Week 8 Flashcards
Rheumatology Drugs (20 cards)
Which 2 drugs BLOCK CONVERSION OF PURINES TO URIC ACID BY TARGETING XANTHINE OXIDASE?
Allopurinol and Febuxostat
What do Allopurinol and Febuxostat treat?
TREATS GOUT BY URATE LOWERING THERAPY – PROPHYLACTIC
Also used in lymphoma and leukemia to prevent tumor lysis syndrome;
What are some side effects of Allopurinol?
Common: rash, N/V, abnormal LFTs
Rare/serious: Stevens Johnson Syndrome/Toxic Epidermal Necrolysis/DRESS
SJS more common in people with HLA-B*5801 Allele (Han Chinese, Korean, Thai decent)
Increased risk of acute gout flare upon initiation/titration
What are the side effects of Febuxostat?
Common: rash, N/V, abnormal LFTs
Rare/serious:
Cardiovascular risk
(FDA Black box warning for increased risk of CV death among those with established CVD)
Increased risk of acute gout flare upon initiation/titration
Which drug is a PEGYLATED RECOMBINANT FORM OF URICASE (ENZYME ABSENT IN HUMANS) WHICH CONVERTS URIC ACID TO ALLANTOIN (WHICH IS INACTIVE AND WATER SOLUBLE)?
Pegloticase (recombinant uricase)
What does Pegloticase treat?
LAST RESORT – EVERYTHING ELSE HAS FAILED AND HAVING ONGOING FLARES OR NON-RESOLVING TOPHI
Intravenous administration only
What are some adverse effects of Pegloticase?
Infusion reactions – premediate with antihistamines and corticosteroids
Humans don’t have uricase
Screen for G6PD deficiency – contraindicated if present
Which drug INHIBITS REABSORPTION OF URIC ACID IN PROXIMAL CONVOLUTED TUBULES OF THE KIDNEY, LEADING TO URINARY EXCRETION OF URIC ACID?
Probenecid (uricosuric)
What does Probenecid treat?
Chronic Gout
What are some adverse effects of Probenecid?
Common: rash can occur
Rare/Serious: kidney stones because of uric acid excretion in the urine
Do not give to a patient who is prone to developing uric acid kidney stones
Which drug is an anti-inflammatory (not an NSAID) that inhibits beta-tubulin polymerization which impairs neutrophil chemotaxis?
Colchicine
What does Colchicine treat?
ACUTE GOUT FLARE
(Best if used within 36 hours of symptom onset if used for a gout flare)
Gout flare prophylaxis during urate lowering therapy
Pseudogout
Pericarditis (extra credit)
What are the adverse effects of Colchicine?
Common: GI (diarrhea), neuromyopathic
Rare/serious: myelosuppression, nephrotoxicity especially in patients with CKD
MULTIPLE DRUG INTERACTIONS – MUST CROSS CHECK WITH OTHER MEDICATIONS
Which glucocorticoids decrease cytokines, prostaglandins, and leukotrienes (anti-inflammatory)?
Prednisone
Methylprednisolone
Prednisolone
Dexamethasone
Hydrocortisone
Etc.
What do Prednisone
Methylprednisolone
Prednisolone
Dexamethasone
Hydrocortisone
Etc. (GLUCOCORTICOIDS) treat?
ACUTE GOUT FLARE
GOUT FLARE PROPHYLAXIS DURING URATE LOWERING THERAPY INITIATION
For gout, can consider oral or intra-articular joint injection
Intra-articular, topical, systemic (IM, IV, PO), inhaled
Used in multiple specialties including rheumatology, dermatology, transplant, allergy, pulmonary, etc.
What are some adverse effects of Prednisone
Methylprednisolone
Prednisolone
Dexamethasone
Hydrocortisone
Etc. (GLUCOCORTICOIDS) ?
Common: sleep disturbance, agitation, weight gain, hyperglycemia, acne
Rare/Serious/
Chronic use: HTN, psychosis, cushingoid, adrenal suppression, skin thinning, osteoporosis, infection
What drugs are topical steroids and have the same MOA as glucocorticoids?
Clobetasol
Triamcinolone
Hydrocortisone
Betamethasone
What does Clobetasol, Triamcinolone, Hydrocortisone, and Betamethasone treat?
DERMATITIS
PSORIASIS
VITILIGO
CUTANEOUS MANIFESTATIONS OF LUPUS, DERMATOMYOSITIS
Variety of vehicles and formulations
Ointments are more potent due to their occlusive effect
What are the side effects of Clobetasol, Triamcinolone, Hydrocortisone, and Betamethasone?
SKIN ATROPHY, HYPOPIGMENTATION, ACNE
What is the MOA of xanthine oxidases, urate oxidase, and uricosurics?
