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First generation H1 antagonists
Diphenhydramine side effects
Reduces flushing, edema, mucous secretion, itching and pain
highly sedating, seizures, pupil dilation, tachycardia
What are the effects of histamine?
- increased capillary permeability
- bronchoconstriction (increased secretions)
- CNS effects
Second generation antihistamines
- blocks histamine receptors
- less side effects
- long acting
Second generation antihistamine nasal spray
Causes a little bit of drowziness
What is the difference between ASA and first line NSAIDs?
- ASA is irreversible
- NSAIDs are reversible
Nonselective irreversible COX inhibitor
Physiologic difference between ASA and NSAIDs
ASA decreases platelet aggregation
NSAIDs have an increase in thrombotic events
When are NSAIDs used first line?
Osteoarthritis and RA
Side effects of NSAIDs
- Renal impairment
COX inhibitors will usually result in what as an adverse effect?
What is a first generation NSAID?
What is an NSAID given IV/IM?
What is the difference between first and second generation NSAIDs?
1st generation - COX I and II inhibitors
2nd generation - COX II inhibitor
Second generation NSAID
Action of Celebrex
- Reduces pain
- Reduces fever
- Reduces inflammation
What is the action of Acetaminophen?
Inhibits prostaglandin production (CNS only)
What are the effects of Acetaminophen?
What does Acetaminophen inhibit the metabolism of?
What is the antidote for Acetaminophen?
What class is Celebrex?
Second generation NSAID
COX II inhibitor
Don't take alcohol with Acetaminophen
Causes toxic metabolism of acetaminophen in liver via P450 system
What class is Cortisol?
What class is Prednisone?
What basic effect do glucocorticoids have?
What physiologic effects are glucocorticoids going to be similar to?
What two major actions does Cortisone have?
What can Cortisone be used to treat?
Receiving Glucocorticoids will have a negative feedback effect, so it will cause what?
How do you avoid adrenal insufficiency in a patient taking long term therapy glucocorticoids?
How do you avoid adrenal insufficiency?
- do not stop taking cortisol abruptly
- carry an extra supply
- Seek tx for illness/stress
- Wear an ID bracelet
What is the first line of drugs used to treat RA?
What type of NSAIDs are best for tx of RA?
COX II inhibitors
Why are COX II inhibitors the best NSAID for tx of RA?
Less side effects
Could someone with RA start tx using Celbrex?
Second Generation NSAID
Why would someone getting tx for RA not get Celebrex?
They are already at risk for MI or thrombotic events
What is an option for someone with limited affected joints RA?
What is the advantage of Glucocorticoid injections?
No systemic effects
What is the next step in therapy for RA if NSAIDs are ineffective?
Name four nonbiologic DMARDs
Two biologic DMARDs
If nonbiologic DMARDs are ineffective for RA, switch to what?
What is the strange biologic DMARD?
What is the short term relief tx of Gout?
What is the more dangerous short term tx for gout?
- abdominal pain
What is the long term tx of Gout?
Zyloprim and Uloric
What is Colchicine used to treat?
How and when is Probenicid given?
Once gout is under control using Zyloprim and Uloric
Then Probenicid is used to prevent Gout
What would you like to do?
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