Week 6 Respiratory and Gout Flashcards

Question

Cough Expectorants and Mucolytics

Answer 1

Expectorants Efficacy?? Guanifenesin makes cough more productive Mycolytics Acts directly with mucus to make more watery Acetycysteine and hypertonic saline

Answer 2

Nasal Decongestant Antitussive Analgesic Antihistamine (suppress mucus secretion) Caffeine (offset sedation from antihistamine) Do not use in children; especially antihistamines and codeine >1 yr: honey for sore throat >2 yr: mentholated chest rubs (VICKS) for cough Acetaminophen and ibuprofen for discomfort

Answer 3

Autoimmune inflammatory disease Attacks joints (hands, wrists, knees) lining of joined becomes inflamed causing damage to tissue can attack HRT/Lungs/Eyes Diagnose: pain/stiffness/tenderness in more than one joint, on both sides

Answer 4

Goal: Relieve symptoms, mange pain, maintain function of joints, delay disease progression DMARDS: Disease Modifying Antirheumatic Drugs conventional, biological, targeted take time to work (weeks-months) Nonsteroidal Anti-inflammatories: manage pain while waiting for DMARDS Glucocorticoids directly injected into joint for flare ups and relief while waiting on DEMARDS

Answer 5

Methotrexate Faster acting than other DMARDS (3-6 weeks to therapeutic range) MOA: Folate antagonist (inhibit DNA) Immunosuppression 2/2: reducing activity of the B and T lymphocytes ADE: BLACK BOX: fatal toxicities to bone marrow, liver, lungs, kidneys, hemorrhagic enteritis, gastrointestinal perforation Can cause fetal death and congenital abnormalities Supplement with folic acid 5mg/week: reduce GI/hepatoxicity Avoid drugs: with liver injury, alcohol, myelosupression Reduces response to vaccines live vaccines are contraindicated Prior to stating: vaccine PNA, Flu, HepB, HPV, Herpes zoster

Answer 6

Leflunomide 2nd line therapy Equally as efficacious More expensive and hazardous!!!! Prodrug MOA: Inhibits Tcell proliferation and antibody production ADE: diarrhea; respiratory infection, reversible alopecia and rash Pancytopenia, SJS, peripheral neuropahty; intestinal disease and severe hypertension Hepatotoxic and Immunosupresive Teratogenic: 3 steps to clear system for pregnancy: D/C drug/ Cholestyramine dosed for ll days/ plasma drug levels <20mcg/L (may stay in body up to 2 years if drug is not given) NSAIDS: risk of inhibiting metabolism and ^ drug level in body Rifampin: ^ Leflunomide levels in body do not admin together

Answer 7

Sulfasalazine can slow profession of joint deterioration GI reactions; skin reactions; liver injury; none marrow suppression Avoid in Sulfa allergy

Answer 8

Hydroxychloroquine used only on combo with Methotrexate MOA in RA unknown Delayed onset 3-6 months ADE: retinal damage (directly related to dose levels), caridomyopathy, QTc prolongation, Hypoglycemia

Answer 9

Etanercept Inflixmab Adalimumab Golimumab Certolizumab Pegol Etanercept: first available; inhibit tumor necrosis factor to prevent inflammation Mod-Sever RA Superior to methotrexate ADE: RISK FOR INFECTION/SEPSIS/DEATH injection site reactions children-lymphoma May ^ HRT failure; ^risk of cancer, ^ risk of liver injury Reduce vaccine efficacy Infliximab Admin IV similar to Etanercept

Answer 10

Rituximab Reduce # of B Lymphocytes which cause attach on joints CD20 monoclonal antibody Mod-severe RA in combination with methotrexate in patients who have not responded to TNF inhibitors Admin IV ADE: infusion reaction 80%; premeditate: antihistamine, acetaminophen, methylprednisone Mucocutaneous reactions: SJS, TEN, lichenoid dermatitis (1-3 weeks after) Hep B reactivation Progressive multifocal leukoencephalopathy (severe infection of CNS; d/c if seen immediately)

Answer 11

Abatacept T cells inhabit the synovium of joints in pts with RA; cause autoimmune attach MOA: bings to antigens presenting T cells Mod-Severe RA < symptoms in mod-severe polyarticular juvenile idiopathic arthritis ADE: Headache, upper respiratory infection; nausea IMMUNOSUPRESSION Blunts vaccine effectiveness NOT WITH TNF inhibitors (^risk infection) But yes with conventional DMARDS

Answer 12

Tocilizumab Expensive Only used when not responding to other DMARDS Only combine with methotrexate; all others ^risk of infection ADE: infection; neutropenia; thrombocytopenia; GI perf; liver

Answer 13

Anakinra Mod-severe RA and not responding to other drugs ADE: Severe infection

Answer 14

Tofacitinib Baricitinib Prevents activation of STAT pathway Failed other DMARD treatment ADE: long term unknown; risk for serious infection

Answer 15

1st DEMARD moderate disease: Methotrexate Glucocorticoids: if conventional DMARD prescribed with a therapeutic dose in 3-6 weeks recommended not to use; however, >3 months wait then use Low disease RA: Hydroxchloroquine over csDMARDs

Answer 16

initially oral is recommended over sub q Titrate to a dose of 15mg within 4-6 weeks Not tolerating weekly dosing; try split dose of oral or sub q weekly and increase folic acid before switching to an alternative DMARD

Answer 17

children taking TNF risk for lymphoma Pregnant: TNF cat B, Hydroxychloroquine and sulfasalazine cat B Azathioprine is teratogenic Leflunomide: 3 step process to clear system before trying to get pregnant; toxic to fetus Methotrexate toxic to fetus Do not take DMARDS while breastfeeding Older: > risk for infection

Answer 18

recurring inflammatory disorder that can be painful and disabling Sever joint pain; hyperuricemia (>6 crystal formation) Risk: Male, onset, alcohol, red meat, CHF, HTN, DM, Metabolic syndrome, kidney dysfunction Diagnose: blood uric levels, uric acid crystals in affected joints only diagnosed during a flair up First sign: big toe in 50% of cases

Answer 19

Colchicine Anti inflammatory gout attack: ^ dose, relief in hours Prevention low dose Administer with ULT to prophylactically prevent flare ups which waiting for ULT to be effective ADE: N/V/D Myelosuppression (leukopenia) Myopathy Interacts with STATINS/ PGP inhibitors or CYP3A4 inhibitors

Answer 20

Allopurinol MOA: Xanthine oxidase inhibitor ADE: N/V/D; cataract formation; bone marrow suppression; rash Drug drug: theophylline and WARFARIN Probenecid MOA: acts at renal tubules to inhibit reabsorption of uric acid Delay therapy if onset of acute attack: will take wks/months for drug ADE: N/V/D, rash, hypersensitivity, G6PD deficiency Renal injury: weeks to months to lower uric acid; crystals can form initially; reduce the risk by drinking 3 liters of water daily to alkalinize urine Pegloticase IV Admin last line for those nor responding to oral very expensive ADE: anaphylaxis in 6% pt 40% infusion reactions provide antihistamine and glucocorticoid prior to admin

Answer 21

Urate lowing therapy not recommended in patients experiencing first attack ULT for subcutaneous tophi, radiographic damage; frequent flare ups (>2 annually) Not recommended in pts with asymptomatic hyperuricemia

Answer 22

Allopurinol > Probenecid> Pegloticase Admin NSAIDS, colchicine, steroids for anti-inflammatory prophylaxis when starting a UTL and continue for 3-6 months

Answer 23

Bezlotoxumab: C Diff; combine with abx for bacterial tx Erenmab: migraine; monthly sub q injection ADE: immune reaction, anaphylaxis, cytokine release syndrome (manage with tocilizumb), derm/GI/liver toxicity

Week 6 Respiratory and Gout Flashcards

(47 cards)