NPTE Pharmacology

Anti-Inflammatory Medication -Inhibits prostaglandin synthesis. Prostaglandins are mediators of the inflammatory response Indications: Antipyretic (reduce fevere), Analgesic, Andi-inflammatory, Antiplatelet Side Effects: Gastrointestinal upset-nausea, gastritis Adveres Effects: prolonged bleeding times, Gastrointestinal ulceration, Allergic reactions especially: bronchoconstriction, angioedema, or even anaphylaxis

Anti-Inflammatory Med - Ibuprofin ( Advil, Motrin, and others) Inhibits COX-1 and COX-2 enzymes. COX-1 are "good" protective prostaglandins, COX-2 invloved with inflammation. Non Selective COX inhibitor - Indications: Antipyretic, Analgesic (esp metastatic bone pain), Anti-inflammatory Side Effect: Fluid retention and edema(can be problematic in renal dysfunction, congestive heart failure), GI irritation (ulceration can still occur in body)

Anti-Inflammatory Drug - Selectively inhibit COX-2 inhibitors and spare the "good" COX-1 inhibitors - Celecoxib (Vioxx, Celebrex, Bextra, others) - Indicated for Rhuematoid Arthritis and DJD Potentially fatal cardiac effects have severely limited teh current use of the drugs. Too bad-very good benefits versus horrible risk!

Anti-inflammatory Drug - Cortisol/hydrocortisone (endogenous from adrenal cortex) and synthetic corticosteriods (prednisone, dexamethasone) are potent anti-inflammatories - They inhibit several parts of the inflammator process including capillary dilation, edema formation and migration of leukocytes and macrophages to teh affected area -Used extensively with RA and DJD (intra-articular injections) Intra-articular injections decrease risk of side effects: however, accelerated joint destruction and tendon atrophy is possible. Side Effects. Potentiall serious - Adrenal Insufficiency. Can result in fever, malaise, arthralgia and more - Immmunosuppression. - Depression, anxiety, euphoria, mood swings "steroid buzz" - Cataracts, increased intraocular pressure - Cushingoid state including moon face, hirsutism, acne, and stretch marks on extremities - Fluid retention - Hyperglycemia - Osteoporosis - Myopathy which can affect ambulatory status

Used with active, continuing inflammatory disease. Goal is to stop inflammation and joint destruction. Best used early and aggressively. Sometimes used in conjunction with NSAIDS and corticosteroids

-DMARDS Works by enzyme inhibition. Used as an anticancer agent as well as DMARD -Side Effects: Hepatic Dysfunction, GI disurbances, Blood complications including thrombocytopenia, Cannot be used with renal dysfunction, Folic acid may decrease adverse effects

- Binds with TNF and inactive it. TNF is directly invloved with RA inflammation.

Leflunomide, Infliximab, Anakinra Side Effects: increased risk for serious infection

DMARD -Mechanism is unknown - Side Effects: Blood disorders, Renal dysfunction, Skin Problems- Dermatitis

Calcium and Vitamin D intake. Also cod liver oil, calcitriol can be taken Weight bearing, stop smoking, decrease alcohol consumption, decrease caffein intake

Antiosteoporosis - Inhibit osteoclastic bone resorption without affecting bone formation. - Increase bone mass density and decrease risk of fracture Alendronate (Fosamax) and risedronate (Actonel) SIde Effects: