Term
| What are the drugs used in an acute gouty attack and what is their mechanism of action |
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Definition
Indomethacin:NSAID
Corticosteroids
ACTH
Colchincine: Prevents microtubule polimerazation inhibiting leukocyte Migration and phagocytosis, also decreases LTB4 |
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Term
| What is the mechanism of action of Probenecid and its adverse effects? |
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Definition
Decreases Uric Acid secretion but decreases Reabsorption more
Adverse: Kidney Stones
Acute Exascerbation
Alters drug clearance:
Hypoglycemics, Zidovudine, Methotrexate
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Term
| What are the contraindications to Probenecid use |
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Definition
Low GFR
High Uric Acid secretion prior to Admin
Methotrexate, Hypoglycemic Drugs, Zidovudine |
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Term
| What is the mechanism of Allopurinol and what are the adverse effects |
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Definition
Hypoxanthine Isomer converted to alloxanthin(active metabolite) blocking Xanthine Oxidase
Adverse: Acute Exacerbation of gout (Tissue->Plasma)increase dose slowly
Monitor Liver and Kidney Function
Interaction with XO drugs(Azathioprine, Mercatopurine) |
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Term
| When can allopurinol be used where Probenecid cannot |
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Definition
Renal dysfunction
High Urate levels and Secondary hyperuracemia
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Term
| What is the mechanism of Methotrexate and what are the adverse effects |
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Definition
DH Folate Reductase Inhibitor
Increases Adenosine(Anti-Inflammatory)
Adverse: Mucosal Ulcers(Give Leucovorin, Folic Acid)
Liver Disease especially in Alcoholics
Marrow Suppression |
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Term
| What are the pharmokinetics of Methotrexate |
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Definition
Liver metabolism to 7-hydroxymethotrexate(active)
Long half life bc Polyglutamated |
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Term
| What is the mechanism of action of Hydroxychloroquine and its adverse effects and when is it typically used |
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Definition
Lysosomal accummulation altering pH which blocks spingomyelinase preventing TNF transduction
Adverse: Retinal(Basal eye exam)
Peripheral Neuropathy
Leukopenia
Use: Pt not responding to NSAIDS |
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Term
| What is the mechanism and adverse effects of etanercept |
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Definition
2/3 Human, 1/3 mouse, bind TNF-Alpha
Adverse: TB
URT Infections
Demyelinating disease: Not to MS patients |
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Term
| What is the MOA, and adverse effects of sulfasalazine |
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Definition
MOA: Unknown, but has sulfapyradine active moiety
Adverse: Neutropenia, Hepatotoxic |
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Term
| What is the mechanism and Adverse effects of Adalimumab |
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Definition
Human Anti-TNF-Alpha
Adverse: TB |
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Term
| What is the mechanism and Adverse effects of Anakinra |
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Definition
IL-1 Receptor Antagonist
Adverse: Lymphoma,
Serious Infections
Not with TNF blockers
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Term
| What is the mechanism and adverse effects of Leflunomide |
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Definition
Dihydroorotate Dehydrogenase Inhibitor-> decrease in UMP-> GI Arrest (mostly B-cells)
Adverse: Cholestryamine blocks the enterohepatic circulation
Increase Ibuprofen/NSAID's through p450's
Reversible Allopecia
Increased Liver Enzymes
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Term
| What is the Mechanism and adverse effects of Abatacept |
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Definition
Block T-costimulation by binding CD80 blocking CD28 binging
Adverse: Serious Infections
Not to COPD
Not with TNF blockers |
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Term
| What is the Mechanism and Adverse effects of Rituximab |
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Definition
Binds CD20 on B-cells(prevents activation->lysis)
Adverse: Myelosuppression in long term |
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Term
| What rheumatoid drugs should not be given to a pregnant women |
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Definition
Methotrexate
Infliximab
Leflunomide |
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Term
| Which TNF-aplha blocker is given IV |
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Definition
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Term
| What is the mechanism of Uricase and Febuxostat |
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Definition
Uricase: Produces Allantoin from uric acid which least toxic
Feboxostat: Non-purine Selective Inhibitor of Xanthine Oxidase |
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Term
| What are the advantages of Febuxostat |
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Definition
Hepatically eliminated: good for renal insufficiency
Unaffected by Allopurinol allergies
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Term
| When is colchicine used for gout and when do you stop increasing the dose |
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Definition
NSAIDs Contraindicated
Intolerable diarrhea |
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