Musculoskeletal - Pharmacology

hezikry's version from 2015-08-06 20:25

Arachadonic acid products

Question Answer
Corticosteroids on arachadonic acid productsInhibits Phospholipase A2 and synthesis of COX1/2
Zileutoninhibits Lipoxygenase
Used in maintenance treatment of asthma
Zafirlukastinhibits LTD4 → ↑ bronchial tone
Longterm asthma treatment
Montelukastinhibits LTD4 → ↑ bronchial tone
Longterm asthma treatment
LTB4Neutrophil chemotactic agent (Neutrophils arrive B4 others)
LTC4, D4, E3Bronchoconstriction
contraction of smooth muscle
↑ vascular permeability
PGI2inhibits platelet aggregation
↓ vascular tone
↓ bronchial tone
↓ uterine tone
PGE2, PGF2α↑ uterine tone
↓ vascular tone
↓ bronchial tone
TXA2↑ platelet aggregation
↑ vascular tone
↑ bronchial tone
Relaxation of smooth musclePGI2, PGD2, PGE2 (high concentrations)
Constriction of smooth muscleTXA2
Platelet aggregationTXA2
Inhibition of platelet aggregationPGI2
Increases uterine tonePGE2, PGF2
Decreases uterine tonePG12

MSK drugs

Question Answer
MOA of acetaminophenreversibly inhibits cyclooxygenase, mostly CNS. Inactivated peripherally
A/E of acetaminophenNAPQI depletes glutathionin and forms toxic tissue byproducts in liver.
Antidote of acetaminophenn-acetylcysteine. regenerates glutathione.
MOA aspirinirreversibly inhibits cyclooxygenase.
Affect of aspirin on plateletsdecreases thromboxane A2 and prostaglandins via COX1. Increases bleeding time.
A/E of aspirin toxicitygastric ulceration, tinnitus, chronic use can lead to renal failure.
Acid base disorder in aspirin toxicityrespiratory alkalosis early and then metabolic acidosis
MOA celecoxibreversibly inhibits COX2. does not impair platelet function
Celecoxib clinical useRA, OA
Celecoxib effect on gastric mucosanone
A/E celecoxibdecreases PGI2 which leads to an increased risk of thrombosis. SULFA DRUG
NSAIDS MOAreversibly inhibit cyclooxygenase
Bisphosphonates MOApyrophosphate analogs. Binds hydroxyapaptite in bone, inhibiting osteoclast activity and decreases bone resorption
Clinical use of bisphosphonatesosteoporosis, hypercalcemia, Paget
A/E of bisphosphonatescorrosive esophagitis
Teriparatide MOArecombinant PTH analog. increases osteoblastic activity (pulsatile)
A/E of teriparatidetransient hypercalcemia. may increase risk of osteosarcoma

Gout drugs

Question Answer
What drugs should be used in acute gout attackNSAIDS, glucocortiocids, colchicine
What drugs should be used for chronic goutallopurinol
What tests should also be conducted before starting a patient on TNF alpha inhibitorsTB test! Can predispose to reactivation of latent TB since since TNF is important in granuloma formation
MOA of allopurinolinhibits XO after being converted to alloxanthine. Decreases conversion of xanthine to uric acid.
Clinical use of allopurinolchronic gout, lymphoma, leukemia to prevent tumor lysis
A/E allopurinolincreases concentration of 6-MP and azathioprine. Cans cause SJS and bone marrow suppresions. Hypersensitivity-rash, fever, eosinophilia.
Febuxostat moainhibits XO
A/E febuxostatnone safer in patients with decreased GFR
MOA pegloticaserecombinant uricase that catalyze metabolism of uric acid to allantoin
MOA probenecidinhibits reabsorption of uric acid in PCT
A/E probenecidcan precipitate uric acid calculi, need lots of fluid
colchicine MOAbinds and stabilizes tubulin to inhibit microtubule polymerization, impairing neutrophil chemotaxis and degranulation
Salicylates and acute goutDO NOT GIVE.
etanercept MOAfusion protein. TNF decoy preceptor.
clinical use of etanerceptRA, ankylosing spondylitis and psoriasis
Infliximab and adalimumab moaanti-TNF alpha monoclonal antibody
clinical use of infliximabIBD, RA, psoriasis, ankylosing spondylitis

Drugs that can cause osteoporosis

Question Answer
drugs that decrease estrogenaromatase inhibitors
proton pump inhibitors decreasecalcium absorption
drugs that decrease bone formationglucocorticoids, heparin, TZDs
drugs that increase vitamin D catabolismanticonvulsants