serious; can be lethal: thrombocytopenia, leukopenia, aplastic anemia
c. Proteinuria; metallic taste, skin pigmentation, enterocolitis.
CAUTION: monitor urine (UA) & blood (CBC)
Auranofin (Ridaura)
Gold Compound
oral-less effective, less AEs
Clinical uses: mild to moderate RA
May take 3-6 months to start working


•Diarrhea*
• Exfoliative dermatitis – rare

b. Blood dyscrasias: Rare, but serious; can be lethal: thrombocytopenia, leukopenia, aplastic anemia
c. Proteinuria; metallic taste, skin pigmentation, enterocolitis.
CAUTION: monitor urine (UA) & blood (CBC)
Methotrexate (Rheumatrex)
what type of drug is it
Immunosuppressive Agent(“Cytotoxic”)
Methotrexate (Rheumatrex)
MOA
MOA:Dihydrofolate reductase
inhibitor; FOLATE ANTAGONIST
Methotrexate (Rheumatrex)
Clinical uses:
Clinical uses: DOC for moderate to severe RA
-very effective
-well tolerated
-GI side effects
Methotrexate (Rheumatrex)
AEs
bone marrow depression (neutropenia, thrombocytopenia, anemia)

GI disturbances

Infection (due to decreased immune reactivity)

increased risk of teratogenesis

increased risk of malignancies

stomatitis, megaloblastic anemia, hepatitis/cirrhosis, pneumonitis
Methotrexate (Rheumatrex)Contraindications
•Pregnancy; children--Teratogenic

• Alcoholism; liver disease

• Blood dyscrasias

• Renal insufficiency/elderly
Cyclosporine (Sandimmune)
category?
alone or used with?
An immunosuppressant used in some patients with refactory RA. Used alone or with methotrexate.
Cyclosporine (Sandimmune)
MOA
Selectively supresses T-cell proliferation (B-cells also affected)
Cyclosporine (Sandimmune)
AEs
nephrotoxicity, hepatotoxicity
hypertension
hyperkalemia
drug interactions
Leflunomide (Arava)
MOA
A prodrug

inhibits dihydroorate dehydrogenase and DNA synthesis
Has antiproliferative effect on T-cell
anti-inflammatory effect.
Leflunomide (Arava)
Uses
for moderate to severe RA
alternative to methotrexate
PO, QD
Leflunomide (Arava)
AEs
COMMON:
diarrhea
elevation of liver enzymes

alopecia (reversable)
rash
anaphylaxis
teratogenic in animals
Sulfasalazine (Azulfidine; generic)
Uses
ulcerative colitis
mild to moderate RA
Sulfasalazine (Azulfidine; generic)
MOA:
Converts to sulfapyridine and 5-acetyl salicylate.

Sulfapyridine supresses lymphocyte and PMN function (helps with RA)
5-ASA --ANTIINFLAMMATORY
Sulfasalazine (Azulfidine; generic)
Adverse reactions:
Nausea, anorexia, dizziness;
skin rash.
Blood dyscrasias and hepatitis – rare.
Infliximab (Remicade)
Tumor necrosis factor (TNF) inhibitor

a chimeric human/mouse anti-TNF monoclonal antibody; IV

also used in crohns dz
Etanercept (Enbrel)
Tumor necrosis factor (TNF) inhibitor

a recombinant human TNF receptor; SC
MOA of tumor necrosis factor inhibitors
Binds to and blocks TNF, a cytokine and inhibits inflammation.
Clinical Uses of tumor necrosis factor inhibitors
RA refractive to methotrexate
can be used alone or w/ methotrexate
better than mtx in preventing jt distruction
infliximab
Adverse reactions
Headache, infection, infusion reaction (fever, urticaria, dyspenea, and hypotension)
etanercept
Adverse reactions
Erythema, local pain and itching at injection site
Anakinra (Kineret)
type and MOA
Interleukin-1 (IL-1) receptor antagonist:

Competitively block IL-1 R which decreases INFLAMMATION & JOINT DESTRUCTION
Anakinra (Kineret)
Uses & route:
Severe RA - - daily SC injection
Anakinra (Kineret)
AEs
Pruritus, rash, erythema and pain at injection site

• Neutropenia; severe infection – ↑ with etanercept (Enbrel).
prednisone
MOA
A CORTICOSTEROID

Anti-inflammatory action mediated by several possible mechanisms, including inhibition of phospholipase A2,selective inhibitition of COX immunosuppressive effects.???
prednisone
uses in RA
1) Adjunctive therapy (5-10
mg prednisone) for severe, rapidly progressing disease that does not respond or intolerant other DMARDs.

2) Low-dose prednisone may be especially useful in pregnant, elderly and younger pts to control active disease temporarily.

3) High-dose corticososteroids may be required to control severe, life- threatening situations– PERICARDITIS, VASCULITIS
Prednisone
Intra-articular injections
what are the injectable forms and when should you use them?
Use long-acting,microcrystal suspensions:

prednisolone tebutate (generic)
triamcinolone (generic; Kenalong; Aristocort)


Accepted adjunctive therapy when painful symptoms are confined to only one or two joints.
prednisone
Adverse Reactions:
Numerous and potentially serious, especially at high doses systemically and with chronic use.

Osteoporosis, poor wound healing, gastric ulcer, hypertension.

• Adrenal suppression, increased risk of infection, etc.