Flashcards in MSK/Rheum Pharm Deck (176)
What class of drugs does Acetaminophen belong to?
What is the MOA for acetaminophen?
anti-prostaglandin blocks peripheral pain impulse generation; inhibits hypothalamic heat regulation center
When should you use acetaminophen?
Mild to moderate pain relief; fever
What are common SE/ADRs
Edema, rash, increase uric acid, increase ammonia, blood dyscrasias
What are contra-indications for acetaminophen?
Liver disease, hypersensitivity
What are common Dx-Dx interactions with acetaminophen?
Anti-convulsants, decrease APAP concentration, increase warfarin effect
What should you monitor when people are taking acetaminophen?
Liver function; symptom relief; 24H dose
When should pregnant women stop taking acetaminophen?
Should we avoid acetaminophen with alcohol?
Yes. Don't take it on Old Port nights ya hear!?
What is the max concentration of acetaminophen in peds?
Max 24H dose for elderly of acetaminophen?
Max 24H dose for adults of acetaminophen?
What class of drugs does Tramadol belong to?
Synthetic opioid analgesic
What is the MoA for tramadol?
Opioid analgesic; mu receptor antagonist and inhibits uptake of NE and 5HT--both modify ascending pain pathways
What do you use tramadol?
Moderate to moderately severe pain
What are common SE/ADRs of tramadol?
Flushing, dizziness, somnolence, pruritus, constipation, and seizures
What should we monitor when patients are taking tramadol?
Symptom relief, sedation, fever
What is the maximum dose of tramadol that should be prescribed?
Dosing: 50-100mg, q4-6h
Reduce dosing if renal or hepatic impairment
Pregnancy category for tramadol?
What class of drugs does Ibuprofen belong to?
What is the MoA for ibuprofen?
Inhibit COX1 and COX2 enzymes reducing PG, prostacyclin, thromboxane
When should we use Ibuprofen?
Pain secondary to inflammation in selected patients
What are common SE/ADRs to ibuprofen?
Nausea, dyspepsia, diarrhea, anorexia, increased BP, fluid retention, increased bleeding (20%)
What is contraindicated for ibuprofen?
Uncontrolled HTN, CKD, HF, CVD, anti-coagulant Tx, Hx GI bleeding or ulcer
Common Dx-Dx interactions with ibuprofen?
Anti-coagulant, other NSAIDs, diuretics, lithium, anti-HTN
What should we monitor when patients are taking ibuprofen?
CrCl, CBC, LFT
CrCl is creatinine clearance (in case you were wondering...)
Pregnancy category for ibuprofen?
What class of drugs does Celecoxib belong to?
COX2 selective NSAID
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.
MoA for celecoxib?
selectively inhibits COX-2 enzymes reducing PG, prostacyclin
When do we use celecoxib?
Pain secondary to inflammation in selected patients.
Common SE/ADRs of celecoxib?
Headache, diarrhea, dyspepsia, rash, nausea, vomiting, increased BP, fluid retention, CV disease, increased clotting
Contra-indications for Celecoxib?
uncontrolled HTN, CKD, HF, CVD
Common Dx-Dx interactions of celecoxib?
other NSAIDs, diuretics, lithium, HTN
What do we need to monitor in patients taking celecoxib?
CrCl, EKG, CBC, LFT
Pregnancy category for celecoxib?
What does celecoxib help with in the elderly?
Helps with elderly GI bleed, but will increase CVD problems
What class of drugs does Methotrexate belong to?
(Disease-modifying antirheumatic drugs)
MoA for Methotrexate?
Inhibits dihydrofolate reductase and DNA production, inhibits production of cytokines
When should we prescribe methotrexate?
Recent RA (
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
Contra-indications of methotrexate?
Severe renal or liver disease, bone marrow suppression, AIDS, alcoholic liver disease, PUD, ulcerative colitis
Common Dx-Dx interactions of methotrexate?
Live vaccines, increase or decrease in warfarin levels, ethanol
What should we monitor in patients on methotrexate?
CBC, LFT, CrCL, PG
How long does it take to see a response to methotrexate?
Initial response in 3-4 weeks, full response in 3-6 months.
What class of drug does Hydroxychloroquine belong to?
When is the MoA of Hydroxychloroquine?
Unknown in RA but possibly suppression of T-cell response to mitogens and several others
Indications for Hydroxychloroquine?
RA, systemic lupus erythematosus, malaria
Common SE/ADRs of Hydroxychloroquine?
N/V, abdominal pain, rashes, nightmares, ocular toxicity
Contraindications of Hydroxychloroquine?
Hypersensitivity, prior history retinal or visual field changes with this drug, significant liver disease, G6PD deficiency, Hx porphyria, psoriasis
Dx-Dx interactions of Hydroxychloroquine?
Avoid ethanol (GI irritation)
What should we monitor when patients are taking Hydroxychloroquine?
LFTs, CBC, Ophthalmologic exams
Pregnancy category for Hydroxychloroquine?
How long does it take for Hydroxychloroquine to be effective?
3-6 months for full effect, half life up to 45 days
What class of drugs does Etanercept belong to?
Biologic DMARDs: TNF-alpha-blocker
MoA for Etanercept?
Binds TNF-alpha preventing its binding to TNF-alpha receptors
Indications for Etanercept?
Aggressive RA, non-response to nonbiologic DMARDs
SE/ADRs to Etanercept?
Headache, abdominal pain, edema. Reactivation of hepatitis, TB, lymphoma, infection, varicella
What drug class does Abatacept belong to?
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
When should we use Abatacept?
RA, not-responding to other DMARDs
SE/ADRs of Abatacept?
Headache, nausea, infection, hypertension
What class of drugs does Rituximab belong to?
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...
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
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
What class of drug does Mycophenolate Mofetil belong to?
MoA for Mycophenolate Mofetil?
Immunosuppressant of both T lymphocytes and B lymphocytes
Indications for Mycophenolate Mofetil?
post renal, hepatic, cardiac transplant; off-label RA
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,
What class of drugs does Sulfasalazine belong to?
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
Indications for Sulfasalazine?
Management RA and Ulcerative colitis; off-label for Crohn's disease, psoriasis, psoriatic arthritis
SE/ADRs to sulfasalazine?
photosensitivity, headache, reversible oligospermia, cholestatic jaundice
Contraindications for sulfasalazine?
Hypersensitivity to sulfa, salicylates; porphyria; GI or GU obstruction; G6PD deficiency; Folate deficiency
Dx-Dx interactions for sulfasalazine?
multiple; increased effect of oral hypoglycemics, MTX-induced bone marrow suppression; NSAIDs may increase impact
What should we monitor in patients who are on sulfasalazine?
CrCl, LFT, CBC, Glucose, folate level, uric acid
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
What class or drugs does Prednisone belong to?
MoA for prednisone?
inhibition of cytokines and inflammatory mediators
Indication for prednisone?
Short-term use in RA
SE/ADRs of prednisone?
Weight gain, fluid retention, straie, impaired wound healing, Osteoporosis, HTN, mood changes, cataracts, hyperglycemia, dyslipidemia, PUD, HPA suppression, HF
Contraindications of prednisone?
Dx-Dx interactions of prednisone?
What should we monitor in patients who are on prednisone?
CrCl, HFP, CBC
When should you start down titrating when a patient is taking prednisone?
Down titrate dosing if more than 2 weeks
What class of drugs does Colchicine belong to?
Anti-gout Meds: Leukocyte migration inhibitor
MoA for Colchicine?
Inhibits leukocyte migration, phagocytic activity
Indications for Colchicine?
Acute gout; Initial Dx
SE/ADRs to Colchicine?
Diarrhea, N/V/abd pain (about 80% of patients); myopathy, bone marrow suppression
Contraindications of Colchicine?
CKD, hepatic disease
Dx-Dx interactions of Colchicine?
May increase levels of HMG-CoA drugs
What should we monitor in patients who are taking Colchicine?
What kind of patients should Colchicine be reserved for?
Reserve for people who cannot use NSAIDs or NSAID treatment failure
What class of drugs does Probenicid belong to?
Anti-gout Meds: Uricosurics
Moa for Probenicid?
Blocks PCT reabsorption of uric acid
Indications for Probenicid?
SE/ADRs to Probenicid?
Nausea, fever, rash, hepatic toxicity, nephrolithiasis
Contraindications for Probenicid?
Hx of uric acid stones or nephropathy; avoid when CrCL is
Dx-Dx interactions of Probenicid?
Increases level of multiple antibiotics, NSAIDs
What should we monitor while patients are on Probenicid?
CrCl, uric acid, CBC
What class of drug does Allopurinol belong to?
Anti-gout meds: Xanthine Oxidase Inhibitor
MoA for Allopurinol?
Inhibits xanthine oxidase and blocks the formation of uric acid
Indications for Allopurinol?
SE/ADRs to Allopurinol?
N/D, rash, Stevens-Johnson syndrome, allopurinol hypersensitivity syndrome, bone marrow suppression
Contraindications for Allopurinol?
Prior allopurinol hypersensitivity reaction
Dx-Dx interactions for Allopurinol?
What should we monitor in patients taking Allopurinol?
CrCl for dosing, serum uric acid level
Pregnancy category for allopurinol?
C, ok in nursing
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
What class of drugs does Febuxostat belong to?
Anti-gout: Nonpurine Xanthine Oxidase Inhibitor
MoA for Febuxostat?
Selectively inhibits xanthine oxidase to reduce uric acid production
Indications for Febuxostat?
Management of hyperuricemia in gout
SE/ADRs to Febuxostat?
Rash, nausea, liver function abnormalities, arthralgia
Contraindications for Febuxostat?
Use with azathioprine, mercaptopurine, severe hepatic or renal impairment
Dx-Dx interactions for Febuxostat?
increase concentration of azathioprine, mercaptapurine, theophyline
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
What class of drug does Baclofen belong to?
Centrally-Acting muscle relaxant
MoA for Baclofen?
Inhibits transmission of synaptic reflexes at SC level
Indications for Baclofen?
Muscle spasticity in multiple sclerosis, spinal cord lesions
SE/ADRs to Baclofen?
Drowsiness, vertigo, psych disturbances, slurred speech, ataxia
Contraindications for Baclofen?
Hypersensitivity; SDO, impaired renal function
Dx-Dx interactions for Baclofen?
Increased effects of opiates, benzodiazepines, hypertensive agents, increases toxicity of ethanol, CNS depressants, TCAs, clindamycin, MAOIs
What should we monitor in patients taking Baclofen?
Symptoms, blood pressure, mental status, renal function
Pregnancy category for Baclofen?
C, (but not during lactation)
What kind of patients should we very cautious of when prescribing Baclofen?
Caution with renal dysfunction; reduce dose in renal impairment
Can we stop Baclofen abruptly?
What else should we avoid with Baclofen?
St. John's Wart, valerian, kava kava, and also caution in elderly
What class of drugs does Cyclobenzaprine belong to?
Centrally-active muscle relaxant
What is the MoA for cyclobenzaprine?
Centrally-acting muscle relaxant related to tricyclic antidepressants, reduces tonic somatic motor activity decreasing muscle spasm
Indications for cyclobenzaprine?
SE/ADRs to cyclobenzaprine?
Anticholinergic effects, CNS depression, inhibits serotonin reuptake; drowsiness, dizziness, xerostomia, fatigue, headache
Contraindications for cyclobenzaprine?
Dx-Dx interactions for cyclobenzaprine?
Increased anticholinergic effects, ethanol, serotonin reuptake inhibitors; tramadol, acetylcholinesterase inhibitors
What should we monitor in patients who are taking cyclobenzaprine?
Symptoms, signs of serotonin syndrome, LFTs, mental status
Pregnancy category for cyclobenzaprine?
B (but not during lactation)
What class of drug does Dantrolene belong to?
Peripherally-Acting Muscle Relaxant
MoA for Dantrolene?
Acts directly on skeletal muscle to inhibit release of Ca+ from sarcoplasmic reticulum reducing spasticity
Indications for Dantrolene?
Muscle spasticity secondary to CVA, CP, SC injury, MS; malignant hyperthermia; neuroleptic malignant syndrome
SE/ADRs to Dantrolene?
Alter BP, heart failure, incr heart rate, confusion, chills, hepatitis, photosensitivity
Contraindications for Dantrolene?
Hepatic impairment, cardiac disorders, COPD
Dx-Dx interactions for Dantrolene?
Ethanol, St. John's Wart, Kava Kava
What should we monitor in patients who are taking Dantrolene?
Symptoms, LFTs, BP, pulse, temperature
Pregnancy category for Dantrolene?
C, (but not during lactation)
Is Dantrolene a CYP3A4 substrate?
What forms does Dantrolene come in?
PO and IV
What is the maximum dose for Dantrolene?
400 mg daily in divided doses q6-8h
What else should we avoid with Dantrolene?
Sunlight and elderly
What class of drugs does Tafacitinib belong to?
Antirheumatic drug, NBDMARD, Janus Associated Kinase Inhibitor (JAK inhibitor)
Indications for Tofactinib?
Treatment of mod to severe RA in adults not responding to, or intolerant of, Methotrexate
MoA for Tofactinib?
Inhibits JAK enzymes & prevents gene expression & intracellular activity of immune cells and IgG, IgM, IgA
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
What class of drug does Anakinra belong to?
Antirheumatic, BDMARD: Interleukin-1 Receptor Antagonist
Indications for Anakinra?
Mod to severely active Rheumatoid Arthritis unresponsive to one or more DMARDs
MoA for Anakinra?
Naturally occurring antagonist of IL-1 receptor which reduces degradation of cartilage and inhibits bone resorption
SE/ADRs to Anakinra?
Headache (12%), fever (12%), injection site reaction (3-73%), infection (39%), neutropenia (5%); Anaphylaxis, infections, malignancy, neutropenia
what drug class does amitriptyline belong to?
tricyclic antidepressant (used to treat neurologic pain)
what is the MOA of amitriptyline?
inhibits the reuptake of serotonin, norepinephrine in CNS
what are the indications for amitriptyline?
chronic pain, depression, diabetic neuropathy, mirgraine prophylaxisis
what are SE/ADRs from amitriptyline?
anticholinergic side effects
what are the contraindications for amitriptyline?
MAOI within 14 days
acute recovery phase from MI
what do you need to monitor with amitriptyline?
mental status, suicide ideation, sedation, EKG
what do you NEED to know for amitriptyline?
BLACK BOX WARNING FOR SUICIDE RISK
what drug class is cyclophosphamide?
anti-neoplastic alkylating agent
what is the MOA of cyclophosphamide?
alkalating agent that prevent cell division by cross-linking DNA strans and decreasing DNA synthesis, cell-phase nonspecific
Indications for cyclophosphamide
basically any maligancy...literally
what are the common side effects of cyclophosphamide?
there are a bunch....key ones:
cardiotoxicitiy, fertility impairment, GI distress,secondary malignancies, immunosuppression
what drug class is pilocarpine?
what is the MOA of pilocarpine?
agonist impact on muscarinic receptors that stimulate salivary gland secretion
what are SE/ADRs from pilocarpine?
urinary frequency, sweating, lacrimation
what are contraindications for pilocarpine?
-sever hepatic impairment Child Plough score >10
-closed angle gluacoma
what are the common dx-dx interactions with pillocarpine?
acteylcholinesterases, ase inhibitors, beta blockers
what are important monitoring for pillocarpine?
what pregnancy category is pillocarpine?
what is avaliable in alternative form of pillocarpine?
systemic or opthalmic