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