Gout Flashcards
Nonselective irreversible COX 1&2 inhibitors
Prevention of arterial thrombosis
Inflammatory disorders
Prevents uric acid excretion
Aspirin
Anti inflammatory drugs
NSAIDs
DMARDs
Aspirin
<300
300-2400
2400-4000
Platelet aggregation first order
Antipyretic and analgesic
Anti inflammatory zero order
Aspirin overdose
TD 150 mg/kg
LD 30g
HAGMA
Alkalinize with BICARBONATE
Nonselective NSAID
Long term use reduces risk of colon cancer
Ibuprofen
Nonselective NSAID
Post surgical anasthesia control
Only IV NSAID
WOF GI and nephrotoxicity
Ketorolac
Nonselective NSAID
Closure of PDA
WOF APLASTIC ANEMIA THROMBOCYTOPENIA
Indomethacin
Nonselective NSAID
COX2>1
Meloxicam
Peroxicam
COX2 NSAID
Reduced risk for GI bleeding
Celecoxib
COX2 NSAID
Inc risk for MI and stroke
Rofecoxib
Valdecoxib
COX 3 Inhibitor
Preferred antipyretic for children
Inc hepatoxicity with alcohol
Paracetamol
Paracetamol overdose 0.5-24 h 24-72 h 72-96 h 4d-2w
N/V
Elevated liver enzymes
Hepatic encephalopathy HAGMA
Recovery
NAC
Most common form of chronic inflammatory arthritis
RA
Inhibits AICAR transformylase and thymidilate synthase
Sec effects on PMN chemotaxis
WOF PSEUDOLYMPHOMATOUS REACTION and mucosal ulcers
FIRST CHOICE DMARD TO TREAT RA
Methotrexate
- rescue leucovorin
Binds to TNFa to prevent TNFa receptor activation WOF HEP B and TB REACTIVATION WOF LYMPHOMA Autoantibody formation DMARD
Infliximab
Synergistic with methotrexate
Forms 6 thioguanine
WOF BM SUPPRESSION AND LYMPHOMA
Do not give with Allopurinol
DMARD
Azathioprine
Suppression of T lymphocyte response to mitogens, dec WBC chemotaxis, stabilize lysosomal enzymes, inhibit DNA and RNA synthesis, trap free radicals WOF OCULAR TOXICITY SAFE FOR PREGNANT Malaria DMARD
Chloroquine
Forms phosphoramide mustard to prevent DNA replication
WOF HEMORRHAGIC CYSTITIS
DMARD
Cyclophosphamide
- rescue mesna
Inhibits IL1 and IL2 receptor production
Sec inhibits macrophage T cell interaction and T cell responsiveness
Tissue transplantation
WOF nephrotoxicity gingival hyperplasia hirsutism
DMARD
Cyclosporine
Active product (mycophenolic acid) inhibits IMP dehydrogenase and inhibits T cell lymphocyte proloferation
WOF REVERSIBLE MYELOSUPPRESSION (neutropenia)
DMARD
Mycophenolate Mofetil
Active metabolite (sulfapyridine) inhibits release of inflammatory cytokines
Inflammatory Bowel Disease
WOF HA METHEMOGLOBINEMIA REVERSIBLE MALE INFERTILITY
DMARD
Sulfasalazine
Inhibits microtubule assembly
FAMILIAL MEDITERRANEAN FEVER
INITIAL TREATMENT FOR ACUTE GOUT
Colchicine
Alternative to colchicine in acute gout
Indomethacin
Compete with uric acid for tubular reabsorption
WOF GI irritation and aplastic anemia
Prevent precipitation of scute gout during early phase of drug action by combination with colchicine or indomethacin
Probenecid
