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Flashcards in MSS Pharm Deck (40):
1

What does the Lipoxygenase pathway yield?

Leukotrienes

2

What is LTB4?

Neutrophil chemotatic agent 

3

What do LTC4, D4 & E4 function in?

Bronchoconstriction, vasoconstriction, contraction of sm & inc vascular permeability 

4

What do PGI2 do?

Inhibits platelet aggregation & promotes vasodilation

(Platelet-Gathering-Inhibitor)

5

What is the MOA of aspirin?

Irreversibly inhibits COX-1 & COX-2 by acetylation, which dec synthesis of both thromboxane A2 (TXA2) & PG. Inc bleeding time. Nof affect on PT, PTT. Type of NSAID

6

Clinical use of aspirin

  • Low dose: (
  • Indermediate dose (300-2400 mg/day) antipyretic & analgesic 
  • High dose (2400-4000 mg/day) anti-inflam

7

What can aspirin toxicity cause?

  • Gastric ulceration
  • Tinnitus (CN VIII)
  • Chronic use can l/t acute renal failure, intersitial nephritis, & upper GI bleeding
  • Risk of Reye's synd in children tx w/ apsirin for viral infection
  • Stim resp centers, causing hyperventilation & resp alkalosis 

8

What are examples of NSAIDs?

  • Ibuprofen
  • Naproxen
  • Indomethacin
  • Ketoralac
  • Diclofenac

9

What is the MOA of NSAIDs?

Reversibly inhibits COX 1 & 2 & blocks PG synthesis 

10

What are the clinical uses of NSAIDs?

  • Antipyrenic
  • Analgesic
  • Anti-inflam
  • Indomethacin is used to close a PDA

11

What can NSAID toxicity cause?

  • Interstitial nephritis
  • Gastric ulcer (PG's protect gastric mucosa)
  • Renal ischemia (PG vasodilate afferent arteriole)

12

What is the MOA of COX-2 inhibitors (celecoxib)?

Reversibly inhibit specifically the COX isoform 2, which is found in inflam cells & vascular endothelium & mediates inflam & pain. Spares COX-1 & TXA2

13

What is the clinical use of COX-2 inhibitors?

Rheumatoid arthritis & osteoarthritis; pts w/ gastritis or ulcers 

14

What can COX-2 inhibitor toxicity cause?

Inc risk of thrombosis; sulfa allergy

15

What is the MOA of Acetaminophen?

Reversibly inhibits COX, mostly in CNS. Inactivated peripherally

16

What are the clinical uses of Acetaminophen?

  • Antipyretic
  • Analgesic but not anti-inflam
  • Used instead of aspirin to avoid Reye's synd in children w/ viral infection

17

What can Acetaminophen toxicity cause?

Overdose produces hepatic necrosis; acetaminophen metabolite depletes gluthione & forms toxic tissue adducts in liver. N-acetylcysteine is antidote-regenerates glutathione.

18

What is an example of a bisophosphonates?

Alendronate, other -dronates

19

What is the MOA of Bisphosphates?

Pyrophosphate analogs; bind hydroxyapatite in bone, inhibiting osteoclast activity

20

What are the clinical uses of Bisphosphonates?

  • Osteoporosis
  • Hypercalcemia
  • Paget's dz of bone

21

What can Bisphosphonate toxicity cause?

Corrosive esophagitis, osteonecrosis of the jaw

22

What are the chronic gout drugs?

  • Allopurinol
  • Febuxostat
  • Proenecid
  • Colcchicine

23

What are the Acute gout drugs?

  • NSAIDs (naproxen, indomethacin)
  • Glucocorticoids (oral or intraarticular)

24

What is the MOA of Allopurinol?

Inhibits xanthine oxidase, dec conversation of xanthine to uric acid

25

What is Allopurinol used for?

  • Gout
  • Lymphoma & leukemia to prevent tumor lysis- assoc w/ urate nephropathy

26

What can Allopurinol inc conc of?

Azathioprine & 6-MP (both normally metabolized by xanthine oxidase)

27

What can you not give Allopurinol w/?

Don't give w/ salicylates; all but the highest doses depress uric acid clearance. Even high doses (5-6g/day) have only minor uriosuric activity

28

What is the MOA of Febuxostat?

Inhibits xanthine oxidase

29

What is the MOA of Probenecid?

Inhibits reabsorption of uric acid in PCT (also inhibits sec of penecillin)

30

What is the MOA of Colchine?

Binds & stabilizes tubulin to inhibit polymerization, impairing leukocyte chemotaxis & degranulation

31

What are the TNF-alpha inhibitors?

  • Etanercept
  • Infliximab
  • Adalimumab

32

What can all TNF-alpha inhibitors cause?

Predispose to infection including reactivation of latent TB since TNF blockade prevents activation of macro & destruction of phagocytosed microbes

33

What is the MOA of Etanercept?

Fusion protein (recptor for TNF-alpha + IgG1 Fc), produced by recombiant DNA

34

What are the clinical uses of Etanercept?

  • Rheumatoid arthritis
  • psoriasis
  • Ankylosing spondylitis

35

What is the MOA of Infliximab & Adalimumab?

Anti-TNF-alpha monoclonal Ab

36

What are the clinical uses of Infliximab & adalimumab?

  • Chron's dz
  • Rheumatoid arthritis
  • Anklylosing spondylitis
  • Psoriasis 

37


How do you treat Osteoporosis?


SERMs (Estrogen)

Calcitonin

Bisphosphonates

Pulsatile PTH

38

What is osteoporosis prophylaxis?


weight-bearing exercise

adequate Ca & Vit D throughout life

39


What drugs are contraindicated in osteoporosis?


Glucocorticoids

40