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Flashcards in Muskuloskeletal Deck (29):
1

Gout treatment

Pain
-nsaids
-corticosteroids

Antigout
-allupurinol
-febuxostat
-colchicine

Uricosuric
-probenecid
-sulfinpyrazone

2

GOUT
drugs that act directly on patho and prevent progression

allopurinol and febuxostat

3

GOUT
ALLOPURINOL
uric acid falls in

ADRs

Pregnancy

DOC

2-3 days

maculopapular skin rash, hepatotoxicity, renal/liver function

C

4

GOUT
FEBUXOSTAT
uric acid falls in

should not be administered with

can cause___

two weeks

xanthine oxidase drugs (theophylline, mercaptopurine, azathiprine)

C

acute gout flare- nsaid or colchicine given first 6 months

5

GOUT
COLCHICINE

does not prevent___
decreases ____
used for _____

ADRS

Drug interactions

progression
inflammatory response
acute attack

significant diarrhea
neuropathy, myopathy
b12 malabsorption
hepatotoxicity

FEW COMPARED TO REST

C

6

URICOSURIC DRUGS GOUT

General considerations:

Probenecid
Increases levels of____

Pregnancy category

Sulfinpyrazone
has ____ effect
can cause

highly protein bound
LIVER
Do not take with aspirin
Monitor CBC blood dyscrasias
Careful with PUD
SULFA BASED DRUGS- allergy

penicillin and cephalosporins

B

antithrombotic effect
blood dyscrasias

7

Allopurinol and colchicine risk _____

Colchicine, and uricosuric acid have _____

Renal in which?

hepatotoxicity

GI ADR's- caution PUD

ALL BUT FEBUXOSTAT

8

allopurinol best for patients

uricosuric for

overproduction uric acid

undersecrete uric acid

9

Rheumatoid arthritis

Initial tx

salicylates, nsaids, or celecoxib (do not change course or prevent joint destruction

low dose prednison glucocorticoid inj

First- NSAID
Low dose prednisone short term can decrease progression for first 2 years
Prophylaxis with a biphosphonate and calcium/vitamin D to lower osteop

10

Corticosteroids

Metabolized by

Excreted by

Pregnancy

liver

kidneys

C but can cross placenta risk cleft 1st trimester

11

Corticosteroids PRECAUTIONS/ADRS

Contraindicated in

Caution with

active untreated infections (can mask)

htn and cardiovascular (elevate bp, retain salt and water)

postmenopausal women (osteoporosis, excrete calcium)

diabetics (alters liver glucose regulation)

Ulcerative colitis or GI (increased risk bleed)

12

Corticosteroids ADR

Muscle/skin (atrophy, thinning, hump, mood face)
Skeletal (osteoporosis)
Eyes (cataracts, glaucoma, ocular infx)
GI (PUD esp. combo nsaids aspirin)
CV (HTN, electrolyte imbalance)
CNS (delirium, agitation, insomnia, mood, swings, depression onset 15-30 days)
Endocrine (adrenal supp, withdrawal, glucose metabolism)

13

Corticosteroids

Inflammation

Immune suppression

methylpred, pred, triamcinolone or dexamethasone

predison (shorter half life, different strengths)

14

Corticosteroids selection

Short acting

Long acting

less likely to produce hpa suppression

preferred if high doses must be maintained (increased ICP, organ transplant rejection)

15

Corticosteroids

Monitoring

Education

weight electrolytes glucose CBC
Long term high dose- GI bleeding
lipids
eye exam

changes body image, mood, gi bleed, immune suppression

Diet high in potassium and calcium low in sodium and carbs

16

NSAIDS

ADRS


Indomethacin

GI disturbances
Acute renal insufficiency
Increase bleeding time
Fluid retention and peripheral edema

BB- increase change heart attack stroke
Pregnancy B/C avoid in last trimester

aggravate depression or psychiatric symptoms

17

NSAIDS monitoring

Renal function long term
GI ulcer/bleed CBC prior to initian

18

Acetaminophen

Metabolized by

Pregnancy

DOC fore

Liver- 4 gm max (otc 3, social drinking 2 gm)

B

Pregnancy, GI bleed hx, aspirin allergy, blood coag disorders upper GI disease

Drug of choice for fever for above adults and children (esp. flu like illness)

19

Aspirin

ADRS

Pregnancy

Poisoning

Used:

Monitor

ototoxic, GI irritation, iron defieciency anemia, reye syndrome, avoid 1 week post up, caution hepatic, can damage esophagus remain upright

D

lavage, alkalinize urine

post MI stroke prevention

renal function, CBC, salicylate level, fecal blood testing

20

Pain threshold

Pain tolerance



Aging

point at which stimulus experienced as pain

duration of time or intensity of pain that a person will endure before taking action

decrease threshold (neuropathies)
decrease tolerance
alt. metabolism of drugs

21

Somatic-

Visceral-

connective tissue bone (acetaminophen cortico nsaids opiates local anesthetics ice massage)

radiates (internal organs poorly localized) - OPIATES may also use corticosteroids nsaids

22

NSAIDS avoid in

Pregnancy elderly renal dysfunction

23

Cox2

avoid in

interactions

celecoxib (celebrex)

pregnancy children renal pain r/t CABG

CV patients (HT HTN fluid retention)- increased risk MI stroke

good for patients with GI problems but cardiovascular risk

cyp
increased risk renal failure with acei



24

salicylates avoid in

pregnancy children renal

25

OPIODS

agonists

mixed agonist-antagonist

partial agonist

codeine, fentanyl, hydrocodone, hydromorphone, leveorphanol, meperidine, methadone, morphine, oxycodone

butorphanol, nalbuphine, pentazocine

buprenorphine and dezocine

26

Opiods

metabolized by

pregnancy

adrs

mod

severe

liver

c

resp depression hypotension CNS (all) constipation dep cough reflex paresthesia

hydrocodone codeine

morphine oxycodone

27

Opioid antagonist

Naloxone (narcan) Naltrexone Nalmefene

28

Central chronic pain

Non-neuropathic pain

Neuropathic pain

CNS lesion migraine

fibromyalgia, myositis, myalgia, muscle strain
TX: nsaids tcas and serotonin reuptake inhibitors

Nerve (tingle burn shooting) diabetic neuropathy, postherpetic neuralgia
TX: antiepileptics- tegretol, neurontin, lyrica; antidepressants- tcas, serotonin and norepinephrine reuptake inhibitor like cymbalata

29

PAIN
Antidepressants

TCAs

amitriptylline, desipramine, imipramine, and nortiptyline