recitation 6.21 Flashcards Preview

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Flashcards in recitation 6.21 Deck (103):
1

Ziconotide

indicated for intrathecal admin for severe chronic pain

2

Ziconotide MOA

N-type calcium channel blocker in primary nociceptors in the dorsal horn

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Ziconotide Warnings

neuropyschosis

4

Ziconotide ADR

dizziness, ataxia, somnolence, nausea

5

intrathecal baclofen

severe spasticity

6

Intrathecal Baclofen ADR

hypotonia, somnolence, dizziness,

7

Topical analgesics

methyl salicylate, Trolamaine salicylate

8

Counter irritants

menthol, camphor, capsaicin

9

Counter irritants ADR

creates irritation/inflammation locally to relieve inflammation in underlying or adjacent tissues and local anesthetic action

10

Menthol indications

orally for GI complaints and topically for pain, inflammation

11

Menthol ADR

oral: heartburn, NV. Topical: dermatitis, irritation

12

Camphor

topical anti-tussive, analgesic

13

Camphor toxicity

NV, burning of mouth, and throat. can lead to seizure and respiratory depression

14

Capsaicin MOA

TRPV 1 channel agonist. enhances TRPV1 stimulation and relieves pain when these receptors are desensitized.

15

Capsaicin indications

post herpetic neuralgia

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Capsaicin ADR

oral- GI discomfort, sweating, flushing, anitcoag
Topical- burning, stinging, erythema

17

Iontophoresis

ion current to deliver charged drugs through the skin

18

Gout

allopurinol, colchicine, febuxostat, probenacid, Rasburicase, pegloticase

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Allopurinol MOA

Xanthine oxidase inhibitor and purine analog. Reduces production of uric acid

20

Allopurinol indications

Chronic treatment of rimary or secondary gout, tumor lysis syndrome in chemo patients, hyperuricemia with recurrent calcium oxalate stones

21

Allopurinol Drug interactions

Azothioprine, warfarin, increases theophylline

22

Allopurinol ADR

rash, ND, increased LFT, acute gout attack

23

Probenacid

chronic treatment for hyperuricemia associated with gout and boosts PSN levels

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Probenacid MOA

blocks renal tubular reabsorption of urate

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Probenacid ADR

HA, nausea, worsening gout flares, dizziness, uric acid, kidney stones, blood dyscrasias

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Febuxostat

chronic treatment for gout

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Febuxostat MOA

Xanthine oxidase inhibitor

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Febuxostat ADR

higher CV events and hepatic failure

29

Lesinurad

use with an XOI when target uric acid levels are not acheived

30

Lesinurad MOA

blocks uric acid resborption

31

Lesinurad interactions

metabolized at CYP2C9- amlodipine, soldenafil

32

Lesinurad ADR

increased SCr, renal failure, kidney stones, HA, flu, GERD

33

Colchicine

prophylaxis and treatment of gout flare and familial mediterranean fever

34

Colchicine MOA

inhibits microtubule formation in bone cells and prevents neutrophil activation

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Colchicine warnings

blood dyscrasias, neuromuscular toxicity, rhabdo, contraindicated with strong 3A4 inhibitors

36

Colchicine ADR

DIARRHEA, throat pain

37

Pegloticase

refractory chronic gout

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Pegloticase MOA

PEGylated uricase enzyme catalyzies oxidation of uric acid to allantoin

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Pegloticase ADR

gout flare, infusion reaction, nausea, ecchymosis, nasopharyngitis, constipation, chest pain, vomiting, CHF exacerbation

40

Rasburicase

hyperuricemia due to tumor lysis syndrome

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Rasburicase MOA

urate-oxidase, catalyzes oxidation of uric acid to allantoin

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Rasburicase ADR

anaphylaxis, hemolysis, methemoglobinemia

43

Systemic Corticosteroids

prednisone, methylprednisone, prednisolone

44

Systemic corticosteroid MOA

inhibit cytokine production, adhesion, protein activation, inflammatory cell migration, and activation (anti-inflammatory)

45

Systemic Corticosteroids short term ADR

hyperglycemia, increased appetite, fluid retention, wt gain, mood alteration, HTN, peptic ulcer

46

Systemic Corticosteroids Long term ADR

adrenal axis suppression

47

Systemic corticosteroid indications

Rheumatoid arthritis

48

DMARDS (disease modifying rheumatic drugs)

Methotrexate, leflunomide, hydroxychloroquine, Sulfasalazine, Minocycline

49

DMARDs biologics

humira, enbrel, Remicade, Cimzia, Simponia, orencia, Rituxan, Actemra, Stelara

50

Methotrexate MOA

folate analog, relieves inflammation, swelling and pain

51

Methotrexate

rheumatoid arthritis. psoriasis, some cancers

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Methotrexate contraindications

pregnancy and lactation, liver disease, alcoholism, blood dyscrasias

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Methotrexate ADR

NV, hair loss, rash, abnormal liver enzymes, fatigue, mouth sores, diarrhea, low blood counts

54

Leflunomide MOA

pyrimidine synthesis inhibitor

55

Leflunomide

reduces signs and symptoms, inhibit structural damage in RA

56

Leflunomide contraindications

pregnancy

57

Leflunomide warnings

hepatotoxicity

58

Leflunomide ADR

Diarrgea, N, stomach pain, indigestion, rash, hair loss, cough, SOB, lung injury

59

Hydroxychloroquine

antimalarial, RA, discoid and systemic lupus

60

Hydroxychloroquine contraindications

retinal or visual field changes, long term use in kids

61

Hydroxychloroquine ADR

bulls eye maculopathy, nausea, diarrhea, skin and hair changes

62

sulfasalazine

ulcerative colitis, RA, ankylosing spondilitis. psoriatic arthritis

63

Sulfasalazine MOA

anti-inflammatory and immunomodulatory

64

Sulfasalazine ADR

Nausea, abd discomfort, photosensitivity

65

Minocycline

mild RA

66

Minocycline ADR

dizziness, rash, photosensitivity

67

Anti-TNF drugs MOA

genetically engineered proteins that block proinflammatory cytokines

68

Anti-TNF indications

used when DMARDs fail in RA, psoriatic arthritis, peds crohns and UC, anylosing spondylitis and psoriasis

69

Anti-TNF contraindications

infection, HF, MS, cancer

70

Anti-TNF ADR

infection, injection site reactions (local rash, burning, itching), infusion reaction (headache and abdominal pain)

71

Anti-TNF

Humira, Enbrel, remicade, cimzia, Simponi

72

Abatacept (Orencia)

second line for RA, juvenile arthritis after MTX and biologics

73

Orencia MOA

selective T cell costimulation modulator. prevents T cell activation

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Orencia contraindications

Concomitant use with other biologics

75

Orencia ADR

HA, URI, nasopharyngitis, nausea

76

Ritixumab (Rituxan) MOA

chemo drug- targets and removes abnormal B cells decreasing autoimmune response

77

Rituxan

Non-hogdkins lymphoma, Chronic lymphocytic Leukemia, Second line RA, wegeners granulomatosis, Microscopic polyangitis

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Rituxan Warnings

tumor lysis syndrome, SJS, TEN, Hep b reactivation, cardiac arrhythmias, renal toxicity, bowel obstruction

79

Rituxan ADR

infusion reaction, hypotension

80

Tocilizumab (Actemra)

RA, JA

81

Actemra MOA

IL-6 receptor agonist- binds and inhibits signaling

82

Actemra warnings

serious infections, GI perforation, neutropenia, live vaccines

83

Actemra ADR

HA, HTN, increased cholesterol, increased ALT, URI

84

Stelara

psoriasis, psoriatic Arthritis

85

Stelara MOA

selectively targets IL-12 and IL-23

86

Stelara ADR

nasopharyngitis, URI, HA, fatigue, arthralgia, nausea

87

Calcium

Osteoporosis

88

Difference in Ca carbonate and Ca citrate

Citrate absorbs better, Carbonate must take with food.

89

Biphosphonates

Alendronate, Risedronate, Ibandronate, Zoledronic acid

90

Biphosphonates MOA

block osteoclasts activity

91

Biphosphonates warning

GI side effects, infusion reactions, osteonecrosis of the jaw, arrhythmias, bone quality, Uveitus/scleritis, esophagitis, not for women of child bearing age

92

Alendronate ADR

dyspepsia, abd pain, acid reflux, constipation, diarrhea, musculoskeletal pain, nausea

93

Zolendronate indications

osteoporosis (Reclast), hypercalcemia of malignancy, multiple myeloma (Zometa)

94

Raloxifene (Evista)

increases BMD without breast Cancer or endometrial hyperplasia

95

Raloxifene ADR

increased risk of DVT

96

Teriparatide (Forteo)

synthetic PTH that builds bone by stimulating osteoblast activity

97

Teriparatide warnings

osteosarcoma

98

Teriparatide contraindications

Pagets disease, preg/nursing, peds, prior radiation therapy, bone mets, skeletal malignancies, hypercalcemia

99

Teriparatide ADR

hypercalcemia, HA, myalgia, arthralgia

100

Denosumab MOA

monoclonal antibody that blocks RANK ligand which stimulates osteoclasts

101

Denosumab indications

postmenopausal women with osteoporosis (Prolia) unresectable giant cell tumor, increase bone mass in high risk for fracture (Xgeva)

102

Denosumab ADR

cellulitis, eczema, flatulence, fatigue, asthenia, hypophosphatemia, nausea, dyspnea, arthralgia, HA

103

AACE guidelines first line for osteoporosis

alendronate, risedronate, zoledronic acid or denosumab