pharmacology test 4 gout & RA

level indicating hyperuricemia

how effective is diet in lowering purine levels

2 groups who have problems with urate in the body and the prevelance

steps of metabolism of a purine

dosage effects of aspirin on gout

gout pathophysiology

5 triggers of acute gouty arthritis

first choice for gout
does not lower uric acid levels
severe diarrhea
inhibits chemotaxis

3 uses of gout

2nd choice for gout
efffective at any point during attack
inhibits PG synthesis
inhibits phagocytosis of urate crystals

3 NSAIDS not to be used for gout

used for gout only when NSAIDS and colchiine are ineffective or contraindicated

prophylaxis for gout
promotes the excretion of uric acid
do not use if CrCl < 50 ml/min
never begin therapy during acute attack

what 4 groups would you use allopurinol in

MOA of allopurinol

adverse effects of allopurinol

xanthine oxidase inhibitor
not a purine analog
can be used without dose reduction in patients with mild to moderate renal impairment

indicated for hyperuricemia in children with leukemia, lymphoma and solid-tumor malignancies

generally the first DMARD prescribed

also preferred therapy for mild RA

MOA of methotrexate

leflunomide MOA

DMARD
oral inhibitor of pyrimidine synthesis
AE - debilitating diarrhea
teratogenic

DMARD
inhibits IL-1 release
used in combination with methotrexate and sulfasalazine
AE - nausea
       hemolysis in G6PD deficient subjects
       immediate blurred vision

DMARD
prevents joint erosion 
inhibits cell proliferation
ROS scavenger
AE -lupus-like syndrome
      hemolysis in patients with G6PD   deficiency

DMARD
AE - drug induced lupus
C/I - young children and women during pregnancy and breast feeding

RA agents reserved for moderate to severe disease
tumor necrosis factor inhibitors
act more quickly than DMARDs

TNF inhibitor
recombinant human fusion protein linked to human IgG1 Fc fragment

TNF inhibitor
chimeric human/mouse anti-TNF monoclonal antibody
given IV

TNF inhibitor
recombinant human monoclonal anti-TNF antibody
subQ

TNF inhibitor
monoclonal antibody approved as monotherapy or in combination with methotrexate
subQ

TNF inhibitor
humanized pegylated anti-TNF monoclonal antibody

adverse effects of this group of RA drugs are serious infections
make sure the patient is current on immunizations
CHF
hepatotoxicity

non-tnf biologic
chimeric monoclonal antibody against CD20
given with DMARD
IV infusion

non tnf biologic
genetically engineered fusion protein that interferes with T-cell activation
IV & SC

non tnf biologic
humanized monoclonal antibody that competively inhibits the binding of the pro-inflammatory cytokine interleukin 6 to its receptor
IV

non - tnf biologics
genetically engineered IL-1 receptor antagonist
least effective biologic DMARD