MSK/pain Flashcards
(33 cards)
ASA/NSAIDs
ASA- irreversibly acetylates and inactivates COX other, NSAIDs- reversible COX inhibitors which decrease prostaglandins, which decrease pain and inflammation
-reduce inflammation, reduce pain, reduce fever
Used for mild to moderate pain for MSK
Do not USE ASA in less than 19 years old for risk of Reyes
Celecoxib
Selective COX2 inhibitor
Uses- RA, OA, acute pain similar to NSAID efficacy
ADE- HA, dyspepsia, diarrhea, abdominal pain, less likely for GI bleed
Acetaminophen
Inhibits prostaglandin in CNS reducing fever produce analgesic
Less peripheral COX effects weak anti inflammatory
Used for fevers, pain relief
Liver metabolites
IV- ofirmev
ADE- few, large doses live toxicity
antidote for OD- n acetyl cysteine
TDMA (traditional disease modifying anti rheumatic drugs)
Drugs- methotrexate*, hydroxychloroquine (plaquenil), leflunomide (arava), sulfasalazine (azulfidine)
Uses- RA
MOA- slow disease progression induce remission, and prevent further damage
Can be used in mono, combo or with TNF inhibitor or biologics
Methotrexate
Folic acid antagonist that inhibits cytokine production causing immune suppression and anti inflammatory
3-6 weeks for effectiveness
ADE- mucosal ulcers and nausea, leukopenia, cirrhosis, pneumonia like syndrome with chronic use
Folic acid to improve tolerability and. Reduce GI and liver ADE
Monitor LFTs, CBC, pregnancy status, infection
Hydroxychloroquine (plaquenil)
Mild early RA
MOA unknown
6-24 weeks for full effect
Less ADE on liver and immune compared to other DMARDs, ocular toxicity, CNS disturbances, GI upset, skin discoloration and eruptions
Leflunomide (arava)
Cell arrest of autoimmune lymphocytes through its action on dihydroorotate dehydrogenase
ADE- HA, diarrhea, nausea, weight loss, allergic reactions, flu like reaction, skin rash, alopecia, low potassium,
Hepatotoxicity
Contraindicated in pregnancy, monitor for infection, CBC, electrolytes and LFTs
Sulfasalazine (azulfidine)
RA like arava
MOA- unknown
Onset 4-12 weeks
ADE- nausea, vomiting, anorexia, leukopenia
Glucocorticoids
RA
Bridge into DMARDs become fully effective
biologics
TNF alpha use in caution with CHF can worsen condition
Increased risk for lymphoma or other CAs
Increased risk for infection
No live vaccines
Adalumumab (humira(
Recombinant MAB binds to TNF alpha with cell surface receptor
SQ weekly or Q2 weeks
ADE- HA, nausea, agranulocytosis, rash, injection site reactions, increased risk of infection
Certolizumab (cimzia)
Humanized antibody that neutralizes TNF alpha
SQ every 2 week
ADE- similar to TNF alpha inhibitors
Etanercept (embrel)
Protein binds to TNF alpha and blocks interaction with cell surface deceits
With MTX more effective
SQ weekly
Well tolerated
Golimumab (simponi)
Neutralizes the activity of TNF alpha by binding to it and blocking interaction in cells
SQ monthly
With MTX
Can increase LFTs
Infliximab (remicade)
Chimeric MAB
Binds to TNF alpha and inhibits its receptor
Not for mono therapy as it leads to anti remicade antibodies and reduced efficacy
Give with MTX
IV infusion Q 8 weeks
Abstacept (orenica)
Constimulation modulator and prevents T cell activation and decreases inflammatory cascade
IV infusion every 4 weeks
ADE- infusion related reaction, HA, URI, nausea
Rituximab (rituxin)
MAB, directed at CD30 antigens
For RA
can cause B cell depletion
Given IV 4-6 months
Pre medicated with steroids, APAP, Benadryl to reduce reactions
Toculizumbab (actemra), sarilumab (kevzara)
MAB binds to IL 6
SQ every 2 weeks
Actemra IV infusion every 4 weeks
ADE- elevated LFTs, DLP, neutropenia, HTN, infusion and infection related
Tofactinib (xeljanz)
JACK inhibitor
For RA not responded to MTX
Monitor for Anemia, hemoglobin needs to be above 9 before starting, can increase CA risk, long term effects reserved for those who’s failed other agents
Opioids not good with
Bone dull, aching, throbbing
Smooth muscle spasm
Voluntary muscle rigidity or spasticity
Neuropathic
Increased ICP
Mild peripheral agents
Block pain impulses and substance P
Pain is relieved when inflammatory is reduced
-Tylenol
-NSAIDs
-ASA
-combo Tylenol with codeine, hydrocodone, Tramadol
Signs of salicylate OD
Tinnitus **, vertigo; HA, confusion, drowsiness, swearing, hyperventilation, diarrhea, vomiting
Triptans
First line for migraines
MOA- 5HT1B and 5HT1D agonist causes vasoconstriction and inhibit inflammation
Prototype- sumatriptan (imitrex)
Coronary vasospasm ***
ADE- burning at injection site; warm tingling sensation, flushing, tachycardia, neck jaw tightness, GI upset, heaviness in chest
Serotonin syndrome
Use in caution in CV disease, MOAIs, PVD, other SSRI, SNRI, Tramadol
Ergots
MOA- bind to 5HT receptor as vasoconstrictor
Prototype- ergotamine tartrate (cafergot)
Potent vasoconstrictor
ADE- n/v, tingling, angina like pain, rebound vasodilation, rebound HA
Do not use in renal, hepatic, sepsis, CAD, CV disease
Contradicted with strong CYP3A4 and vasoconstrictors
Category X
