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NSG 323 > gout, OP, and RA > Flashcards

gout, OP, and RA Flashcards

1
Q

3 agents for acute gout attacks

A

NSAIDS, steroids, colchicine

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2
Q

MOA of colchicine

A

inhibits leukocyte infiltration which prevents the destructive lysosomal enzymes

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3
Q

AE of colchicine

A

GI (25%), d/c if this occurs

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4
Q

dosing of colchicine

A

1.2 mg loading, 0.6 mg 1 hr later. 1.8 mg/24 hrs

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5
Q

rare but serious SE of colchicine

A

BM suppression, rhabdo, severe kidney/liver disease

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6
Q

other considerations for colchicine

A

NO grapefruit juice, d-d interactions: PGP or CYP3A4

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7
Q

prototype for inhibiting uric acid formation

A

allopurinol

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8
Q

what special considerations do you have to think about with allopurinol?

A

may cause acute gout attack!!

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9
Q

what other times can allopurinol be used?

A

in cancer, chemo, and blood dyscrasias.

increased levels of uric acid with chemotherapy because of cell death!

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10
Q

common AE of allopurinol

A

GI

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11
Q

rare but serious AE of allopurinol

A

hypersensitivity syndrome

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12
Q

d-d interactions with allopurinol

A

warfarin

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13
Q

pt teaching with allopurinol

A

increase fluids to flush kidneys and protect from urate crystals

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14
Q

vitamin supplementation for OP

A

vitamin D, Ca

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15
Q

drugs that decrease bone resorption AKA inhibit osteoclasts (classes of drugs)

A 
calcitonin-salmon
bisphosphonates
estrogen replacement
SERMS
monoclonal antibodies
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16
Q

drugs that increase bone formation

A

PTH (forteo)

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17
Q

Calcium supplementation general info

A

1200 mg/day, divided doses
take Ca Carbonate!
lots of food interactions– leafy greens, beans, whole grains. separate by 1 hour.

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18
Q

vitamin D general info

A

diet and sunlight
oral supplementation– 800-1000 mcg/daily
characteristics of a hormone

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19
Q

calcitonin- salmon MOA

A

keeps Ca in the bone and prevents pulling Ca into the blood stream

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20
Q

SE of calcitonin

A

nausea, nasal drying, increased malignancies

21
Q

admin of calcitonin

A

intranasal or subq

22
Q

prototype of bisphosphonates

A

alendronate

23
Q

MOA of bisphosphonates

A

undergo incorporation into the bone and decreases the osteoclast activity
integrates themselves into the bone!

24
Q

alendronate bioavailability

A

0.7%, if taken with food- NONE is absorbed

25
Q

AE of alendronate

A

esophagitis, atypical fracture of femur, MS pain, ocular inflammation, osteonecrosis of the jaw

26
Q

pt teaching of alendronate

A 
take on an empty stomach
nothing to eat or drink for 30 mins
remain upright for 30 mins
take with a full glass of water
don't chew or suck tablets
27
Q

estrogen replacement general info

A

no longer standard therapy
suppresses osteoclast activity
increase risk of breast cancer and endometrial cancer, cholecystitis and MI/Stroke

28
Q

SERMS MOA

A

block or mimic estrogen receptors.
mimics on bone, lipid metabolism, or blood clot
blocks on breasts

29
Q

prototype of SERM

A

raloxifene

30
Q

general info of SERM

A

improve bone density
improve lipid profiles and improves CV risk
risk of DVT and PE
no help with hot flashes and can cause them!

31
Q

prototype of monoclonal antibodies

A

Denosumab

32
Q

denosumab admin

A

subq every 6 months

33
Q

SE of denosumab

A

back pain, MS pain, pain in extremities, UTI, hypercholesterolemia
injection site reaction

34
Q

rare but serious SE of denosumab

A

serious infections, derm reactions, osteonecrosis of the jaw

35
Q

MOA of denosumab

A

prevents activation of RANK

36
Q

prototype of drugs that increase bone formation

A

teriparatide

37
Q

MOA of teriparatide

A

form of PTH made by recombinant DNA technology

38
Q

admin of teriparatide

A

given subq

39
Q

SE of teriparatide

A

nausea, HA, back pain, leg cramps, ortho/hypo initially

increased risk of osteosarcoma

40
Q

3 classes of drugs for RA

A

NSAIDS, steroids, DMARDS

41
Q

Non-biological DMARD prototype

A

methotrexate

42
Q

methotrexate general info

A

immunosuppressive
takes 3-6 weeks to work (take NSAID until it kicks in)
take folic acid 5mg/week

43
Q

methotrexate SE

A

hepatic fibrosis, BM suppression, GI ulceration, pneumonitis

44
Q

methotrexate other considerations

A

reduced life expectancy from CV disease, infection and certain cancers
category X!!

45
Q

Bio DMARDS prototype

A

etanercept

46
Q

bio DMARDs MOA

A

immunosuppresive drugs that target specific parts of the inflammatory process

  • tumor necrosis factor
  • promotes destruction of B cells
  • inhibits activation of t-cells
47
Q

other considerations of bio DMARDs (etanercept)

A

high risk of serious infection: test for TB!!!, fungal infection, hep B
made with recomb DNA
EXPENSIVE
used for other autoimmune infections too

48
Q

AE of etanercept

A

injection site rxn

49
Q

special considerations for etanercept

A 
test for TB
watch for Hep B reactivation
no active infections while on it
no live vax
risk of HF, cancer, CNS disorders, rarely serious skin rxns.

NSG 323 (12 decks)

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