NSaids antirheumatoids nonopioids and antigouts

Question 1

COX-1

Answer 1

homeostatic in function

Question 2

COX 2

Answer 2

induced during inflammation anf tends to facilitate inflammatory response.

Question 3

NSAIDs

Answer 3

Aspirin is the original NSAID.All Nsaids are weak organic acids except nabumetone which is a ketone prodrug that is metabolized to the acidic active drug.

Question 4

MOA of NSAIDs

Answer 4

inhibition of biosynthesis of prostaglandins. Aspirin irreversibky acetylates and blocks platelet Cyclooxygenase .

Question 5

Toxicity

Answer 5

all of them are gastric irritants .Can be nephrotoxic due to interference with autoregukation of renal blood flow which is regulated by prostaglandins.

Question 6

positive effect

Answer 6

most appear to reduce the incidence of colon cancer when taken chronically.

Question 7

cox2 selective inhibitors

Answer 7

have analgesic, antioyretic and antiinflammatory effects.eg…Celecoxib and meloxicam though not as selective as celecoxib.

Question 8

Non selective cox inhibitors

Answer 8

diclofenac ,diflunisal, etodolac,flurbiprofen,ibuprofen(brufen)-closes patent ductus arteriosus in infants.,Indomethacin-also inhibits phospholipase A and C,,ketoprofen,ketolorac,nabumetone,naproxen,oxaprozin ,piroxicam,sulindac-prodrug and tolmetin.

Question 9

DMARDs

Answer 9

disease modifying antirheumatic drugs.They are grouped into biologic and non biologic derived .

Question 10

Non biologic dmards

Answer 10

methotrexate,salfasalazine, azathioprine,chloroquine and hydroxychloroquine , gold salts,leflunomide, cyclosporin and minocycline.

Question 11

biologic dmards

Answer 11

eternercept ,infliximab ,adalimumab,rituximab,abatacept ,tocilizumab and golimumab.

Question 12

abatacept

Answer 12

MOA:inhibits activation of Tcells…………………………………………………..Adverse effects:increased risk of infection.

Question 13

Azathioprine

Answer 13

MOA:acts through its active metabolite ,6-thioguanine which suppresses inosinic acid synthesis,B-cell and T-cell function,immunoglobulin priduction and IL-2 secretion.Adverse effects:bone marriw suppression.

Question 14

HCQ

Answer 14

MoA -trapping of free radicals,suppression of T lymphocyte respinses to mitogens

Question 15

cyclosporine

Answer 15

inhibits IL2 and IL 1 receptor production .grapefruit juice increases its bioavailabiliy can cause nephrotoxicity

Question 16

leflunomide

Answer 16

its metabolite inhibits dihydroorotate dehydrogenase also inhibits Tcell proliferation.it causes elevation of liver enzymes

Question 17

methotrexate

Answer 17

inhibits dihrydrofolate reductase. its toxic effects are nausea and mucosal ulcers

Question 18

Rituximab

Answer 18

its is an antibody that targets CD20 B lymohocytes

Question 19

sulfasalazine

Answer 19

inhibits the release of inflammatory cytokines

Question 20

TNF alfa blocking agents

Answer 20

adalimumab,infliximab,etanercept.

Question 21

glucocoorticoids(corticosteroids)

Answer 21

they are used in rheumatoid arthritis patients

Question 22

acetaminophen

Answer 22

weak cox1 and cox 2 inhibitor.treats mild to miderate pain such as headache

Question 23

Drugs used to treat Gout

Answer 23

gout is associated with hyperuricemia.

Question 24

drugs used to treat acute gout

Answer 24

colchicine,Nsaids,glucocorticoids.

Question 25

colchicine

Answer 25

it has no effect on the metabolism or excretion of uric acid so it does not affect blood uric acid levels.It inhibits the formarion of leukotriene B4.toxic effects are diarrhea ,nausea .

Question 26

drugs used to treat chronic gout

Answer 26

uricosuric agents-probenecid and sulfinpyrazone and uric acid synthesis inhibitor- allopurinol.

Question 27

uricosuric agents -probenecid and sulfinpyrazone

Answer 27

they affect active transport sites of uric acid so that its reabsorption is reduced .As its ecxretion increases the size of urate pool reduces .these drugs can cause gastrointestinal irritation

Question 28

allopurinol

Answer 28

inhibits xanthine oxidase which is an enzyme that is involved in the metabolism of xanthine and hypoxanthine into uric acid.Therefore reducing urinary and blood concentrations of uric acid.

Question 29

febuxostat

Answer 29

non purine inhibitor of xanthine ixidade

Question 30

corticosteroid

Answer 30

prednisone-most common