Tx of Bone and Joint Disorders (Part II) Flashcards
1
Q
NSAID’s – Naproxen Sodium: sub class ?
A
propionic acid
2
Q
Naproxen Sodium trade ?
A
Naprosyn
Alieve
3
Q
Naproxen Sodium indications ?
A
Anti-inflammatory
Osteoarthritis Rheumatoid arthritis Acute gout Mild – Moderate Pain Dysmenorrhea Fever
4
Q
Naproxen Sodium adult dosing ?
A
220, 275, 550 mg naproxen sodium = 200, 250, 500 mg naproxen
Special Ped’s dosing 11-22 mg/kg/day
Divided dose q8-12 hrs
5
Q
Naproxen Sodium BBW / caution ?
A
CABG / CAD / CHF / PUD
- *Watch its with NSAIDS if they are post CABG
- *
6
Q
Naproxen Sodium preg. cat ?
A
C
7
Q
IR(Imed release) doses expressed as ?
A
naproxen sodium
8
Q
ER (extended release) doses expressed as ?
A
naproxen equivalents
9
Q
NSAID Combo Cytoprotective example ?
A
Diclofenac/misoprostol
10
Q
Diclofenac/misoprostol trade ?
A
Arthrotec
Cytotec)
11
Q
Diclofenac/misoprostol (Arthrotec, Cytotec) MOA ?
A
Acts upon gastricparietal cells inhibiting the secretion ofgastric acid
Stimulate increased secretion of the protective mucus that lines theGI tractand increase mucosal blood flow, thereby increasing mucosal integrity
12
Q
Misoprostol trade ?
A
Arthrotec, Cytotec
13
Q
Misoprostol indicated ?
A
Indicated NSAID induced ulcer or protection
14
Q
Misoprostol inhibits ____________ secretion and mucosal __________ ?
A
Inhibits gastric acid secretion and mucosal protections
15
Q
Misoprostol used with ?
A
NSAID’s / ASA
Used in early pregnancy termination
**long standing NSAIDS use you want to use these protection agents
the proactive agents are used to stimulate contractions or bleeding after delivery for uterine bleeding agent **
16
Q
Misoprostol BBW ?
A
Black Box warning with pregnancy / miscarriage, induce labor, uterine rupture
17
Q
NSAID that has been discontinued in the US because of renal disease ?
A
Nabumetone (Relafen)
18
Q
Muscle Relaxants examples ?
A
Metaxalone
Cyclobenzaprine
Baclofen
Tizanidine
19
Q
Metaxalone trade ?
A
Skelaxin
20
Q
Metaxalone (Skelaxin)
MOA ?
A
exact mechanism of action unknown; depresses CNS activity (centrally-acting muscle relaxant)
21
Q
Metaxalone (Skelaxin)
indication ?
A
MS pain / Spasm
22
Q
Metaxalone (Skelaxin) caution in ?
A
renal / Liver Dz
23
Q
Metaxalone (Skelaxin) dosed ?
A
Dosed 800 mg tid/qid
24
Q
Metaxalone (Skelaxin) is give on ______ stomach ?
A
empty
25
Metaxalone (Skelaxin) preg cat ?
C
26
Metaxalone (Skelaxin) peds ?
12 years old
27
Metaxalone (Skelaxin)
| common reactions ? low incidence ?
drowsiness
dizziness
headache
nervousness
nausea
vomiting
dyspepsia
**low incidence**
28
Cyclobenzaprine trade ?
Flexeril
29
Cyclobenzaprine (Flexeril)
| MOA ?
potentiates norepinephrine and binds to serotonin receptors, reducing spasticity (centrally-acting muscle relaxant)
30
Cyclobenzaprine (Flexeril)
| indications ?
Muscle Spasm
31
Cyclobenzaprine (Flexeril)
| dosing ?
Dosing 5-10 mg tid up to three weeks
32
Cyclobenzaprine (Flexeril)
| pregnancy category ?
B
33
Cyclobenzaprine (Flexeril)
| cautions ?
anticholinergic effects
CNS depression
lowers seizure threshold
34
Cyclobenzaprine (Flexeril)
| can cause serotonergic effect which include what sxs ?
Increased heart rate, shivering, sweating, dilated pupils, myoclonus (intermittent jerking or twitching)
Hyper-reflexia
Hyperactive bowel sounds, high blood pressure
Hyperthermia - temperature as high as 40 °C (104 °F).
35
Baclofen trade ?
Lioresal
36
Baclofen (Lioresal)
| class ?
GABA receptor Stimulant (agonist)
37
_____________ is an amino acid which acts as a neurotransmitter in the central nervous system.
Gamma-Amino Butyric acid (GABA-b)
38
Baclofen (Lioresal)
| inhibits _____ ___________ in the brain, calming nervous activity
nerve transmission
39
Baclofen (Lioresal)
| : " Think of it as a ___ depressant "
CNS
40
Baclofen have what effects ?
Sedative effects (anxiolytics)
41
Baclofen MOA ?
Inhibits monosynaptic and polysynaptic spinal reflexes (centrally-acting muscle relaxant)
42
Baclofen indication ?
Spacity
43
A beneficial property of ________ is that tolerance to its muscle-related therapeutic benefits
baclofen
44
Baclofen retains its therapeutic anti-spasmodic effects even after ?
many years of continued use
* *can be on these for a while and you dont become resistance - continuously same dose (no tolerance)
* *
45
Discontinuation of baclofen can be associated with a ?
withdrawal syndrome
** you can get WD sxs. - taper it cause we dont want spastic sxs. **
46
Resembles benzodiazepine or alcohol withdrawal ?
Baclofen WD
47
Baclofen route ?
PO / Intrathecal
Baclofen pump
**intrathecal cath. into L2 or L3 that is not a dispensing
it is set at a standard dose and they can get an extra dose by hitting the button
the port underneath the skin and they go in a fill back up the port depending on the dosage depends on how frequently you need to refill **
48
Tizanidine trade ?
Zanaflex
**non-narcotic narcotic **
49
Tizanidine (Zanaflex)
| MOA ?
Centrally acting alpha-2 adrenergic receptor agonist (centrally-acting muscle relaxant)
50
Tizanidine (Zanaflex)
| indication ?
spasticity
51
Tizanidine (Zanaflex)
| dosing ?
Start at 2mg PO q6-8hr
52
Goal of Drugs Used to Treat Gout are used because they ?
End painful attacks of gout
Prevent the formation of uric stones in the kidney
Prevent complications from uric stone formation in the joints
53
Drugs Used to Treat Gout examples NSAID ?
Indomethacin or Indometacin (Indocin)
54
Indomethacin sub class?
Acetic acid
55
Indomethacin inhibits ?
production of prostaglandins
56
Indomethacin indication ?
Acute Gout
OA / RA
Bursitis / Tendonitis
Dysmennorrhea
Peds IV dosing for patient ductus arteriosus
57
Indomethacin (Indocin)
| side effects same as ?
non-selective COX inhibitors / NSAIDS
58
Indomethacin (Indocin)
| side effects ?
mostly renal
Edema from fluid retention
Hyperkalemia
Hypernatremia
HTN
59
Indomethacin cautions ?
HTN / CAD / CHF / Renal Dz / PUD
60
Indomethacin preg cat ?
C
61
Indomethacin dosing ?
25-50mg TID
62
Drugs Used to Treat Gout: Allopurinol trade ?
Zyloprim
63
Allopurinol (Zyloprim)
| MOA ?
Inhibits the enzyme xanthine oxidase in purine metabolism
64
Allopurinol (Zyloprim)
| blocks ?
formation of uric acid
65
Allopurinol (Zyloprim)
| reduces ?
serum uric acid
66
Allopurinol (Zyloprim)
| clinical uses ?
Chronic gouty arthritis (prophylaxis)
Prevention of uric acid calculi (common kidney stones)
Hyperuricemia (excess serum uric acid)
Calcium oxalate calculi (most common kidney stone)
Tumor Lysis Syndrome from chemotherapy (generates large quantities of nucleic acids, the purines )
67
Allopurinol (Zyloprim)
| indication ?
Chronic gouty arthritis (prophylaxis)
NEVER in acute attack
68
Allopurinol (Zyloprim)
| dosing ?
200-600 mg/day divided qd-qid
69
Allopurinol (Zyloprim)
| preg cat ?
C
70
Drugs Used to Treat Gout: Cholchicine trade ?
Colcrys
Generic
71
Cholchicine: Toxic natural plant alkaloid extracted from Colchium plant believed to interfere with ?
WBC function, affecting the inflammatory response
72
Colchicine does not affect ______ levels in the serum ?
uric acid
Hyperuricemia
73
Colchicine (Generic)
| clinical uses ?
treatment of acute gout attacks
74
Colchicine (Colcrys) side effects ?
GI at high doses
Diarrhea and stomach upset
Neutropenia
Damage bone nmarrow – anemia
Corneal clouding
Peripheral neuropathy
75
Colchicine (Colcrys)
| facts ?
Generic production halted
Trade $$$$
76
Colchicine (Colcrys) route ?
PO
77
Colchicine (Colcrys) dosing ?
1.6 mg PO x1 then, 0.6 mg (30 ea): $220.57
prevention is 0.6 bid
78
Colchicine (Colcrys) preg cat ?
C
79
Colchicine (Generic)
| extreme caution in ?
renal patients
80
Drugs Used to Treat Gout : Probenecid trade ?
Probalan
81
Probenecid (Probalan)
| MOA ?
Lowers serum levels of urate (hyperuricemia) by competitive inhibition of reabsorption in the renal tubules
increases uric acid excretion in the urine
82
Probenecid (Probalan)
| clinical uses ?
Chronic gout
Hyperuricemia
Gonorrhea or neurosyphillis by delaying the excretion of penicillin
83
Drugs Used to Treat Gout : Sulfinpyrazone trade ?
Anturane
84
Sulfinpyrazone (Anturane)
| MOA ?
Inhibits reabsorption of urates at the proximal tubule
Similar to probenecid
Increases uric acid excretion
85
COX-2 example ?
Celecoxib (Celebrex)
86
Only remaining COX-2 on the market ?
Celecoxib (Celebrex)
87
Celecoxib (Celebrex)
| MOA ?
Inhibits prostaglandin synthesis by decreasing the activity of the COX-2 enzyme
88
Celecoxib (Celebrex)
| does NOT exhibit ?
antiplatelet activity
89
Celecoxib (Celebrex)
| clinical uses ?
Rheumatoid arthritis
Osteoarthritis
- Most common joint disorder in the United States
- Increased incidence of self-medication
- Degree of joint pain and dysfunction guides intervention
Dysmenorrhea
90
Systemic oral corticosteroids
| are ?
Anti-inflammatory agents
91
Systemic oral corticosteroids
| clinical uses ?
RA / OA
Acute Gout
Asthma: short-term burst therapy
COPD
Replacement therapy in adrenal insufficiency
Crohn’s disease
**people who cant tolerate GOUT medications ( b/c kidney disease) then steroids are good for them**
92
Systemic oral corticosteroids
| examples ?
Hydrocortisone (Solu-Cortef)
Prednisone (Deltasone)
Methylprednisolone (Solu-Medrol)
93
Systemic oral corticosteroids contraindications ?
serious fungal, viral, or tubercle skin infection
Diabetes
94
Hydrocortisone trade ?
Solu-Cortef
95
Hydrocortisone (Solu-Cortef) route ?
IV / IM / PO
96
Hydrocortisone (Solu-Cortef) example doses ?
```
Solumedrol
Medrol Dose Pack
Prednisone Taper Dose
Prednisone
Decadron
Prelone elixir
```
97
Hydrocortisone (Solu-Cortef) dosing ?
100-500 mg IM / IV
98
DMARDs Influence the disease process of rheumatoid arthritis by ?
preventing bone loss and cartilage erosion
99
DMARDs Are prescribed in combination with ?
biologic modifiers (such as etanercept, inflixamab) or in multiple drug regimens with :
NSAIDs
other DMARDs
w or w/o CCS
100
DMARDs examples ?
Methotrexate
101
Methotrexate trade ?
Rheumatrex, Trexall)
102
Methotrexate MOA ?
immunosuppressant
inhibits dihydrofolate reductase
inhibits lymphocyte proliferation (folate antagonist)
Folate antimetabolite that inhibits DNA synthesis
103
Methotrexate Appears to act as a _____________ with multiple effects when used to treat arthritis
cell anti-proliferative
for CA and mitochondrial proliferation
104
Methotrexate indications ?
```
RA
Severe psoriasis
ALL
Osteosarcoma
Ectopic Pregnancy
SLE
```
105
Methotrexate BBW ?
Fetal death
Hepato-toxicity
Pulmonary toxicity – fibrosis
Tumor Lysis Syndrome
GI Toxicity
106
Methotrexate route ?
IV / PO form
107
Methotrexate side effects ?
Pulmonary Fibrosis
for these people on it long term they need serial CXRs
Blurred vision / transient blindness
Alopecia
N/V diarrhea
Anemia, Thrombocytopenia
bone marrow supression
Neuropathy
Hyperuricemia
make GOUT worse
**respiratory sxs. with this medication - pulmonary fibrosis **
108
Leflunomide is a ?
DMARDs
109
Leflunomide trade ?
Arava
110
Leflunomide (Arava) facts ?
1998 minimal use today
Indicated for RA, Crohns, Sarcoidosis
Immunomodulator
It is a pyrimidine synthesis inhibitor (mitochondrial enzyme) reduction lymphocytes
Reduces signs and symptoms of rheumatoid arthritis and slows the progression of its associated joint damage
111
DMARDs:Hydroxychloroquine trade ?
Plaquenil
112
Hydroxychloroquine (Plaquenil)
| suspected to decrease ?
T-cell response
113
Hydroxychloroquine (Plaquenil)
| clinical uses ?
Used for years for treatment of malaria
Severe RA
Systemic lupus erythematous
114
Hydroxychloroquine (Plaquenil)
| can cause ___________________ w/ resultant _________
irreversible retinopathy with resultant blindness;
ensure patient undergoes frequent eye examinations
Vomiting, Headache common
Used more so when others have failed
115
Gold Salts are ?
Ionic chemical compounds of gold
116
Gold Salts are used primarily to ?
reduce inflammation and to slow disease progression in patients with rheumatoid arthritis
Mechanism by which gold drugs affect arthritis is unknown
Slow acting
Toxic
Agents of last resort
117
Gold Compounds examples ?
Aurothioglucose suspension (Solganal)
Gold sodium aurothiomalate (Myochrysine)
Auranofin (Ridaura)
118
Auranofin trade ?
Ridaura
119
Auranofin (Ridaura)
| is _____ acting and can be ____
slow
toxic
Rarely used today due to the advent of TNF
like last resort options for RA
120
Auranofin (Ridaura)
| administered ?
IM
PO (lower efficacy)
121
Immune Modifying Agents or Biologicals
| are used when ?
When corticosteroids fail or require long term therapy
122
Immune Modifying Agents or Biologicals not used in ?
acute flare-ups
123
__________ therapy that targets the rheumatoid process
Anticytokine
124
Tumor Necrosis Factor Inhibitors examples ?
Etanercept (Enbrel)
Infliximab (Remicade):
Adalimumab (Humira)
Anakinra (Kineret)
125
Etanercept (Enbrel): TNF receptor joined to a ______ ___ molecule
huma IgG
126
Infliximab (Remicade): _____________ monoclonal antibody
mouse/human
127
Adalimumab (Humira): TNF-inhibiting ___________?
anti-inflamatory
128
Anakinra (Kineret) blocks ?
interleukin-1
129
Class: Tumor Necrosis Factor (TNF) Inhibitors
| examples ?
infliximab (Remicade)
etanercept (Embrel)
Adalimumab (Humira)
**use in OA, RA and crohns **
130
TNF inhibitors BBW ?
Chronic or recurrent infection
Pulmonary and extrapulmonary tuberculosis (TB)
Invasive fungal infections and other opportunistic infections incl. Legionella and Listeria
Consider all patients to be immunosuppressed! - if respiratory sxs.
131
TNF indications ?
Rheumatoid Arthritis
Ankylosing Spondylitis
Paoriasis
Crohns
Ulcerative Colitis
132
TNF reactions
serum sickness
infection, sepsis, pneumonia, opportunistic infection, tuberculosis, malignancy, lymphoma, hepatosplenic T-cell lymphoma (peds pts), leukemia, HBV reactivation, hepatotoxicity, CHF
anaphylactoid rxn
hypersensitivity rxn
**can cause malignancies to be exacerbated and CHF and patients will retain water **
