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DnD-Skin/Con/Misc > OA/RA/AD Pharmco > Flashcards

OA/RA/AD Pharmco Flashcards

(79 cards)

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1
Q

Aspirin

A
  • Non-selective COX Inhibitor
  • pseudo- irreversible
  • Uncouples mitochondrial oxidative phosphorylation
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2
Q

Aspirin ADR

A
  • NVD
  • GI upset + Bleed
  • heartburn
  • tachycardia
  • Asthma
  • Blood in vomit and stool
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3
Q

Which PG gives GI protection?

A

COX-1: PGE2

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4
Q

What happens when you inhibit PGE2?

A

GI Bleeding + peptic ulcer

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5
Q

Which COX and PGs are important for cardio?

A

COX-1 and COX 2
PGI2 and TxA2

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6
Q

Which NSAIDs are NON-selective but has more COX-2 activity?

A
  • Diclofenac
  • Etodolac
  • Ketorolac
  • Meloxicam
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7
Q

NSAID Prodrugs?

A
  • Diclofenac
  • Nabumetone
  • Sulindac
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8
Q

NSAID Therapeutic use

A
  • Headache
  • Fever
  • Pain
  • RA/OA
  • Dysmenorrhea
  • Bursitis, tendonitis
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9
Q

What occurs when you take Aspirin with another NSAID?

A

You lose antiplatelet effect

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10
Q

NSAID ADR

A
  • NVD
    -Ulcers
  • Neutropenia
  • Aplastic or Hemolytic Anemia
  • Eosinophilia
  • Hypersensitivity
  • decrease in GFR
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11
Q

NSAID is associated with?

A
  • Nephrotoxicity
  • hematuria
  • fluid retention
  • colitis
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12
Q

COX-2 Inhibitors

A
  • Celecoxib
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13
Q

Celecoxib Use

A
  • OA/ RA
  • Pain
  • Dysmenorrhea
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14
Q

Celecoxib DI

A
  • Fluconazole
  • Lithium
  • Loop diuretic
  • Warfarin
  • Rifampin
  • MTX
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15
Q

Acetaminophen

A

Cox-3 inhibitor
Analgesic
Antipyretic
(Not anti-inflammatory)
High activity when Low ROS

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16
Q

APAP ADR

A
  • Hematological effects
  • CNS depression
  • GI irritation + bleeding
  • Metabolic acidosis
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17
Q

Arthritis treatment

A
  • anti-inflammatory drugs
  • Steroids
  • Immunosuppressants
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18
Q

Other drugs for Arthritis

A
  • capsaicin
  • tramadol
  • opioids
  • duloxetine
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19
Q

Capsaicin

A

Desensitizes TRPV
Depletes Substance P

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20
Q

Tramadol

A
  • opioid
  • mu receptor agonist
  • Suppresses 5-HT and NE- mediated nociceptors
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21
Q

Duloxetine

A
  • SNRI
  • 5-HT2A agonist
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22
Q

Anti-inflammatory Corticosteroid Class

A

Class 1 - Most potent
Class 7 - Least Potent

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23
Q

Corticosteroid MOA

A

Stimulate the synthesis of lipocortin which inhibits PLA1 from synthesizing AA

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24
Q

Corticosteroid effects

A
  • Anti-inflammatory
  • anti-mitotic
  • immunosuppressant
  • vasoconstriction
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25
Corticosteroid ADR (short-term)
- GI issues - Fluid retention - insomnia - agitation - concentration difficulties - irregular menses / vaginal yeast infection
26
Corticosteroid ADR (rare)
- psychosis - diabetes - Aseptic necrosis (skeletal)
27
Corticosteroid ADR (long-term)
- myopathy - fragile skin - osteoporosis - lipodystrophy - hair loss or facial hair - cataracts
28
What are DMARDs?
Disease Modifying Anti-rheumatic Drugs - immunosuppressants - Stop underlying progression (without analgesic and inflammatory effects)
29
DMARD drugs
- hydroxychloroquine - leflunomide - methotrexate - sulfasalazine - tofacitinib - baricitinib - upadacitinib
30
Biologics are DMARDs
- TNF-inhibitor - IL-1 Inhibitor - IL-6 inhibitor - T-cell inhibitor - AntiCD20 Antibody
31
Anakinra (Biologic)
- IL-1 inhibitor - immunosuppressant
32
Anakinra ADR
- Immunosuppression - Inj Site rxn - Upper respiratory infection - NVD - Allergic rxn - autoantibody dyscrasias
33
Methotrexate
- Inhibits Dihydrofolate reductase (DHFR) - inhibit the synthesis of polyamine - Anti-folate properties
34
Methotrexate ADR
- NVD - Hepatic/renal Failure - anemia - rigidity - GI issues - CNS toxicity - pharyngitis - cirrhosis - portal vein fibrosis
35
Methotrexate Contraindication
Do NOT take with NSAIDs - NSAID compete with MTX which causes toxic levels of mtx in the blood
36
Leflunomide
- antirheumatic, immunosuppressant, immunomodulator - Inhibits DHODH and pyrimidine synthesis (t-cell) - analgesic, anti-pyretic, histamine-blocking
37
Leflunomide ADR Common
- alopecia - Diarrhea - increased LFTs - rash
38
Leflunomide ADR serious
- bronchitis - HTN - Respiratory infection - Hepatotoxicity - SJS
39
Apazone + Nimesulide
- weak COX inhibitors - inhibits interleukin and leukocytes
40
Tumor Necrosis Factor inhibitor
- blocks signals from macrophage to Helper T-cells (TNF-alpha) - for severe RA - May be toxic, but for QoL
41
What receptors are on the Osteocyte surface?
IL-1 receptor IL-6 receptor TNF receptor
42
TNF Inhibitor (drug names)
- adalimumab - certolizumab - etanercept ** - golimumab - infliximab **
43
IL-6 Inhibitor Drugs
- Tocilizumab - Sarilumab
44
B-cell Inhibitor (Anti- CD20)
Rituximab
45
CD80 and CD86 inhibitor
Abatacept
46
Infliximab (biologic)
TNF-alpha NEUTRALIZER - chimeric antibody - reduces synovial inflammation, bone resorption, cartilage degradation - binds to both transmembrane and soluble form of TNF
47
Infliximab ADR
(common) Abdominal pain, NVD Serious - delayed hypersensitive rxn - infusion rxn - an invasive fungal infection - tuberculosis - epilepsy - worsening of CHF
48
Etanercept (biologic)
- TNF-alpha BINDER recombinant DNA technology
49
Etanercept ADR COMMON
- GI effects - NVD - Inj site rxn - respiratory symptoms - exacerbation of CNS disorders
50
Etanercept Serious ADR
- allergic rxn - anemia - leukopenia - neutropenia - pancytopenia - thrombocytopenia - sepsis - optic neuritis (permanent )
51
Abatacept (biologic)
- T-cell co-stimulatory inhibitor - blocks release of co-stimulatory factors from APCs (prevent activation of T cells) - binds to B7 protein
52
Abatacept ADR
- NVD. fever, chill flu-like symptoms, weight loss - trouble breathing, chest pain, wheezing, painful urination - skin infection - stomach pain, indigestion, back pain
53
Tocilizumab IL-6 inhibitor
- reduce pain + inflammation - blocks metalloproteases
54
Tocilizumab ADR
- NVD - Flu-like symptoms - trouble breathing, chest pain, phlegm, painful urination - Skin infection - blistering rash - bruising, tarry stool, coffee ground vomit - stomach pain, indigestion, back pain
55
Sarilumab IL-6 Inhibitor
- Human monoclonal AB - IL-6 receptor inhibitor - reduces pain and inflammation - slows/ prevents joint dmg
56
Rituximab (biologic)
- B-cell CD20 inhibitor - B-cell lysis
57
Rituximab ADR
- NVD - CV - inj site rxn - allergic rxn - abdominal pain - flu, bronchitis - vertigo - Heart failure
58
Tofacitinib
- JAK 1/3 inhibitor - blocks STAT activity, affecting gene expression - reduction in t- and b- lymphocytes
59
Tofacitinib ADR
- Systemic infection (nose, throat, UTI) - NVD, headache - increase in TG/ cholesterol
60
Upadacitinib
JAK 1 inhibitor
61
Baricitinib
Oral JAK 1 AND 2 inhibitor
62
Baricitinib ADR
- IMMUNOSUPPRESSION - Flu-like symptoms - increased urination + pain (?) - stomach pain - diarrhea - SoB - pink/ red mucus
63
Cutaneous Drug Reaction
- can be mildly discomforting or life-threatening - often associated with anti-infective and anti-convulsant medications
64
Major classes that Cause cutaneous rxn
- NNRTI - Anticonvulsant - sulfonamides - antibiotics - NSAID (oxicams) - Antifungal - Antimalarial - allopurinol
65
(Main) 4 drugs Cutaneous Rxn
- sulfamethoxazole-trimethoprim - sulfasalazine - phenytoin - carbamazepine
66
Exfoliative Dermatitis
- aka erthema multiforme - mainly seen on extensor surface - may be associated with herpes, systemic infection, Disease-drug rxn - sudden onset with history of occurrance
67
Erythema multiform MAJOR (SJS)
- more than 50% of skin has fallen off - erosive involving 2 or more mucosal surface - commonly: coral, conjunctiva
68
Drug-Induced EM Toxic Epidermal Necrolysis
- most severe vesiculobullous disease on this spectrum - more than 20% BSA in 24 hrs - Skin peels in large sheets - accompanied by: constitutional (flu-like) symptoms
69
SJS Treatment
- supportive - fluid balance; acid-base - pain management - prednisone - Cyclosporine or azathioprine - IgG - Biologics (infliximab) loss of skin - loss of protein
70
Low dose Aspirin Inhibits?
COX-1
71
Heteroaryl propionic acid
- contains heteroaryl ring - more cox-2 than cox-1 - this selectivity lowers GI risks
72
Oxicams Tautomer B is more potent than Tautomer A. Why?
In Tautomer A, there is NH which allows the H to constantly travel. In tautomer B, Instead of NH, it's a N= which stops the movement of H
72
COX-1 enzymes
- constitutive - Produces TxA2
72
COX-2 enzymes
- Induced by cytokines and GFs to produce PG - Produces PGI2
72
PGI2 (prostacyclin)
- vasodilator - anti-platelet
72
Phospholipase A2
Cleaves AA from cell membrane phospholipids
72
Misoprostol
- Semi-synthetic derivative of PGE1 (prodrug) - reduced gastric ACID secretion - stimulates gastric MUCUS secretion - Vasodilation (increased blood flow)
73
TxA2 (thromboxane)
- vasoconstriction - platelet aggregation
74
Antidote to APAP?
N-Acetyl Cysteine

DnD-Skin/Con/Misc (5 decks)

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