Pharm Flashcards by Danielle Collins

NSAID ingredient of topical gel that is perhaps the most effective pain remedy for osteoarthritis

diclofenac

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biologic DMARD of limited efficacy, recombinant version of endogenous human IL-1 receptor antagonist

Anakinra

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JAK3 antagonist used as a biologic DMARS, novel in that it is orally active

Tofacitinib

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Peptide blocker of N-type voltage gated calcium channels administered intrathecally for refractory pain

ziconotide

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classic NSAID with COX1 selectivity, remains a drug of choice for treating acute gouty arthritis

Indomethacin

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Drugs that relieve pain without causing loss of consciousness

Analgesics

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Noteworthy because it suppresses fever and pain but not inflammation, presumably in part by inhibiting prostaglandin synthesis in the CNS

Aceetaminophen

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COX-2 inhibitor that can be administered to treat pain and inflammation of RA if the benefits outlay the risk; only member of its class still marketed in the US

Celecoxib

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Accumulates outside of the cell as a consequence of AICAR accumulation inside cells due to the action of polyglutamated methotrexate; binds to purinergic GPCR on cell surface to exert anti-inflammatory response

Adenosine

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Pts with pain due to RA are often administered NSAIDs or glucocorticoids despite their lack of effect on disease progression while waiting for a drug from this class to begin exerting its effects

DMARD

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Abbreviation for a prostaglandin that has widespread effects throughout the body including inc vascular permeability, mucosal protection in the gut, fever in the CNS, pain sensation in the periphery, and salt & water homeostasis in the kidney

PGE-2

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What class of drugs do lidocaine and pramoxine that can help treat things such as neuropathic pruritus or pruritus due to CKD belong to?

Local anesthetics

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Prototypical bisphosphonate, drug class of first choice for treating osteoporosis, its incorporation into bone inhibits the number and activity of osteoclasts

Alendronate

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Osteoporosis monoclonal Ab therapy that binds RANKL (receptor activator of NF-kB ligand) to decrease formation and function of osteoclasts

Denosumab

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Potentially lethal consequence of acetaminophen overdosage

Hepatic necrosis

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disrupts pyrimidine synthesis, a second choice traditional DMARD due to more common serious adverse effects

Leflunomide

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Classic alpha2-adrenergic agonist administered PO to reduce blood pressure, also administered intrathecally as adjunct therapy for severe cancer pain not treated effectively by opioids alone

Clonidine

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This is cleaved from cell membrane phospholipids by phospholipase A2 in response to ‘stimuli’, converted to eicosanoids such as prostaglandins and thromboxjnes

Arachidonic acid

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What pt population is at greater risk for serious adverse effects of NSAIDS?

Elderly

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Antidote for acetaminophen poisoning, substitutes for depleted glutathione in liver cells

Acetylcysteine

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Local anesthetics such as lidocaine interfere with this component of pain sensation

Transmission

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The dorsal horn of the SC is where descending inhibitory fibers and various drugs such as ketamine and SNRI’s influence this component of pain sensation

Modulation

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Biologic DMARS, fusion protein blocks T cell CD80/86 co-stimulatory signal needed for activation

Abatacept

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This structure can be closed prematurely by NSAIDS

Ductus arteriosus

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COX that is induced in response to pathologic stimuli; unfortunately its selective blockade was found to inc the risk for vascular thrombosis as balance between local TxA2 and PGI2 was altered to favor platelet aggregation and vasoconstriction

COX-2

Dexamethasone, betamethasone, and triamcinolone are among the ____________ prednisolone, which have much greater potency and/or 1/2 life than natural hydrocortisone

Fluorinated

Fusion protein made from Fc portion of IgG and 2 TNF receptors, a biologic DMARD administered 1-2x/wk by subcutaneous injection; also used for psoriasis

etanercept

a weak mu agonist that also blocks 5-HT and NE re-uptake, used by many to treat moderate to severe pain

tramadol

Damage to this is a serious side effect of hydroxycloroquine, but little risk from low doses now used to treat RA

retina

Expensive non-purine xanthine oxidase inhibitor used for reducing rate levels in those with allopurinol intolerance

Febuxostat

abbreviation for the class of antidepressant drugs having the most evidence of benefit for treating neuropathic pain; SE's include dry mouth, constipation, tachycardia, palpitations, nausea and sedation

TCA

Drugs that lower serum urate levels by increasing its fractional excretion by the kidneys

Uricosuric

SERM with agonist effects on bone but not breast or uterus used to treat osteoporosis

Raloxifene

Bisphosphonate administered by IV injection once per year; also assoc with highest incidence of osteonecrosis of the jaw

Zolendronic acid

Antagonist at NMDA-type glutamate receptors that relieves pain, widely used veterinary anesthetic also used to reduce amount of morphine needed by humans; SE's are agitation and hallucination

Ketamine

Blocks urate reabsorption by URAT1 transporter in PCT to inc fractional excretion of filtered urate in the urine

Probenecid

happens during the initial phase of aspirin poisoning

Respiratory alkalosis

Blocking the effects of this inflammatory mediator is a common target when treating RA and various other autoimmune diseases

TNF

Calcitonin from this species has a longer 1/2 life and greater potency than human calcitonin, can be administered intranasally or parenterally to treat established osteoporosis

Salmon

What is the preferred/standard of care therapy for treatment of recurrent gout if low GFR or past urate stone or to reduce effects of urate overproduction from things such as tumor lysis syndrome?

allopurinol

Type of nociceptive pain that tends to be poorly localized, deep, dull and cramping

Visceral

abruptly doing this with exogenous glucocorticoids can be deadly

Stopping

Mammalian enzyme that converts uric acid to allantoin, mutated/nonfuncitonal in humans

Uricase

Antiepileptic drug also used to treat neuropathic pain of diabetes, shingles and fibromyalgia

pregabalin

Abbreviation for the prostaglandin formed by endothelial cells that causes local vasodilation and inhibits platelet aggregation

PGI2

Its presence greatly increases risk of developing gastric ulcer in response to NSAID therapy

H. Pylori

This can be triggered by aspirin, presumably because local leukotriene effects predominate over prostaglandin effects

Asthma

biologic DMARd that is humanized antihuman IL-6 receptor Ab, among its effects is to dec acute phase response of the liver

Tocilizumab

1-34 PTH, only agent that forms bone but must be administered in a pulsed manner otherwise leads to bone resorption

Teriparatide

nature of the interaction between COX and aspirin, but not other NSAIDs

irreversible

Calcium receptor sensitizer, acts to lower PTH secretion in chronic kidney disease

Cinacalcet

Most effective and fastest acting of the traditional DMARDS, monitor for myelosuppression but generally well tolerated at low doses, often added to biologic DMARDs

methotrexate

Allopurinol is among the widely used drugs that can cause this potential syndrome of epidermal necrolysis

steven johnson syndrome

absolute contraindication for tx of RA with methotrexate, reason to choose hydroxychloroquine instead

Pregnancy

NSAID notable for often being administered IM or IV

Ketorolac

agent used as a traditional DMARD alone or in combo and also to tx IBD, GI side effects are a common reason for discontinuing

sulfasalazine

uricosuric agent acting similar to probenecid, both require GFR > 60

Sulfinpyrazone

Exerts its pain relieving effects by binding to the alpha2-Delta subunit of N-type voltage-gated Ca channels (contrary to what its name might suggest)

Gabapentin

Happens to methotrexate, appears to be responsible for its low dose ability to treat RA and reason its beneficial effects persist for some time after drug discontinuation

polygutamation

opioids, alpha2-agonists and general anesthetics are among the pharmacological agents that interfere with this component of pain

perception

alpha2-adrenergic agonist administered IV for pain and sedation

Dexmedetomidine

Antimalarial that is also a traditional DMARD used alone or in combo, alters Ag presentation by disrupting lysosomal pH

hydroxychloroquine

non-aspirin NSAID with long 1/2 life that can be useful for treating inflammation and/or pain of arthritis, a recommended drug of choice when benefits still outweigh concurrent CV risks

naproxen

never do this with biologic DMARDs

combine

drug class associated with atypical fractures (ex. simple fracture of compact bone such as the shaft of the femur)

bisphosphonates

seen during second potentially lethal phase of salicylate poisoning

Metabolic acidosis

COX that is constitutive in all tissues, has physiological role and contributes to pathological responses

COX-1

Abbreviation for the thromboxane synthesized by platelets that causes vasoconstriction and promotes platelet aggregation

TXA-2

Chimeric (human and mouse) monoclonal Ab directed against TNF that can be administered IV every 6wks as a biologic DMARD

infliximab

methotrexate, hydroxychloroquine, and sulfasalazine are examples of this type of DMARD

traditional

Relieves inflammation from gout if administered with 12-24hrs of sx onset by blocking the tubular polymerization (microtubule formation) needed by leukocytes of migration and phagocytosis; can cause GI distress when used for prophylaxis

colchicine

AutoAbs present in a majority of RA pts target arginine residues in proteins that have been converted to this

Citrulline

Targets CD20 Ag of B cells to cause a B cell 'do-over' used to treat non-hodgkin lymphoma and CLL, and can be effective in some Ab-dependent autoimmune diseases

rituximab

along with chondroitin, widely used in hopes of treating osteoarthritis but little evidence of benefit beyond placebo effect

Glucosamine

can occur in the jaw of people using bisphosphonates, can be triggered by dental work

Osteonecrosis

These cells are particularly vulnerable to the effects of aspirin as they cannot synthesize replacement COX

platelets

PEGylated version of recombinant mammalian uricase used to treat chronic gout in those refractory to conventional therapy

Pegloticase

Dietary supplements for adolescents, postmenopausal women and elderly to treat mild hypocalcemia by facilitating bone growth or limited bone loss

Calcium salts

non-PEGylated recombinant uricase administered for prevention of acute uric acid nephropathy due to tumor lysis syndrome

Rasburicase

What is the common triple therapy used to treat RA?

Methotrexate hydroxychloroquine Sulfasalazine **all used together

Pain due to nerve damage rather than stimulation of nociceptors

Neuropathic

anti-TNF biologic DMARD, this is humanized monoclonal Ab administered subcutaneously every 2 weeks; also used for psoriatic arthritis, ankylosing spondylitis, Crohn's disease

Adalimumab

irreversible COX inhibitor used to relieve inflammation and pain of RA, does not alter disease progression

Aspirin

Capsaicin and camphor stimulation of these receptors gives a sensation of "heat" that can be useful counterirritant to reduce pain

TRPV-1

"Cold" receptor stimulated by menthol in IcyHot

TRPM-8

Pharm Flashcards

(85 cards)