Gout drugs:

price

First line

First line script (side effects)

Very expensive

NSAIDs: indomethacin and naproxin

Cochicine (GI side effects)

Long term mgt of Gout (3)

What is 20xs more potent thans aspirin?

Do you treat Gout with an ASA?

Allopurinol and uloric (uloric is new and expensive)

Long action NSAID, 20 xs more potent than aspririn

No ASA

Rheumatoid Arthritis

Common Age

What % of ppl with RA have positive rheumatoid factor?

Short term trtmt and Long term trtmt.

What do you take with MTX?

DMARDS = ?

20-40

80%

Short term: NSAIDs

LOng term MTX: use NSAIDs in meantime

Example:2.5mg tablets: take 5 tablets by mouth once weekly

Take foic acid w/ MTX bc must be used as well.

DMARDS= MTX and Enbrel

What % of people have osteoarthritis by the time they're 65?

What is first time Tx for OA? (dose)

Topical Tx. Dosage. What makes you hot?

80-90%

Tylenol: 325-Q4-6H, max 4 grams

Caspacin, TID-QID, several weeks-red pepper makes you hot

What is osteoporosis?

What is strength?

What % have osteoporosis ove 50?

Primary type 1 and 2. Secondary

-Loss of total bone volume

-Strength= density + quality

50%

Primary: type 1 is most preventable, loss of sex hormones

Type 2: age, 75 +

Secondary: chronic dz, drug therapy (steroids most common)

When do you test for osteoporosis for men and women?

What  has a 20-40% reduction of risk?

When do we calcium and how much can be absorbed at one time?

Women: 65+, postmenopausal women with risk factors of fx

Men: 70+, 50-70 with predisposition

Wt. bearing exercise.

Need Ca most while growing, 500-600 mg can be absorbed.

How much Ca should people have a day at age:

9-18

19-50

51+

1300 mg

1000 mg

1200 mg

What is the best absorbed oral form of vit D?

What does HRT increase. Example

What is Evista and Tamoxifen?

Vit D3 (Cholecalciferol) best absorbed oral form

HRT: Increases osteoblast activity, Ex. premarin

Evist: only SERM for OA.

Tamoxifen: SERM but not for OA.

Bisphosphonates (ronate)

1st line for OA ___ ? mg/week

2nd line: ___ ? mg monthly

Instructions for taking Boniva.

Actonel: side effects

Calcitonin- when do you use it

Recombinant PTH- limit to ___ yrs

Prolia: only approved treatment for who?

1.)Fosamax 70 mg/week

2.) Boniva 150mg/month

Take w/ H20, on empty stomach, do not lie down until bfast, not with meds

Actonel- doesn't have side effects of Fosmax

Calcitonin: use in conjunction with a specialist, last line

Nasal Spray; Inactivated by gastic fluid

Recombinant PTH- limit to two years

Prolia: only approved tx for high risk postmenopausal women

Bone and Joint Disorders

Two categories of ____ and _____

1st line: ?

Muscle relaxants: 1st and 2nd line

antispasmodic and anispascity

1st line: NSAIDs

Muscle relaxants: 1.) Metaxalone 2.) Cyclobenzaprine

Diazepam (Valium) only benzodiazepam with indication for what?

Trizanidine (Zanaflex) alpha adrenergic agonist and is effective for what?

Diazepam (Valium) indicated for muscle spasm, direct skeletal muscle relaxant

Trizanidine (Zanaflex) effective for both CNS and non CNS

spasms (antispasmodic and antispastic)

Most individuals with gout have reduced what?

What causes gout?

Reduced uric acid clearance.

Causes: Purine metabolism abnormalities (PRPP and HGPRT)

Gouty arthritis: where to crystals aggregate?

WHat are Tophi?

In joints causing inflammation.

-Deposits of monsodium urate crystals. Appear as white nodules.

What does cochicine?

How do you stop the pain?

Prevents proliferation and migration of leucocytes.

Stop the inflammation- stop the pain

How do you prevent stone formation?

What was probenecid originally developed to do?

Maintain fluids and high urine output

Alkalinizine urine to enhance solubility of uric acid

Probenecid was developed to prolong penicillin blood levels

What is the first new gout drug in 40 yrs?

How is this drug used?

Febuxostat (Uloric)

Febuxostat is used prophylactically like allopurinol.

What NSAID is used most for gout?

What is the dosage of Naproxen?

Indomethacin

Aleve OTC- prescription strengh of 500mg

RA vs. OA:

duration of pain, joint location, labs

Osteoarthritis: less than 30 mins

location- DIP, PIP, hips (asymmetrical)

Labs- no change in ESR

Rheumatoid Arthritis: greater than 30 mins

location- PIP, MCP, wrist, elbow, MTP (symmetrical)

Elevated ESR

General Classes for RA trtmt

Short onset of action

Long onset of action

NSAIDs (Celebrex, ASA)- short onset of action

Methotrexate: initial therapy due to ability to induce a long-term response

Folate antagonism or deficiency --> stomatitis, gastrointestinal intolerance, bone marrow toxicity, and abnormal liver fxn tests.

THat is why folic acid is typically added and birth control must be used

Leflunomide (Arava)- side effects

Pt must us what?

When do you use Etanercept (Enbrel)?

When do you use Infliximab (REmicade)?

liver toxicity

 Pt. must use effective contraception (X)

Use when pts have failed other DMARDs

Must be used in combination with MTX

OA: erosion of ____ and inflammation occurs secondary to

_______.

Systemic or non systemic?

How many joints involved?

Articular Cartilage

joint damage

Systemic.

Only one or a few joints involved.

Osteoporosis is caused by imbalance in ___ and

_____.

What do ostoblasts respond to?

Is osteoporsis gradual or acute onset?

osteoblast and osteoclast

Osteoblasts respond to: Estrogen, Vit. D, Cytokines, growth factors 

Gradual onset.

Modifiable risk factors of Osteoporosis and nonmodifiable risk factors.

Men with Osteoporosis: low levels of what?

Modifiable risk factors: low Ca/Vit. D, sedentary, low body weight, alcohol excess, cigarette smoking, and caffeine

Nonmodifiable risk factors: sex, race, advanced age, history of 1st degree relative, low trauma fracture, or osteoporosis, early menopause, and small thin frame

Low leves of testosterone

Macrominerals: Examples

Microminerals:Examples

Ultratrace: Examples

Mg, Na, K, Cl, and S

Fe, Zn, I, Se, Mn, Mo, F, Cu, Cr, Co and B

arsenic, aluminum, tin, nickel, vanadium, and silicon

Drug disposition to food drug interaction may cause what?

Absorption: Fosamaz absorbtion

Distribution- Warfarin and phenytoin distribution

N/V and diarrhea

Fosamax is negligible if taken with food and reduced by 60% if taken with coffee or orange juice

Inadequate protein intake as Warfarin is 99.9% and phenytoin is 90% protein bound. Low albumin level especially elderly may cause excessing bleeding and toxic leves of phenytoin

Metabolism: Diet high in protein low in carbs can increase hepatic metabolism of ____.

Grapefruits can inhibit the intestinal metabolism of ____ and can last ___ hrs.

What is an example of a drug that competes for metabolism in liver and intestine.

Theophylline

Calcium channel blockers and can last up to 72 hrs

Beta blockers (propranolol and metoprolol)

Excretion: Food and nutrients can alter reabsorption of drugs from ____ by altering the __. Examples?

Loop diuretics Furosemide (Lasix) or Bumetande (Bumex) increas excretion of what?

HIgh dose diuretic and low sodium diets lead to what?

Renal tubule, pH, milk fruits and fruit juices

K, Mg, Na, Cl, and Ca

Hyponatremia, especially older pts/ shows up as confusion

Thiazide diuretics increase excretion of _ and _, but decrease _.

K spraring diuretics Spironolactone (Aldactone) or Triamterene (Dyrenium) increase excretion of _,_, and _. Blood levels of K can rise to dangerous levels if ____or ___.

Ace inhibitors Enalapril (Vasotec) or Fosinopril (Monopril) decrease ____. So Ace and K sparing diuretic increases the danger of ____.

K and Mg, Ca

Na, Cl, and Ca. They take K supplements or suffer from renal insufficiency.

Potassium. Hyperklemia

What is a CNS drug that alters taste or smell of food?

Miscellaneous drug that alters tast or smell of food?

Obesity Tx

Phenteramine.

Docusate Na

Phentermine