Term
| What are some causes of gout? |
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Definition
| genetics, gender, overweight, too much alcohol, foods (liver, dried beans, peas, anchovies, gravies), enzyme defect, Pb expsoure, drugs (diuretics, aspirin, niacin, cyclosporin, L-dopa) |
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Term
| What is the most common treatment for an acute attack of gout? |
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Definition
| NSAIDS (indomethacin, naproxen) |
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Term
| What can one due to prevent an accute attack? |
|
Definition
| take small daily doses of colchicine/NSAIDs, maintain healthy weight, eat properly, drink fluids |
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Term
| How does colchicine work? |
|
Definition
| binds to tubulin>prevents polymerization/microtubule formation>inhibits leukocyte migration/phagocytosis>inhibts leukotriene B4 formation |
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Term
| When and how is colchicine administered? |
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Definition
| When NSAIDs/corticosteroids don't work, administer orally every hour until symptoms improve |
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Term
| What are the ways to treat hyperuricemia? |
|
Definition
reduce UA production: allopurinol
increase UA excretion: probenicid, high doses of aspirin |
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Term
| What you should be careful of when using probenicid? |
|
Definition
can't use in patients w/renal dysfxn, or patients already secreting large amounts of uric acid
GI irritation (take w/food), rash, may intiially aggravate gout (treat w/colchicines first) |
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Term
| Why should you not use aspirin as an analgesic for patients w/gout? |
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Definition
| at low doses, aspirin will inhibit secretory transporters and cause uric acid retention |
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Term
| What are the adverse effects of long term glucocorticoid use? |
|
Definition
| weight gain, diabetes, cataracts, osteoporosis |
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Term
| What drugs can you use to slow the progression of RA? |
|
Definition
mehtotrexate (most common): increases release of adenosine/anti-inflam mediator
hydroxycholoquine: inhibits TNF signal
sulfasalazine: may prevent absorption of antigens from GI tract |
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Term
| What are the risks of TNF alpha inhibitors? |
|
Definition
| can cause serious infections, possibility of demyelinating diseases, may reactive latent TB |
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Term
| When do you use etanercept, and how does it work? |
|
Definition
use etanercept as subcut injection 2x/week, for RA, psoriatic arthritis, ankylosing arthritis
it binds/inhibits TNF molecules |
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Term
| When should you not use etanercept? |
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Definition
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Term
| What is the use of infliximab, and what is it's MOA? |
|
Definition
used for Chron's, alone or w/MTX
a monoclonal antibody that inhibits TNF-A |
|
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Term
|
Definition
fully human antibody against TNF-A (blocks it from interacting w/p55 and p75 surface receptors)
subcutaneous injection every other week, alone or with methotrexate
used for RA
AE: injection site reactions, opportunistic infections |
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Term
| What is the MOA of anakinra? |
|
Definition
| IL1R antagonist: blocks IL1 from cartilage degradation by induction of loss of proteoglycans and bone resorption |
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Term
| When do you use anakinra? |
|
Definition
in patients >18yo who failed 1 or more DMARD, do NOT use w/anti-TNF drugs
AE: injection site rxn, serious infections, lymphoma |
|
|
Term
| Name the lymphocyte antagonists. |
|
Definition
| leflunomide, abatacept, rituximab |
|
|
Term
|
Definition
inhibits dihidroorotate dehydrog>decreased UMP: cells arrest in G phase, mostly reduces B cells, some T cells
converted to active drug in intestines and liver
similar efficacy to MTX
AE: diarrhea, reversible alopecia, elevated liver enzymes, C/I in pregnancy, may increase ibuprofen/other NSAIDs |
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Term
| What is the MOA of abatacept? |
|
Definition
prevents binding w/ CD28 on T cells (inhibits T-cell activation)
used IV every 2 weeks
used for mod/severe RA w/inadequate response to other DMARDs, do NOT use w/TNF antagonists or anakinra |
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Term
| What are the AEs of abatacept? |
|
Definition
| increase in infections, headache, nasopharyngitis, nausea, may exacerbate COPD |
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|
Term
|
Definition
monocolonal antibody, binds CD20 on B cells and causes lysis
used IV @ day 1 and 15; used w/MTX when unresponsive to anti-TNF
AE: chills, fever, headache, nausea, myelosuppression (long term use) |
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Term
| What do you use to treat psoriatic or ankylosing arthritis? |
|
Definition
|
|
Term
| What do you use to treat Chron's disease? |
|
Definition
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Term
| Which drug can increase your risk of opportunistic infections? |
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Definition
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|
Term
| Which drug do you need to do a CBC for because of the risk of neutropenia? |
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Definition
|
|
Term
| cholestyramine can increase the elimination of what drug? |
|
Definition
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|
Term
| How is rituximab administered? |
|
Definition
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