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cyclooxygenase inhibitors - therapeutic effects?
- 1 - decreased inflammation
- 2 - decreased pain
- 3 - reduced fever
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MSA-4 protects against what?
stroke and MI
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when cyclooxygenase is inhibited, it decreases amount of what?
prostaglandins
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COX @ site of tissue injury?
decreased pain and inflammation
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COX @ stomach
protects gastric mucosa
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COX @ blood vessels
vasodilation
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COX @ brain
regulates fever
-
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COX @ platelets
aggregation
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COX @ uterus?
promotes contractions
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2 forms of COX?
- COX 1 - found in all tissues
- COX 2 - produced at site of tissue inflammation/injury
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inhibition of COX-1
gastric erosion, bleeding, renal impairment. protects against MI and stroke
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COX-1 normal effects?
found in all tissues, protects gastic mucosa, supports renal fx, promotes platelets
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COX-2 normal effects?
produced at sites of tissue injury. mediates inflammation and sensitizes to painful stimuli. in the brain - mediates fever and contributes to pain perception
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inhibition of COX-2?
suppresses inflammation, alleviates pain, reduces fever. increased risk of MI and stroke
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difference between NSAIDs and acetaminophen?
- NSAIDS - have anti-inflamm properties
- acetaminophen lack anti-inflamm properties
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aspirin (first generation NSAIDs)
inhibits COX-1 and COX-2. treats inflamm disorders
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adverse effects of aspirin?
- GI upset
- bleeding
- renal impairment
- salicylism (s/s headache, tinnitus, sweating, dizziness)
- Reye's syndrome (in children - do not give < 2 years)
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methotrexate - type of drug & therapeutic use?
- DMARD (disease modifying antirheumatic)
- used for rheumatoid arthritis
-
methotrexate - given how many times?
once a week via IM
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sulfasalazine (Azulfidine)- therapeutic uses?
rheumatoid arthritis, IBD
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Hydroxychloroquine (Plaquenil)- onset?
3-6 months
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Hydroxychloroquine (Plaquenil)- significant side fx?
- retinal damageneed frequent eye exams
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sulfasalazine (Azulfidine)- action?
- slows progression of joint deterioration
- anti-inflammatory
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Enteracept (Enbrel)- therapeutic use?
- mild to moderate RA
- delays progression of joint damage
-
Enteracept (Enbrel)- administration? side fx?
- given subQ
- may have local site reaction
- ^ risk of infection
-
Enteracept (Enbrel)
Infliximab (Remicade)
adalimumab (Humira)
- what type of medication?
Tumor necrosis factor (TNF) blocker
-
mech of action of TNF blockers?
inhibits TNF (tumor necrosis factor), thus reducing inflammation, as in RA
-
disease of altered purine metabolism. associated with hyperuricemia
gout
-
goals of therapy for gout?
- block inflamm process
- increase excretion & decrease production of uric acid
-
usual meds given for an acute gout attack?
NSAIDS & glucocorticoids
-
colchicine - therapeutic use?
acute gout attacks
-
allopurinol - therapeutic use?
- chronic gout
- inhibits uric acid production
-
probenecid - therapeutic use/ action?
- chronic gout symptoms
- decreases reabsorption of uric acid; thereby promoting excretion
-
probenecid - long term side fx?
GI effects, renal fx
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first gen NSAIDs inhibit what?
COX-1 and COX-2
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second gen NSAIDs inhibit what?
selectively COX-2
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causes effects in stomach, kidneys, platelets.
COX-1
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effects on inflammation, pain, fever
COX-2
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difference between inhibition of COX-1 and COX-2?
- COX 1: bleeding, renal impairment, stomach erosion (acts systemically)
- COX 2: reduces inflammation, pain, fever. (acts on CNS and @ sites of tissue injury)
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benefits of ASA?
suppression of pain, fever, inflammation. also protects against MI/stroke.
-
first line treatment/ drug of choice for arthritis?
ASA
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which drug decreases ASA's protection against MI/stroke?
ibuprofen. (reduces ASA's side effect of blood thinning)
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ASA is contraindicated for which children?
<2 years of age, with the flu, with chickenpox
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