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Pharmacology > FA Musculoskeletal, Skin, and Connective Tissue > Flashcards

FA Musculoskeletal, Skin, and Connective Tissue Flashcards

MSK, skin, connective tissue chapter pharm from USMLE Step 1 First Aid 2014.

1
Q

Aspirin Mechanism

A

Irreversibly inhibits COX-1 and COX-2 by covalent acetylation, which ↓ production of TXA2 and prostaglandins

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2
Q

Aspirin Use

A 
Low dose (<300mg/day): ↓ platelet aggregation
Intermediate dose: (300-2400mg/day): antipyretic and analgesic
High dose (2400-4000mg/day): anti-inflammatory
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3
Q

Aspirin Toxicity

A

Gastric ulceration, tinnitus (CN VIII). Chronic use can lead to acute renal failure, interstitial nephritis, upper GI bleeding. Risk of Reye syndrome in children with viral infection. Stimulates respiratory centers, causing hyperventilation and respiratory alkalosis.

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4
Q

NSAIDs

A

Ibuprofen, naproxen, indomethacin, ketorolac, diclofenac

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5
Q

NSAID Mechanism

A

Reversibly inhibit COX-1 and COX-2, blocking PG synthesis.

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6
Q

NSAID Use

A

Antipyretic, analgesic, anti-inflammatory. Indomethacin used to close PDA.

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7
Q

NSAID Toxicity

A

Interstitial nephritis, gastric ulcer (PGs protect gastric mucosa), renal ischemia (PGs vasodilate afferent arteriole).

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8
Q

COX-2 inhibitor

A

celecoxib

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9
Q

COX-2 inhibitor (celecoxib) Mechanism

A

Reversibly inhibit COX isoform 2, which is found in inflammatory cells and vascular endothelium and mediates inflammation and pain. Spares COX-1, which helps maintain gastric mucosa (should not have corrosive effects of other NSAIDs). Spares platelet function (TXA2 production is COX-1 dependent).

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10
Q

COX-2 inhibitor (celecoxib) Use

A

Rheumatoid arthritis, osteoarthritis; patients with gastritis or ulcers.

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11
Q

COX-2 inhibitor (celecoxib) Toxicity

A

↑ risk of thrombosis. Sulfa allergy.

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12
Q

Acetaminophen Mechanism

A

Reversibly inhibits COX, mostly in CNS. Inactivated peripherally.

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13
Q

Acetaminophen Use

A

Antipyretic, analgesic, but not anti-inflammatory. Used instead of aspirin to avoid Reye syndrome in children with viral infection.

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14
Q

Acetaminophen Toxicity

A

Overdose produces hepatic necrosis; metabolite (NAPQI) depletes glutathione and forms toxic tissue adducts in liver. N-acetylcysteine is antidote – regenerates glutathione.

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15
Q

Chronic gout drugs

A

Allopurinol, febuxostat, probenecid

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16
Q

Allopurinol Mechanism

A

Inhibits xanthine oxidase, ↓ conversion of xanthine to uric acid.

17
Q

Allopurinol Use

A

Chronic gout (prevention). Also used in lymphoma/leukemia to prevent tumor lysis associated urate nephropathy.

18
Q

Allopurinol Toxicity

A

↑ concentrations of azathioprine and 6-MP (both metabolized by xanthine oxidase). Do not give salicylates; all but the highest doses depress uric acid clearance. Even high doses (5-6g/day) have only minor uricosuric activity.

19
Q

Febuxostat Mechanism

A

Inhibits xanthine oxidase.

20
Q

Probenecid Mechanism

A

Inhibits reabsorption of uric acid in PCT (also inhibits secretion of penicillin).

21
Q

Acute gout drugs

A

NSAIDS (indomethacin, naproxen), glucocorticoids (oral or intraarticular), colchicine.

22
Q

Colchicine Mechanism

A

Binds and stabilizes tubulin to inhibit microtubule polymerization, impairing leukocyte chemotaxis and degranulation.

23
Q

Colchicine Use

A

Gout - acute and prophylactic value

24
Q

Colchicine Toxicity

A

GI side effects

25
Q

TNF-α inhibitors

A

Etanercept, infliximab, adalimumab

26
Q

TNF-α inhibitor toxicity

A

All TNF-α inhibitors predispose to infection, including reactivation of latent TB, since TNF blockade prevents activation of macrophages and destruction of phagocytosed microbes.

27
Q

Etanercept Mechanism

A

Fusion protein (receptor for TNF-α + IgG1 Fc), produced by recombinant DNA. Etanercept is a TNF decoy receptor.

28
Q

Etanercept Use

A

Rheumatoid arthritis, psoriasis, ankylosing spondylitis

29
Q

Infliximab Mechanism

A

Anti-TNF-α monoclonal antibody

30
Q

Adalimumab Mechanism

A

Anti-TNF-α monoclonal antibody

31
Q

Infliximab Use

A

IBD, rheumatoid arthritis, ankylosing spondylitis, psoriasis

32
Q

Adalimumab Use

A

IBD, rheumatoid arthritis, ankylosing spondylitis, psoriasis

33
Q

Bisphosphonates

A

Alendronate, other -dronates

34
Q

Bisphosphonate Mechanism

A

Pyrophosphate analogs; bind hydroxyapatite in bone, inhibiting osteoclast activity

35
Q

Bisphosphonate Use

A

Osteoporosis, hypercalcemia, Paget disease of bone

36
Q

Bisphosphonate Toxicity

A

Corrosive esophagitis (patients advised to take with water and remain upright for 30 minutes), esophageal cancer, osteonecrosis of the jaw

Pharmacology (14 decks)

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