Muskuloskeletal Flashcards
(29 cards)
Gout treatment
Pain
- nsaids
- corticosteroids
Antigout
- allupurinol
- febuxostat
- colchicine
Uricosuric
- probenecid
- sulfinpyrazone
GOUT
drugs that act directly on patho and prevent progression
allopurinol and febuxostat
GOUT
ALLOPURINOL
uric acid falls in
ADRs
Pregnancy
DOC
2-3 days
maculopapular skin rash, hepatotoxicity, renal/liver function
C
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
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
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
Allopurinol and colchicine risk _____
Colchicine, and uricosuric acid have _____
Renal in which?
hepatotoxicity
GI ADR’s- caution PUD
ALL BUT FEBUXOSTAT
allopurinol best for patients
uricosuric for
overproduction uric acid
undersecrete uric acid
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
Corticosteroids
Metabolized by
Excreted by
Pregnancy
liver
kidneys
C but can cross placenta risk cleft 1st trimester
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)
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)
Corticosteroids
Inflammation
Immune suppression
methylpred, pred, triamcinolone or dexamethasone
predison (shorter half life, different strengths)
Corticosteroids selection
Short acting
Long acting
less likely to produce hpa suppression
preferred if high doses must be maintained (increased ICP, organ transplant rejection)
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
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
NSAIDS monitoring
Renal function long term
GI ulcer/bleed CBC prior to initian
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)
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
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
Somatic-
Visceral-
connective tissue bone (acetaminophen cortico nsaids opiates local anesthetics ice massage)
radiates (internal organs poorly localized) - OPIATES may also use corticosteroids nsaids
NSAIDS avoid in
Pregnancy elderly renal dysfunction
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
salicylates avoid in
pregnancy children renal
