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Flashcards in MSK/Rheum Pharm Deck (176)
1

What class of drugs does Acetaminophen belong to?

Analgesic-Antipyretic

2

What is the MOA for acetaminophen?

CNS

anti-prostaglandin blocks peripheral pain impulse generation; inhibits hypothalamic heat regulation center

3

When should you use acetaminophen?

Mild to moderate pain relief; fever

4

What are common SE/ADRs

Edema, rash, increase uric acid, increase ammonia, blood dyscrasias

5

What are contra-indications for acetaminophen?

Liver disease, hypersensitivity

6

What are common Dx-Dx interactions with acetaminophen?

Anti-convulsants, decrease APAP concentration, increase warfarin effect

7

What should you monitor when people are taking acetaminophen?

Liver function; symptom relief; 24H dose

8

When should pregnant women stop taking acetaminophen?

Third trimester

9

Should we avoid acetaminophen with alcohol?

Yes. Don't take it on Old Port nights ya hear!?

10

What is the max concentration of acetaminophen in peds?

160mg/5mL

11

Max 24H dose for elderly of acetaminophen?

2 grams

12

Max 24H dose for adults of acetaminophen?

4 grams

13

What class of drugs does Tramadol belong to?

Synthetic opioid analgesic

14

What is the MoA for tramadol?

Opioid analgesic; mu receptor antagonist and inhibits uptake of NE and 5HT--both modify ascending pain pathways

15

What do you use tramadol?

Moderate to moderately severe pain

16

What are common SE/ADRs of tramadol?

Flushing, dizziness, somnolence, pruritus, constipation, and seizures

17

What should we monitor when patients are taking tramadol?

Symptom relief, sedation, fever

18

What is the maximum dose of tramadol that should be prescribed?

400mg/24H

Dosing: 50-100mg, q4-6h

Reduce dosing if renal or hepatic impairment

19

Pregnancy category for tramadol?

C

20

What class of drugs does Ibuprofen belong to?

Traditional NSAIDs/tNSAIDs

21

What is the MoA for ibuprofen?

Inhibit COX1 and COX2 enzymes reducing PG, prostacyclin, thromboxane

22

When should we use Ibuprofen?

Pain secondary to inflammation in selected patients

23

What are common SE/ADRs to ibuprofen?

Nausea, dyspepsia, diarrhea, anorexia, increased BP, fluid retention, increased bleeding (20%)

24

What is contraindicated for ibuprofen?

Uncontrolled HTN, CKD, HF, CVD, anti-coagulant Tx, Hx GI bleeding or ulcer

25

Common Dx-Dx interactions with ibuprofen?

Anti-coagulant, other NSAIDs, diuretics, lithium, anti-HTN

26

What should we monitor when patients are taking ibuprofen?

CrCl, CBC, LFT

CrCl is creatinine clearance (in case you were wondering...)

27

Pregnancy category for ibuprofen?

C

28

What class of drugs does Celecoxib belong to?

COX2 selective NSAID

29

And if you're like me, what the heck does COX2 selective mean?

COX-2 selective inhibitor is a form of non-steroidal anti-inflammatory drug (NSAID) that directly targets cyclooxygenase-2, COX-2, an enzyme responsible for inflammation and pain

Thank you Wikipedia.

30

MoA for celecoxib?

selectively inhibits COX-2 enzymes reducing PG, prostacyclin

31

When do we use celecoxib?

Pain secondary to inflammation in selected patients.

32

Common SE/ADRs of celecoxib?

Headache, diarrhea, dyspepsia, rash, nausea, vomiting, increased BP, fluid retention, CV disease, increased clotting

33

Contra-indications for Celecoxib?

uncontrolled HTN, CKD, HF, CVD

34

Common Dx-Dx interactions of celecoxib?

other NSAIDs, diuretics, lithium, HTN

35

What do we need to monitor in patients taking celecoxib?

CrCl, EKG, CBC, LFT

36

Pregnancy category for celecoxib?

C

37

What does celecoxib help with in the elderly?

Helps with elderly GI bleed, but will increase CVD problems

38

What class of drugs does Methotrexate belong to?

Nonbiologic DMARD

(Disease-modifying antirheumatic drugs)

39

MoA for Methotrexate?

Inhibits dihydrofolate reductase and DNA production, inhibits production of cytokines

40

When should we prescribe methotrexate?

Recent RA (

41

Common SE/ADRs of methotrexate?

Arachnoiditis, subacute toxicity reaction (motor paralysis CN palsy, seizure, coma), pulmonary fibrosis, hepatotoxicity, bone marrow suppression, ARF, Stevens-Johnson Syndrome

42

Contra-indications of methotrexate?

Severe renal or liver disease, bone marrow suppression, AIDS, alcoholic liver disease, PUD, ulcerative colitis

43

Common Dx-Dx interactions of methotrexate?

Live vaccines, increase or decrease in warfarin levels, ethanol

44

What should we monitor in patients on methotrexate?

CBC, LFT, CrCL, PG

45

How long does it take to see a response to methotrexate?

Initial response in 3-4 weeks, full response in 3-6 months.

46

What class of drug does Hydroxychloroquine belong to?

Nonbiologic DMARD

47

When is the MoA of Hydroxychloroquine?

Unknown in RA but possibly suppression of T-cell response to mitogens and several others

48

Indications for Hydroxychloroquine?

RA, systemic lupus erythematosus, malaria

49

Common SE/ADRs of Hydroxychloroquine?

N/V, abdominal pain, rashes, nightmares, ocular toxicity

50

Contraindications of Hydroxychloroquine?

Hypersensitivity, prior history retinal or visual field changes with this drug, significant liver disease, G6PD deficiency, Hx porphyria, psoriasis

51

Dx-Dx interactions of Hydroxychloroquine?

Avoid ethanol (GI irritation)

52

What should we monitor when patients are taking Hydroxychloroquine?

LFTs, CBC, Ophthalmologic exams

53

Pregnancy category for Hydroxychloroquine?

C

54

How long does it take for Hydroxychloroquine to be effective?

3-6 months for full effect, half life up to 45 days

55

What class of drugs does Etanercept belong to?

Biologic DMARDs: TNF-alpha-blocker

56

MoA for Etanercept?

Binds TNF-alpha preventing its binding to TNF-alpha receptors

57

Indications for Etanercept?

Aggressive RA, non-response to nonbiologic DMARDs

58

SE/ADRs to Etanercept?

Headache, abdominal pain, edema. Reactivation of hepatitis, TB, lymphoma, infection, varicella

59

What drug class does Abatacept belong to?

Biologic DMARDs

60

MoA of Abatacept?

Inhibits T-cell activity by binding to CD80 and CD86 on surface of APC and blocks C28 interaction of APCs with T-cells

61

When should we use Abatacept?

RA, not-responding to other DMARDs

62

SE/ADRs of Abatacept?

Headache, nausea, infection, hypertension

63

What class of drugs does Rituximab belong to?

Biologic DMARDs

64

MoA for Rituximab?

chimeric monoclonal antibody that reduces inflammatory response by inhibiting CD 20 B-lymphocytes and thereby decreasing the presentation of antigens to T-lymphocytes

at least its not complicated...

65

Indications for Rituximab?

severe RA in combo with methotrexate when inadequate response to one or more TNFα agents; chronic lymphocytic leukemia, non-Hodgkins lymphoma, Wegener’s Granulomatosis

66

SE/ADRs of Rituximab?

about 30% experience rash with first infusion but fewer subsequent infusions (pre-treat with steroid); dependent edema, HTN, fever, fatigue, cytopenia

67

What class of drug does Mycophenolate Mofetil belong to?

Semisynthetic DMARDs

68

MoA for Mycophenolate Mofetil?

Immunosuppressant of both T lymphocytes and B lymphocytes

69

Indications for Mycophenolate Mofetil?

post renal, hepatic, cardiac transplant; off-label RA

70

SE/ADRs of Mycophenolate Mofetil?

HTN, hypotension, peripheral edema, chest pain, tachycardia, pain, headache, insomnia, elevated glucose, elevated cholesterol, decreased WBC, decreases RBC, decreased platelets,

71

What class of drugs does Sulfasalazine belong to?

Synthetic DMARDs

72

MoA for Sulfasalazine?

Systemically: sulfapyridine inhibits prostaglandin synthesis, decreases levels of IgA, IgM RF production; Locally: 5-aminosalicylic acid in colon reduces inflammatory response locally

73

Indications for Sulfasalazine?

Management RA and Ulcerative colitis; off-label for Crohn's disease, psoriasis, psoriatic arthritis

74

SE/ADRs to sulfasalazine?

photosensitivity, headache, reversible oligospermia, cholestatic jaundice

75

Contraindications for sulfasalazine?

Hypersensitivity to sulfa, salicylates; porphyria; GI or GU obstruction; G6PD deficiency; Folate deficiency

76

Dx-Dx interactions for sulfasalazine?

multiple; increased effect of oral hypoglycemics, MTX-induced bone marrow suppression; NSAIDs may increase impact

77

What should we monitor in patients who are on sulfasalazine?

CrCl, LFT, CBC, Glucose, folate level, uric acid

78

What percentage of sulfasalazine is absorbed orally?

10-20% of oral dose is absorbed; not a first line RA drug--used only when others are not effective

79

What class or drugs does Prednisone belong to?

Glucocorticoid

80

MoA for prednisone?

inhibition of cytokines and inflammatory mediators

81

Indication for prednisone?

Short-term use in RA

82

SE/ADRs of prednisone?

Weight gain, fluid retention, straie, impaired wound healing, Osteoporosis, HTN, mood changes, cataracts, hyperglycemia, dyslipidemia, PUD, HPA suppression, HF

83

Contraindications of prednisone?

Infection, TB

84

Dx-Dx interactions of prednisone?

Live vaccines

85

What should we monitor in patients who are on prednisone?

CrCl, HFP, CBC

86

When should you start down titrating when a patient is taking prednisone?

Down titrate dosing if more than 2 weeks

87

What class of drugs does Colchicine belong to?

Anti-gout Meds: Leukocyte migration inhibitor

88

MoA for Colchicine?

Inhibits leukocyte migration, phagocytic activity

89

Indications for Colchicine?

Acute gout; Initial Dx

90

SE/ADRs to Colchicine?

Diarrhea, N/V/abd pain (about 80% of patients); myopathy, bone marrow suppression

91

Contraindications of Colchicine?

CKD, hepatic disease

92

Dx-Dx interactions of Colchicine?

May increase levels of HMG-CoA drugs

93

What should we monitor in patients who are taking Colchicine?

CrCl

94

What kind of patients should Colchicine be reserved for?

Reserve for people who cannot use NSAIDs or NSAID treatment failure

95

What class of drugs does Probenicid belong to?

Anti-gout Meds: Uricosurics

96

Moa for Probenicid?

Blocks PCT reabsorption of uric acid

97

Indications for Probenicid?

Gout

98

SE/ADRs to Probenicid?

Nausea, fever, rash, hepatic toxicity, nephrolithiasis

99

Contraindications for Probenicid?

Hx of uric acid stones or nephropathy; avoid when CrCL is

100

Dx-Dx interactions of Probenicid?

Increases level of multiple antibiotics, NSAIDs

101

What should we monitor while patients are on Probenicid?

CrCl, uric acid, CBC

102

What class of drug does Allopurinol belong to?

Anti-gout meds: Xanthine Oxidase Inhibitor

103

MoA for Allopurinol?

Inhibits xanthine oxidase and blocks the formation of uric acid

104

Indications for Allopurinol?

Gout prophylaxis

105

SE/ADRs to Allopurinol?

N/D, rash, Stevens-Johnson syndrome, allopurinol hypersensitivity syndrome, bone marrow suppression

106

Contraindications for Allopurinol?

Prior allopurinol hypersensitivity reaction

107

Dx-Dx interactions for Allopurinol?

Theophylline, warfarin

108

What should we monitor in patients taking Allopurinol?

CrCl for dosing, serum uric acid level

109

Pregnancy category for allopurinol?

C, ok in nursing

110

What is the primary metabolite in allopurinol?

Oxypurinol--is also active, long half-life, accumulates in CKD, not for an acute episode, possible rash with ampicillin/amoxicillin; don't treat asymptomatic hyperuricemia

111

What class of drugs does Febuxostat belong to?

Anti-gout: Nonpurine Xanthine Oxidase Inhibitor

112

MoA for Febuxostat?

Selectively inhibits xanthine oxidase to reduce uric acid production

113

Indications for Febuxostat?

Management of hyperuricemia in gout

114

SE/ADRs to Febuxostat?

Rash, nausea, liver function abnormalities, arthralgia

115

Contraindications for Febuxostat?

Use with azathioprine, mercaptopurine, severe hepatic or renal impairment

116

Dx-Dx interactions for Febuxostat?

increase concentration of azathioprine, mercaptapurine, theophyline

117

How do you prescribe Febuxostat?

40mg, 80 mg tabs; with or without meals

Can continue if acute flare; use NSAID or colchicine as bridge for first 6 months

118

What class of drug does Baclofen belong to?

Centrally-Acting muscle relaxant

119

MoA for Baclofen?

Inhibits transmission of synaptic reflexes at SC level

120

Indications for Baclofen?

Muscle spasticity in multiple sclerosis, spinal cord lesions

121

SE/ADRs to Baclofen?

Drowsiness, vertigo, psych disturbances, slurred speech, ataxia

122

Contraindications for Baclofen?

Hypersensitivity; SDO, impaired renal function

123

Dx-Dx interactions for Baclofen?

Increased effects of opiates, benzodiazepines, hypertensive agents, increases toxicity of ethanol, CNS depressants, TCAs, clindamycin, MAOIs

124

What should we monitor in patients taking Baclofen?

Symptoms, blood pressure, mental status, renal function

125

Pregnancy category for Baclofen?

C, (but not during lactation)

126

What kind of patients should we very cautious of when prescribing Baclofen?

Caution with renal dysfunction; reduce dose in renal impairment

127

Can we stop Baclofen abruptly?

No

128

What else should we avoid with Baclofen?

St. John's Wart, valerian, kava kava, and also caution in elderly

129

What class of drugs does Cyclobenzaprine belong to?

Centrally-active muscle relaxant

130

What is the MoA for cyclobenzaprine?

Centrally-acting muscle relaxant related to tricyclic antidepressants, reduces tonic somatic motor activity decreasing muscle spasm

131

Indications for cyclobenzaprine?

Muscle spasms

132

SE/ADRs to cyclobenzaprine?

Anticholinergic effects, CNS depression, inhibits serotonin reuptake; drowsiness, dizziness, xerostomia, fatigue, headache

133

Contraindications for cyclobenzaprine?

Hepatic impairment;

134

Dx-Dx interactions for cyclobenzaprine?

Increased anticholinergic effects, ethanol, serotonin reuptake inhibitors; tramadol, acetylcholinesterase inhibitors

135

What should we monitor in patients who are taking cyclobenzaprine?

Symptoms, signs of serotonin syndrome, LFTs, mental status

136

Pregnancy category for cyclobenzaprine?

B (but not during lactation)

137

What class of drug does Dantrolene belong to?

Peripherally-Acting Muscle Relaxant

138

MoA for Dantrolene?

Acts directly on skeletal muscle to inhibit release of Ca+ from sarcoplasmic reticulum reducing spasticity

139

Indications for Dantrolene?

Muscle spasticity secondary to CVA, CP, SC injury, MS; malignant hyperthermia; neuroleptic malignant syndrome

140

SE/ADRs to Dantrolene?

Alter BP, heart failure, incr heart rate, confusion, chills, hepatitis, photosensitivity

141

Contraindications for Dantrolene?

Hepatic impairment, cardiac disorders, COPD

142

Dx-Dx interactions for Dantrolene?

Ethanol, St. John's Wart, Kava Kava

143

What should we monitor in patients who are taking Dantrolene?

Symptoms, LFTs, BP, pulse, temperature

144

Pregnancy category for Dantrolene?

C, (but not during lactation)

145

Is Dantrolene a CYP3A4 substrate?

YES!

146

What forms does Dantrolene come in?

PO and IV

147

What is the maximum dose for Dantrolene?

400 mg daily in divided doses q6-8h

148

What else should we avoid with Dantrolene?

Sunlight and elderly

149

What class of drugs does Tafacitinib belong to?

Antirheumatic drug, NBDMARD, Janus Associated Kinase Inhibitor (JAK inhibitor)

150

Indications for Tofactinib?

Treatment of mod to severe RA in adults not responding to, or intolerant of, Methotrexate

151

MoA for Tofactinib?

Inhibits JAK enzymes & prevents gene expression & intracellular activity of immune cells and IgG, IgM, IgA

152

SE/ADRs to Tofactinib?

Infection (20%); HTN (2%), Headache (4%), serious infection (2%), Diarrhea (4%); bone marrow suppression, GI perforation, hepatotoxicity, lipid abnormalities, malignancy; TB

153

What class of drug does Anakinra belong to?

Antirheumatic, BDMARD: Interleukin-1 Receptor Antagonist

154

Indications for Anakinra?

Mod to severely active Rheumatoid Arthritis unresponsive to one or more DMARDs

155

MoA for Anakinra?

Naturally occurring antagonist of IL-1 receptor which reduces degradation of cartilage and inhibits bone resorption

156

SE/ADRs to Anakinra?

Headache (12%), fever (12%), injection site reaction (3-73%), infection (39%), neutropenia (5%); Anaphylaxis, infections, malignancy, neutropenia

157

what drug class does amitriptyline belong to?

tricyclic antidepressant (used to treat neurologic pain)

158

what is the MOA of amitriptyline?

inhibits the reuptake of serotonin, norepinephrine in CNS

159

what are the indications for amitriptyline?

chronic pain, depression, diabetic neuropathy, mirgraine prophylaxisis

160

what are SE/ADRs from amitriptyline?

anticholinergic side effects
-urinary retention
-tachycardia
-hyptension

161

what are the contraindications for amitriptyline?

MAOI within 14 days
acute recovery phase from MI
concurrent cisapride

162

what do you need to monitor with amitriptyline?

mental status, suicide ideation, sedation, EKG

163

what do you NEED to know for amitriptyline?

BLACK BOX WARNING FOR SUICIDE RISK

164

what drug class is cyclophosphamide?

anti-neoplastic alkylating agent

165

what is the MOA of cyclophosphamide?

alkalating agent that prevent cell division by cross-linking DNA strans and decreasing DNA synthesis, cell-phase nonspecific

166

Indications for cyclophosphamide

basically any maligancy...literally

167

what are the common side effects of cyclophosphamide?

there are a bunch....key ones:
cardiotoxicitiy, fertility impairment, GI distress,secondary malignancies, immunosuppression

168

what drug class is pilocarpine?

cholinergic agonist

169

what is the MOA of pilocarpine?

agonist impact on muscarinic receptors that stimulate salivary gland secretion

170

what are SE/ADRs from pilocarpine?

urinary frequency, sweating, lacrimation

171

what are contraindications for pilocarpine?

-sever hepatic impairment Child Plough score >10
-severe asthma
-closed angle gluacoma
-COPD
-Heart disease

172

what are the common dx-dx interactions with pillocarpine?

acteylcholinesterases, ase inhibitors, beta blockers

173

what are important monitoring for pillocarpine?

IOP
fundiscopic exams
visual fields

174

what pregnancy category is pillocarpine?

C

175

what is avaliable in alternative form of pillocarpine?

systemic or opthalmic

176

what do you need to do in someone with hepatic impairment when taking pillocarpine?

reduce the dose