Drugs for RA, Gout, and Osteoporosis
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Created by:
birdsvsworms on April 10, 2012
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39 terms
Terms | Definitions |
|---|---|
 First line DMARD | methotrexate; fastest onset about 2-6 wks |
| Side effects of methotrexate. Which may be irreversible? | nausea, mucosal ulcers At high doses, WBC depression, liver cirrhosis, pneumonitis (may be irreversible) |
| Leflunomide: MOA | inhibit TK activity and inhibit de novo pyrimidine synthesis |
| Lefluonomide: side effects | elevated liver enzymes suppression of high-turnover cells (so GI sx, alopecia) |
| Abatacept: MOA | binds CD80 and CD86, which are costimulation modulators in T cell activation |
| Abatacept: indications | for mod-severe RA not responding to TNF-inhibitors or methotrexate |
| Abatacept should not be used with ---- | TNF-alpha inhibitors, b/c increases risk of infection |
| Abatacept contraindicated in ppl with | COPD |
| Rituximab: MOA | targets CD20 B lymphocytes |
| Rituximab: side effect and first-time effects | side effect: flu-like sx first time effects: may cause breathing difficulties, cardiac rhythm disturbances, cardiogenic shock |
| Sulfasalazine: pharmacokinetic properties | prodrug; is poorly absorbed, gets modified by gut bacterial to sulfpyradine and 5-aminosalicylate (the anti-inflammatory) |
| Sulfasalazine: indications | usually used after methotrexate fails, or in pts with liver dz who can't take methotrexate Also used in IBD, seronegative spondyloarthropathies |
| Hydroxychloroquine: toxicities | usually ocular: corneal deposits, extraocular muscle weakness, retinopathy--can lead to irreversible vision loss |
| Gold salts: side effects | skin rash, blood dyscrasias, kidney damage |
| D-penicillamine: MOA | cysteine analog |
| D-penicillamine: side effects and indication | derm problems, nephritis, aplastic anemia Usually used last-resort when others fail |
| Infliximab: MOA | Ab binding to TNF-alpha |
| Infliximab: side effects | URIs, immune rxn |
| Etancercept: MOA | two TNF receptors + Fc portion of IgG, so sequesters two molecules of TNF-alpha per molecule of drug |
| Adalimumab: MOA | murine anti-TNF antibody usually less immunoreactive |
| Anakinra: MOA | IL-1ra: analog of IL-1 human receptor antagonist, so blocks the IL-1 receptor |
| Anakinra: not recommended in combo with ---- | TNF-alpha inhibitors, b/c increases infections |
| Tocilizumab: MOA | IL-6 receptor Ab |
| Tocilizumab: indication | for pts who fail TNF-alpha; usually used in combo with methotrexate |
| Tocilizumab: adverse effects | URI, H/A, HTN, elevated LFTs, increased LDL, decreased neutrophils and platelets--infection, GI perforation, hypersensitivity, may increase risk of CA |
| Cyclosporine: MOA and adverse effect | inhibits T cell activity renal toxicity |
| Azathioprine: MOA and adverse effect | purine antimetabolite, interferes with purine biosynthesis causing DNA damage can cause bone marrow suppression and hepatotoxicity |
| Cyclophosphamide: MOA | alkylating agent, suppressing B cells, T cells, and any rapidly dividing cells |
| Capsacin: MOA | causes local depletion of substance P (usually a local cream for RA) |
| Two drugs used for acute gout | NSAIDs Colchicine |
| Colchicine: MOA and adverse effects | binds tubulin so arrests granulocyte migration n/v/d, abd pain; long term use leads to myopathy, agranulocytosis, aplastic anemia, alopecia |
| 3 drugs used for chronic gout | allopurinol/febuxostat probenecid sulfinpyraxole |
| Allopurinol/febuxostat: MOA and side effect | inhibits xanthine oxidase hypersensitivity |
| Probenecid: MOA and side effects | blocks PCT reabsorption of uric acid GI irritation, GI bleeding, hypersensitivity |
| Probenecid: contraindications | in pts with impaired renal function or those predisposed to getting urate stones |
| Sulfinpyrazole: MOA and drug interactions | blocks PCT reabsorption of uric acid may inhibit metabolism of oral hypoglycemic agents and hepatic metabolism of warfarin |
| Side effects of bisphosphonates | esophagitis and osteonecrosis of jaw (alendronate especially) |
| What diuretic increases plasma concentrations of urate? | thiazides Anytime you increase excretion of sodium, the PCT will reabsorb calcium, sodium, urate. However, even if hyperuricemia results, pt is likely not to have an attack of gout |
| Maintain pH of urine at what level when using uricosuric agent? | alkaline urine--maintains ionic form |
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