The following are all types of what drug class?

Ibuprofen, Napoxen, Ketorolac, Piroxicam, Sulindac, Meloxicam, Celecoxib, Indomethacin

What drug class are the following:

methoxtrexate, hydroxychloroquine, sulfasalazine, imfliximab, etanercept, anakinra, leflunomide

What drug class are the following?

Indomethacin, allopurinol, colchicine, probenecid, sulfinpyrazone

NSAIDS

DMARDS

Anti-gout

Corticosteroids

What disease is caused by inappropriate activation of the immune system?

What specifically is being attacked?

RA

Synovium

1. Damaged tissue releases histamine; increasing blood flow to the area.

2. Histamines cause capillaries to leak, releasing phagocytes and clotting factors into the wound

3. phagocytes engulf the bacteria, dead cells and cellular debris

4. Platelets move out of the capillary to seal the wounded area.

Phoslopidase A2 will cleave phospholipids out of membrane to make ARACHIDONIC ACID.

Cyclooxygenase I or II will be used to make the thromboxane, prostacyclin and prostaglandin 

Which cyclooxygenase (I or II) is considered the "housekeeping enzyme- meaning it causes platelet aggredgation, GI protection and kidney funciton"?

Which is more involved in inflammation and is located in the brain, kidney and bone?

"housekeeping enzyme- meaning it causes platelet aggredgation, GI protection and kidney funciton"?

Cox 1

Which is more involved in inflammation and is located in the brain, kidney and bone?

Cox II (larger substrate binding area; more flexible)

The following are roles of what??

refulated inflammatory mediation

regulate calcium movement

control hormones regulation

control cell growth

cause constricito or dilation in vascular smooth muscle cells

cause aggregation or disaggregation of platelts

sensitize spinal neurons to pain

decrease intraocular pressure

PROSTAGLANDINS

Where do PGs act?

Where are they produced?

Where do they NOT act?

prostaglandins at locally

produced locally

DO NOT CIRCULATE IN THE BLOOD

NSAIDS inhibit what enzymes?

What is the black box warning?

Inhibit COX enzymes

Black box warning for all NSAIDS: increase CV thrombus events/ MI/ stroke/ GI bleeding, ulceration of stomache or intestine

Name the derivative for the following drugs:

1. Acetylsalicylic acid

2. Ibuprofen, Naproxen

3. Indomethacin, Sulindac

4. Piroxicam, Meloxicam

5. Ketorolac

6. Celecoxib

1. Acetylsalicylic acid: Salicylic acid derivative

2. Ibuprofen, Naproxen: Propionic acid derivative

3. Indomethacin, Sulindac: Acetic acid derivative

4. Piroxicam, Meloxicam Oxicam derivatives

5. Ketorolac: Hetoaryl acetic acid derivative

6. Celecoxib: Cox 2 inhibitor

Name the drug:

Anti inflammtory

irreversibly acetylates COX

Anti-inflam

Anti-pyretic

Analgesic

Corns, calluses, warts

Anti-coag

Who should not take aspirin?

Who should avoid taking?

Children should not take with viral infection or have taken vaccine

avoid with gout- bc increases uric acid

Btw Ibuprofen and Naproxen:

Which offers mostly analgesic effects?

Which offers mainly anti-inflamm effects?

Analgesic: Ibuprofen: Advil, Motrin

Anti-inflam: Naproxen: Aleve: Naprosyn

What anti-inflam drug offers once daily dosing, has less GI disturbances, given PO..

one drug has a half life of 20-86 hrs?

other drug has a half life 15-20 hrs?

20-86 hrs: Piroxicam

15-20 hrs: Meloxicam

Which of the anti-inflam are a poten analgesic?

What population needs to avoid it?

KETOROLAC

Avoid in PEDS

What drug do you administer if pt overdosed on tylenol?

It's effective if administered within __ hrs.

Aceyticystine

effective if admin within 10 hrs.

What are two types of DMARDS?

Which group do you start with?

What's second line?

When do you initiate therapy in RA?

Most of the DMARDS are contraindicated in what population?

within 3 months to slow progression

Most are contraindicated in pregnant women

What is the #1 drug prescribed for RA?

How long does it take for pt to respond?

Who should not use?

Methotraxate

takes 3-6 weeks to respond

Who should not use? Pregnant women, women trying to get pregnant, men trying to get wife/partner pregnant

CATEGORY X

This DMARD causes 

decreased visual acuity

nausea

stomach cramps

renal toxicity

bulls eye effect in the macula of the eye

**SIDE NOTE: drug also used in treatment of malaria

This DMARD takes 1-3 mts for pt to start seeing effects

It casuses orange-yellow discoloration

photosensitivity

severe depression in young males

leukopenia

DMARD:

If you stop this drug, the symptoms will come back in one month.

This DMARD is an interleukin 1 receptor anatgonist.

It should NOT be used with infliximab and etanercept.

What are causes of acute gout?

What are causes of chronic gout?

Juvenile gout

lack of protein that causes build up of uric acid in all body fluids; can lead to mental problems; poor muscle control, renal problems

GOUT:

What drugs terminate acute attacks?

What drugs PREVENT recurring attacks?

TERMINATORS

Colchicine

NSAIDS

Glucorticoids

PREVENTERS

Uricouric agents: probenacid, sulfinpyrazone

allopurinol

This gout medication: inhibits leukotrienes

it is NOT an analgesic, but does reduce pain

it does NOT prevent progression of gout

needs to be given within 24 hrs to be effective

This med is the drug of choice in pts with hx of kidney stones and renal clearance <50 ml/day of creatinine.

It is preferred in pts with excessive uric acid synthesis

This drug blocks the reabsorption of uric acid back into the kidney at the proximal tubule.

Probenecid

Sulfinpyrazone

What are the three different opioid binding sites?

Where are they located?

What is released there?

This drug is centrally acting analgesic that binds to the mu ipoid receptor.

It weakly inhibits the reuptake of NE and serotonin.

Use: moderate to mod/severe pain

Adv rx: anaphylactoid rx; seizure

Who should avoid taking this med?

What is the drug I'm referring to?

Drug is Tramadol (Ultram)

Avoid if pt taking MAOi

Name two drugs that are Opioid antagonists.

Opiate: derived from poppy plant

Opioid: chemical that binds to opiate receptor

This drug is contraindicated in labor.

It increases urine retention, miosis.

Causes constipation.

Does't cross the BBB; not very lipophilic. 

It's a prototype drug for one of the drug classes.

This drug is commonly used in obstetrics. 

Side effects: dry mouth, blurred vision, mydriasis

In pts with renal problems, it can be toxic causing seizures.

It is structurally unrelated to ______.

What is the drug?

What is the drug class?

It is structurally unrelated to MORPHINE.

What is the drug? Meperidine

What is the drug class? Strong Agonist

This drug is used for heroine and morphine withdrawal. 

It's DOA is 3-6 hrs.

What is the drug?

This drug is very lipophilic

Short DOA: 15-30 min.

100 x potency of morphine.

How can this drug be administered? What specifically do you watch out for with one of the administrations?

Fentanyl

Admin: PO, IV transdermal patch

Transdermal patch: don't use if fever

drug gets released based on body temp.

This drug has less efficacy in smokers bc tobacco increases the liver enzymes that cause oxidation.

It's used in geriatrics or pts with lung disease.

It's an analgesic. 

What is it?

This drug can precipitate withdrawal syndrome in a morphine abuser. 

At high doses it can cause respiratory depression

It decreases activity of the GI tract.

What is it?

More info: increases BP, causes nightmares, hallucinations, dizziness, dysphoria.

This drug is an analgesic.

It is used to supplement anesthesia.

Because Gretchen likes horses:

This drug is used in pain relief in horses.

This drug blocks the effects of heroin for up to 2 days.

This drug is given to patients who overdosed on opioids or heroine.

DOA: 60-100 minutes ** why is this imp?

Naloxone.

DOA imp bc other meds work 3-6 hrs so if someone comes in on overdose and once naloxone wears off they can replace until all of opiates are out of system

1. topical drugs for superficial/dermatophytic infections

2. oral drugs for mucocutaneous/serious dermatophytic infections

3. oral/parenteral admin for systemic infections that primarily occur in those who are immunosuppressed

Define dermatophytic infections.

Mucocutaneous infections

Systemic infections

Dermatophytic: infections fo the skin, nails or scalp

Mucocutaneous: involve infections of the GI tract, gums, perinanal regions, or vagina

Systemic infections: difficult to diagnose; often uneradicable

This drug's main use is for candidiasis.

Can be give as tablets, that you put in solution, you swish and swallow and its for upper/lower GI tract infections.

This drug is used for CNS infections involving meningitis.

It is used in combo with ______.

Flucytosine

used in combo with Amphotericin B

This drug binds to keratin so nail is protected wehn it grows out.

It usually required 6-12 mts of therapy to be effective.

This drug has a possible PNC cross-sensitivity allergy.

It is used for ringworm infections/tineas.

Imidazoles: decreases synthesis of ergosterol AND some sex/steroid hormones in human

Triazoles: litle of any sex/steroid inhibition

This drug should not be taken with antacids/antiulcer drugs/

It causes hepatocellular toxicity.

It inhibits gonadal sex hormones/adrenal steroids.

This is the DOC for coccidiodal meningitis, and prophylaxis pts undergoing organ transplantation/those at risk serious infections.

Preferred drug for chronic suppressive therapy cryptococal meningitis.

If pts don't respond well to amp B or itraconazole.

What drug should you consider?

Hint: inhibits synthesis of D-glucan, an essential component of fungal cell wall

Caspofungin

part of drug class Echinocandins

This is the preferred drug for nail infections

bc its administered daily 12 weeks.

For coagulation cascade:

What is the common pathway of both extrinsic and intrinsic pathway?

analgeic

antipyretic

anti-inflammatory

anti-platelet

Pt comes into your office and asks about using aspirin for their gout to help with the pain.

What do you say?

HELL NO!

It will increase the uric acid levels...sorry!

Name the drug.

This is an anti-viral medication that admin IV for severe infections. It can cause nephotoxicity when given IV and it can decrease renal function if given PO.

Hint: prototype drug for herpes infections.

Trifluridine

Vidarabine

IDOXURIDINE

This drug has a 20x greater efficacy than acyclovir on CMV retinitis.

What is it?

This antiviral drug causes myelosuppression.

It is give IV for acute infection and PO for maintenance and prophylaxis to prevent reactivation.

This drug has a broad antiherpetic activity. 

adverse effects: can cause nephrotoxicity so it's recommended that a pt also take probenacid to help and saline hydration before/after dose.

This anti-viral med causes nephrotoxicity and electrolyte disturbances. It is used to treat CMV retinitis.

It's the last resort for CMV infections.

This drug is used for respiratory viral infections.

It causes livedo reitcularis (discoloration of the lower extremities with edema)

Which of the following two drugs crosses the BBB?

Amantidine

OR

Rimantidine

This drug is used for prophylaxis treatment for influenza A. It binds viral M2 protein.

Used in nursing homes- offers some protection if pt can't get vaccine.

doesn't eliminate the infection; prevents from infecting more cells and replicating.

Prevents new virus from getting in and old viruses from getting out

This is a popular anti-viral med.

It is used for the prevention/treatment of Influenza A/B; probenacid doubles the t 1/2.

This drug is used to prevent infeciton in neonates at risk for RSV infections

ie premature infants (less than 35 weeks) those with bronchopulmonary dysplasia.

If a patient becomes resistant to AZT, what do you think about for next line?

Hint: non-food dependent

This HIV drug requires the individual to also take L-carnitine supplementation for muscle energy which the drug depletes it. 

Advs effects: nephrotoxicity

This HIV drug causes Adv effects: rash, severe/fatal hypersensitivity

NO BONE MARROW SUPPRESSION

Zidovudine, Didanosine, Zalcitabine, Stavudine, Lamivudine, Abacavir, Adefovir, Tenofovir, Emtricitabine and Trizivir.

What drug class?

Neviripine, Delavirdine, Efavirenz and Etraviridine.

What drug class?

Ritonavir, Indinavir, Saquinavir - H, Saquinavir-S, ??Nelfinavir, Amprenavir, Kaletra, Atazanavir and Enfuvirtide

What drug class?

Raltegravir

What drug class?

This drug class causes lipodystrophy.

Causes hyperglycemia/ inc TGs/cholesterol

This HIV drug is used in low doses to increase drug levels of other drugs.

It is very potent and not well tolerated.

This HIV drug requires drinking at least 1/5 liters of   fluid/day to avoid kidney stones.

Adv reactions: crystalluria/nephrolithiasis/flank pain

M2: proton/ion pump

HA: hemagluten

NA: neurominadase

NOPE

NON FOOD DEPENDENT!

heparin injection

T: 1/2-2 hrs. RAPID ONSET

low molecular weight heparin- has longer half life

What do you need to tell your patient to be aware in regards to drug interactions when taking an opiod? (What substances/meds specifically?)

What are the 3 most common effects?

This anti-viral causes chain termination as it's MOA.

This anti-viral does NOT cause chain termination.

causes redistribution of fat

muscle atrophy

hyperglycemia

thinning skin bc metabolized connective tissue

ulcers

high BP bc increase reabsorption of sodium, Cl, and water

Osteoporosis-bc suppress Ca absorption

Cushing syndrome

brainstem

medial thalamus

hypothalamus

limbic system

periphery

immune cells