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Flashcards in Copy of Musculoskeletal and CT - Copy of Musculoskeletal and CT Deck (15)
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1

Aspirin

1) Low dose - decr plt aggregation. Middle dose - antipyretic, analgesic. High dose - anti-inflammatory
2) Irreversibly inhibits COX1/2 by acetylation --> decr TXA2 and Prostaglandins. Incr Bleeding time.
3) Gastric ulcer, TINNITUS (CN8)**. Chronic use: acute renal failure, intersitial nephritis, upper GI bleed. Reyes in children. Stimulate respiratory center, metabolic alkalosis
4) Prevents reccurence/transformation of adenomatous polyps**

2

NSAIDs (Ibuprofen, naproxen, indomethacin, ketorolac)

1) Use: Antipyretic, analgesic, anti-inflammatory. Indomethacin is used to close a PDA.
2) Class/MOA: Reversibly inhibits cycooxygenase (both COX-1 and COX-2). Block prostaglandin synthesis.
3) Interstital nephritis, gastric ulcer, renal ischemia (PGs vasodilate afferent arteriole)

3

COX-2 Inhibitor (celecoxib)

1) Use: Rheumatoid and osteoarthritis; patients with gastritis or ulcers.
2) Class/MOA: Reversibly inhibits the cycooxygenase (COX) isoform 2, which is found in inflammatory cells and vascular endothelium and mediates inflammation and pain
3) Side effects/ADEs: Increased risk of thrombosis. Sulfa allergy.

4

Acetaminophen

1) Use: Antipyretic, analgesic, but NOT anti-inflammatory. Used instead of aspirin to prevent Reye's syndrome in children with viral infections.
2) Class/MOA: Reversibly inhibits COX, mostly in CNS. Inactivated peripherally.
3) Side effects/ADEs: OD --> hepatic necrosis, acetaminophen metabolite depletes glutathione and forms toxic tissue adducts in the liver.
4) N-aceylcystine is antidote - regenerates glutathione.

5

Bisphosphonates (Alendronate; and other -dronates)

1) Use: Hypercalcemia, Paget's diseases of the bone, osteoproposis.
2) Pyrophosphate analogs; bind hydroxyapaptite in bone, inhibit osteoclast activity
3) Side effects/ADEs: Corrosive esophagitis, osteonecrosis of the jaw.
4) pt should stay upright for 30 minutes after taking to prevent esophagitis

6

Chronic Gout Drug (Probenecid)

1) Use: Chronic Gout (urate lowering therapy)
2) Inhibits resorption of uric acid in the PCT (also inhibits secretion of penicillin)
3) Use w Cidofovir to decr nephrotoxicity

7

Chronic Gout Drug (Allopurinol)

1) Use: Chronic Gout (urate lowering therapy)
2) Class/MOA: Inhibits xanthine oxidase

8

Chronic Gout Drug (Febuxostat)

1) Use: Chronic Gout (urate lowering therapy)
2) Class/MOA: Inhibits xanthine oxidase

9

Acute Gout Drug (Colchicine)

1) Use: Acute Gout (urate lowering therapy)
2) Class/MOA: Binds and stabilizes tubulin to inhibit MT polymerization, impairing leukocyte chemotaxis, deregulation, and phagocytosis (Impairs the CYTOSKELETON)
3) GI side effects (N/V/D**), especially if given orally

10

Acute Gout Drug (NSAIDs)

Naproxen and Indomethacin
-use in acute gout
(#1 choice in acute gout)

11

The alpha inhibitors (Entanercept)

1) Use: Rheumatoid arthritis, psoriasis, ankylosing spondylitis.
2) Class/MOA: Recombinant form of human TNF RECEPTOR* that binds TNF.
3) Side effects/ADEs: All TNF alpha inhibitors predispose to infection including reactivation of latent TB
4) Fun Facts: EntanerCEPT is a TNF decoy reCEPTor.

12

The alpha inhibitors (Infliximab)

1) Use: Chron's disease, rheumatoid arthritis, ankylosing spondylitis.
2) Class/MOA: Anti-TNF antibody
3) Side effects/ADEs: All TNF alpha inhibitors predispose to infection including reactivation of latent TB
4) Fun Facts INFLIimab INFLIX pain on TNF
-"xi-" = chimeric

13

The alpha inhibitors (Adalimumab)

1) Use: Psoriasis, rheumatoid arthritis, ankylosing spondylitis
2) Class/MOA: Anti-TNF antibody
3) Side effects/ADEs: All TNF alpha inhibitors predispose to infection including reactivation of latent TB

14

Acute gout drugs (glucocorticoids)

-Acute gout
-Oral or intraarticular
-Use in pts in who NSAIDS and Colchine are Contraindicated (i.e. pts w renal failure)

15

Drugs not to give in gout

Do not dive salicylates; all but the highest dosages depress uric acid clearance. Even high doses (5-6 g/day) have only minor uricosuric activity.