Term
|
Definition
| Effects similar to histamine (vasodilation, pain) |
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Term
|
Definition
| Series of proteins that combine together to neutralize or destroy antigens |
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Term
|
Definition
| Released by mast cells causing vasodilation, smooth muscle constriction, capillary leakage, pruritus |
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Term
|
Definition
| Released by mast cells with effects similar to histamine |
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Term
|
Definition
| Increase capillary permeability, attraction of leukocytes, pain |
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Term
| Prednisone (Sterapred®)
Triamcinolone (Kenalog®)
Dexamethasone (Decadron®)
Methylprednisolone (Depo-Medrol®) |
|
Definition
MoA:
↑ duration of action, ↓ salt-retaining effect, better penetration of lipid barriers (topical use) |
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|
Term
| Prednisone (Sterapred®)
Triamcinolone (Kenalog®)
Dexamethasone (Decadron®)
Methylprednisolone (Depo-Medrol®) |
|
Definition
Uses:
Adrenal disorders: Addison’s disease, Acute adrenal insufficiency
Non-adrenal disorders:
Inflammatory/Immunologic
Asthma, organ transplant rejection, collagen diseases
Hematopoietic Cancers
Neurologic Disorders
Chemotherapy-induced N/V |
|
|
Term
| Prednisone (Sterapred®)
Triamcinolone (Kenalog®)
Dexamethasone (Decadron®)
Methylprednisolone (Depo-Medrol®) |
|
Definition
| Toxicity
Signs & symptoms:
Adrenal suppression (from suppression of ACTH)
Metabolic effects
Salt retention
Psychosis |
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Term
| Ways to minimize synthetic glucocorticoid toxicity |
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Definition
Local application (topicals for the skin or aerosols/inhalation solution for asthma)
Alternating day therapy/ Tapering therapy |
|
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Term
| Drug interactions for synthetic glucocorticoids (including Prednisone) |
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Definition
CYP 450
NSAIDs/Salicylates, Alcohol (cause increased risk of GI ulceration) |
|
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Term
| Cautions for use of synthetic glucocorticoids (like Prednisone) |
|
Definition
HPA suppression
May lead to adrenal crisis, caution with high doses, prolong therapy, pediatrics, prevent by tapered withdrawal from medication
Psychiatric disturbances
Caution with pre-existing psychiatric disorders (may cause exacerbation)
Secondary infections due to immunosuppression
May reduce effectiveness of vaccines
Other cautions:
Thyroid disease, hepatic impairment, renal impairment, cardiovascular disease, diabetes, seizure disorders, GI diseases |
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Term
|
Definition
Anti-inflammatory actions
Inhibit cyclooxygenase (enzyme that converts arachidonic acid to prostaglandins)
Analgesic actions
Peripheral inhibition of PG production & possible inhibition of pain stimuli
Antipyretic actions
Inhibition of PG synthesis in the thermoregulatory center |
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Term
|
Definition
Inflammatory diseases
Mild-moderate pain
Fever
1st line treatment for inflammation & accompanying pain
Treatment of chronic inflammation requires dosages greater than doses needed for antipyresis or analgesia
Increased dosages generally leads to more AE
Anti-inflammatory effects may take weeks of therapy |
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Term
|
Definition
| GI complaints (most common AEs)
Nausea, dyspepsia, abdominal pain
GI ulceration/bleeding through topical & systemic effects
Risk factors: >65 yo, comorbid medical conditions, corticosteroid
Taking NSAIDs with food helps to minimize most GI adverse effects
Other AEs:
Renal dysfunction, hypersensitivity reactions, rash, CNS (drowsiness, dizziness, tinnitus)
Avoid late in pregnancy
Risk of premature closure of ductus arteriosus |
|
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Term
| Drug interactions with NSAIDs |
|
Definition
Anticoagulants & Antiplatelets – ↑ effects
Higher bleeding risk
Corticosteroids, bisphosphonates – GI effects
Higher risk of GI ulceration
Renal mechanisms/ excretion: Methotrexate, Lithium
Renal toxicity – Cyclosporin, Antibiotics (Aminoglyosides & Vancomycin)
Antihypertensives – ↓ antihypertensive effects
ACEI, BB, Diuretics, CCBs |
|
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Term
|
Definition
↑ risk of adverse cardiovascular events (including MI, CVA, HTN)
↑ risk of GI irritation, ulceration, bleeding, perforation
GI irritation/ ulceration
May occur at anytime during therapy
Caution with history of GI disease, concurrent aspirin use, anticoagulants, corticosteroids, smoking, alcohol, elderly
Compromise of renal function
Serious skin adverse events
SJS, TENs
Caution with aspirin triad (aspirin intolerance, asthma, rhinitis)
↓ hepatic function
Preoperative: discontinue 4-6 t ½ before procedures |
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Term
|
Definition
| Specific drug type of Aspirin |
|
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Term
|
Definition
| What differs in nonacetylated salicylates from acetylated salicylates |
|
|
Term
| Nonacetylated Salicylates |
|
Definition
| Salsalate (Amigesic®)
Diflunisal (Dolobid®)
Choline Salicylate
Magnesium Salicylate (Doan’s®) |
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Term
|
Definition
| Etodolac (Lodine®)
Diclofenac (Voltaren®)
Topical gel, Ophthalmic, PO
Indomethacin (Indocin®)
Indicated for PDA, inflammatory disorders, bursitis/ tendonitis, acute gouty arthritis
PO, injection |
|
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Term
|
Definition
| Fenoprofen
Flurbiprofen (Ansaid®)
Ibuprofen (Motrin, Advil®)
Ketoprofen (Orudis®)
Naproxen Sodium (Aleve, Naprosyn®)
Oxaprozin (Daypro®) |
|
|
Term
|
Definition
| Meclofenamate (Meclomen®)
Inflammatory disorders, mild to moderate pain, primary dysmenorrhea
Mefenamic Acid (Ponstel®)
Indicated for mild to moderate pain, primary dysmenorrhea |
|
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Term
|
Definition
Piroxicam (Feldene®)
Rheumatoid & Osteoarthritis |
|
|
Term
|
Definition
Piroxicam (Feldene®)
Rheumatoid & Osteoarthritis |
|
|
Term
|
Definition
|
|
Term
|
Definition
| Celecoxib (Celebrex®)
Removed from market/ unavailable – Rofecoxib (Vioxx®), Valdecoxib (Bextra®) |
|
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Term
|
Definition
| Function of:
Cyclosporine (Sandimmune, Neoral®) & Tacrolimus (Prograf®) |
|
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Term
| Inhibition of DNA, RNA & protein synthesis |
|
Definition
Function of:
Azathioprine (Imuran®) |
|
|
Term
| Alters & decreases the formation of T-cells |
|
Definition
Function of:
Lymphocyte immune globulin |
|
|
Term
| Blocks metabolism of folic acid |
|
Definition
|
|
Term
| Antibodies specific for CD3 receptors on T-cells; used for treatment of kidney transplant rejection |
|
Definition
Function of:
Muromonab-CD3 |
|
|
Term
| Inhibition of T-cells, B-cells, & antibody formation |
|
Definition
Function of:
Mycophenolate mofetil (Cellcept®) |
|
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Term
|
Definition
↓ leukocyte mobility
↓ phagocytosis in joints
↓ deposition of urate crystals |
|
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Term
|
Definition
Anti-inflammatory, Anti-gout
Dosing: Prophylaxis/Maintenance
o Low doses
o Onset of acute attack: ↑ dosing
o Used with antihyperuricemic therapy in patients with significantly elevated uric acid levels to minimize the risk of acute attacks that may occur with the initiation of uric acid lowering therapy |
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Term
| Adverse effects of Colchicine |
|
Definition
| • GI: N/V/D, abdominal pain, anorexia
• Alopecia
• Hematologic abnormalities |
|
|
Term
| Caution for use of Colchicine |
|
Definition
| Serious renal, GI, hepatic disorders, hematologic abnormalities, pregnancy |
|
|
Term
| Drug interactions with Colchicine |
|
Definition
CYP 450 Substrate
o Toxicity with CYP 450 inhibitors
Acid/Base
o ↓ effects with acidic agents, ↑ effects with alkaline agents |
|
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Term
| Uses of Indomethacin (Indocin®) |
|
Definition
| Inhibits prostaglandin synthesis by inhibiting cyclooxygenase |
|
|
Term
| Uses of Indomethacin (Indocin®) |
|
Definition
• NSAID (particularly useful for gout)
• As effective as colchicine in acute attacks for many patients (with less GI toxicity)
• Large doses x 24-48 hours then taper over 3-4 days to minimize the risk of recurrent attacks |
|
|
Term
| Black box warning for Indomethacin (Indocin®) |
|
Definition
GI ulceration (like all NSAIDs)
o Decreased risk by using high doses for short-term only |
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Term
| Adverse effects of Indomethacin (Indocin®) |
|
Definition
CNS: headache, dizziness, tinnitus
GI: N/V, dyspepsia, abdominal pain, GI bleed |
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Term
| Cautions/contraindications of Indomethacin (Indocin®) use |
|
Definition
| NSAID or aspirin allergy, PUD, impaired renal function, CHF, HTN, thrombocytopenia |
|
|
Term
| Drug interactions with Indomethacin (Indocin®) |
|
Definition
↑ K (especially with K-sparing diuretics)
↑ concentration with probenecid
↑ nephrotoxicity with cyclosporin, other NSAIDs, ACEI, digoxin, aminoglycosides, lithium
↓ effects of anti-HTN meds |
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Term
| General actions of uricosuric medications |
|
Definition
| ↑ renal excretion of uric acid by inhibiting renal tubular reabsorption of uric acid |
|
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Term
| General uses of uricosuric medications |
|
Definition
• Started at low doses to avoid marked uricosuria & possible stone formation & ↑ over several weeks until efficacy or max dose
• Maintenance of hydration & adequate urine flow
• Alkalinization of urine (Na Bicarb or Shohl’s solution) during the 1st several days of therapy to ↓ stone formation |
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|
Term
| Adverse effects & contraindications of uricosuric medications |
|
Definition
• GI irritation, rash/hypersensitivity, precipitation of acute gouty arthritis, & stone formation
• Contraindicated in renal impairment (CrCl < 50 Ml/min) |
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Term
| Actions of Probenecid (Benemid®) |
|
Definition
| Competitively inhibits the reabsorption of uric acid at the PCT, leading to promotion of excretion & ↓ serum uric acid levels |
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Term
| Uses of Probenecid (Benemid®) |
|
Definition
| Prevention of gouty arthritis, hyperuricemia, also used for prolongation of antibiotic effects (beta-lactams) |
|
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Term
| Drug interactions of Probenecid (Benemid®) |
|
Definition
| ↑ effects of methotrexate, quinolones, beta-lactams, & NSAIDs |
|
|
Term
| Adverse effects of Probenecid (Benemid®) |
|
Definition
• CNS: headache, dizziness
• Gen/Skin: flushing of face, rash pruritus, hematologic abnormalities
• GI: N/V, anorexia, gingival soreness, hepatic necrosis
• GU: dysuria, renal calculi
• May cause acute gout attack |
|
|
Term
| Actions of Sulfinpyrazone |
|
Definition
| ↑ urinary excretion of uric acid, leading to ↓ serum uric acid |
|
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Term
|
Definition
| Uricosuric, anti-gout
Chronic gouty arthritis, intermittent gouty arthritis |
|
|
Term
| Actions of Allopurinol (Zyloprim®) |
|
Definition
| Inhibits xanthine oxidase (the enzyme that converts xanthine to uric acid) |
|
|
Term
| Uses of Allopurinol (Zyloprim®) |
|
Definition
| • Xanthine oxidase inhibitor, anti-gout
• Prevention of acute gout
• Drug of choice in history of urinary stones or impaired renal function
• Used for pre-treatment in cytotoxic therapy to prevent uric acid neuropathy |
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|
Term
| Adverse effects of Allopurinol (Zyloprim®) |
|
Definition
| Skin rash, N/V, Leukopenia |
|
|
Term
| Drug interactions with Allopurinol (Zyloprim®) |
|
Definition
• ↑ rash when combined with certain antibiotics
• ↑ risk of bone marrow suppression when given with immunosuppressants
• ↑ effect of anticoagulants
• ↓ effect with ethanol |
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