NON-NARCOTICS
SALICYLATES
n
THERAPEUTIC
PROPERTIES
–
ANALGESIA -
mild to moderate pain
–
ANTIPYRETIC
- lowers febrile temperatures
–
ANTI-INFLAMMATORY
–
ANTI-PLATELET
- acetylsalicylate only
n
transient
ischemic attacks
n
post
myocardial infarction
n
cardiac
valve replacement
SALICYLATES
n
GI EFFECTS
–
nausea/vomiting
–
ulcerations
n
TOXICITIES
–
tinnitus
–
metabolic
acidosis
–
dehydration
SALICYLATES
n
URICOSURIC
PROPERTIES
–
higher doses
–
retains uric
acid at low doses
n
HYPERSENSITIVITY
–
higher
incidence in women
–
higher
incidence in asthmatics
–
cross
sensitivity with some non-steroidal anti-inflammatory agents
SALICYLATES
n
DOSES
–
low dose for
antiplatelet
–
high dose
for anti-inflammatory
n
OTHER USES
–
topical use
- keratolytic, counter-irritant for muscle pain
SALICYLATES
n
PRODUCTS
–
acetylsalicylate
- possesses antiplatelet properties
–
salsalate -
low incidence of GI irritation
–
methylsalicylate
- extremely toxic
–
no liquid
form of ASA - must use Alka Seltzer
ACETAMINOPHEN
n
PROPERTIES
–
analgesic
–
antipyretic
n
TOXICITIES
–
hepatotoxicities
- fatal doses at 25 grams
–
antidote -
acetylcysteine (Mucomyst®)
Rheumatoid Arithritis
n
Auto-immune
disease
n
Progressive
n
Destruction
and deformities of joints
n
Juvenile to
adult onset
n
Step Therapy
–
Salicylates,
NSAID’s
–
Progressively
more toxic agents
NSAID’S
n
PROPERTIES
–
analgesic
–
antipyretic
–
anti-inflammatory
NSAID’S
n
Side effects
–
GI effects -
nausea, ulceration
–
sodium and
water retention
–
decreased
renal function
–
anti-platelet
properties - must discontinue prior to a
procedure
NSAID’S
n
Indomethacin
- side effect of severe frontal headaches
n
Ketorolac -
injectable for acute pain, no abuse potential
n
Sulindac -
low incidence of decreasing renal function
COX - 2 INHIBITORS
n
Properties
–
decrease
inflammation with lesser effects on GI tract
–
Specifically
inhibits cyclo-oxygenase 2 receptors
HYDROXYCHLOROQUINE
n
ONSET OF
ACTION - 3 months
n
ALSO
POSSESSES ANTI-MALARIAL PROPERTIES
n
SIDE EFFECTS
–
reversible
corneal opacity
–
irreversible
retinal damage
INTRA-ARTICULAR STEROIDS
n
USEFUL IF
ONLY A FEW JOINTS INVOLVED
SYSTEMIC STEROIDS
n
Consequences
of Prolonged Use
–
Adrenal
Suppression
–
Ulcers
–
Cataracts
–
Depression
GOLD THERAPY
n
Gold sodium
thiomalate and auranofin
n
ONSET OF
ACTION IS 3 MONTHS
n
MAY SLOW
PROGRESSION OF RHEUMATOID ARTHRITIS
n
ADVERSE
REACTIONS
–
renal damage
–
bone marrow
depression
Miscellaneous DMARD’s
n
ALL MAY SLOW DISEASE PROGRESSION
n
Anakinra
– Inhibits interleukin-1
inflammation
n
Etanercept
– Inhibits tumor necrosis factor
(TNF) inflammation
n
Leflunamide
– Inhibits immune modulator
inflammation
CHEMOTHERAPEUTIC AGENTS
n
Examples: Azathioprine, methotrexate, cyclophosphamide
n
Inhibits
Immune Response
n
Adverse
Reactions
–
Carcinogenic
–
Bone marrow
depression
GOUTY ARTHRITIS
n
IN BORN
METABOLIC ERROR
–
overproduction
of urates
–
under
excretion of urates through kidney
n
MAY BE
SECONDARY TO OTHER DISEASE OR DRUG THERAPY
–
sickle cell
anemia
–
thiazide and
loop diuretics
ACUTE THERAPY
n
COLCHICINE
–
blocks
migration of granulocytes to inflamed area, causing less urate deposits
–
side effect
- severe diarrhea
–
dose - every
hour until symptomatic relief or side effects
PROPHYLACTIC THERAPY
n
DIET - low
purine/high carbohydrate
–
avoid beans,
peas, spinach, mushroom
–
restrict
meat, fish, seafood and alcohol
–
increase
intake of water
n
ALLOPURINOL
- decrease metabolic formation
n
PROBENECID
OR SULFINPYRAZONE - uricosuric agents
MIGRAINE
n
RECURRENT
HEADACHE WITH N/V
n
Contraction
of intracranial vessels lead to an aura
n
Serotonin
causes a compensatory vasodilation that impinges on nerves
n
Contributing
factors
–
tension,
medications, food (chocolate,milk)
ACUTE THERAPY
n
Medications
cause severe vasoconstriction
–
ergotamine
–
triptans
PROPHYLACTIC THERAPY
n
RESERVED FOR
INDIVIDUALS THAT HAVE 2 TO 3 BOUTS PER MONTH
–
Propranolol
- beta blocker