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ChemotxofMSDx

lecture 23 karp

QuestionAnswer
drugs for MS pain NSAIDs, acetaminophen, tramadol, opioid analgesics like hydrocodone
drugs to decrease inflammation (and limit tissue damage) prednisone, NSAIDs, hydroxychloroquine (dec type I IFN production), MTX, biological agents like anti-TNF monoclonal Ab
NSAID gastropathy dyspepsia & epigastric pain common esp. in elderly, those with h/o prev GI bleed or on warfarin/heparin. start on PPI or misoprostol concomitantly
NSAID nephropathy acute renal failure, nephrotic syndrome or interstitial nephritis. inc risk in elderly, those with CHF or already poor renal function, pts on diuretics/ACEI
COX2 selective NSAIDs may lessen gastropathy but have inc risk of cardiac and embolic events like stroke
tx of RA simple analgesics don't work. starts with low dose steroids for bridge therapy to more slow-acting agents. then try hydroxychloroquine (+/-) sulfasalazine then low-dose MTX with supplemental folate then etanercept & infliximab for most severe RA
urate lowering tx only indicated for those with renal stones, multi recurrent attacks or visible tophi on exam. allopurinol is prototype. uricosurics: probenecid & sulfinpyrazone if pt has nl renal function and no h/o kidney stones.
fibryomyalgia & back pain use amitriptyline & trazodone @ night for sleep. SSRIs may be used during the day. o/w use centrally acting agents to dec muscle hyperactivity & spasm: soma, flexeril, robaxin. agents to reduce spasticity: baclofen (reduces spinal reflexes) & dantrolene
tx of SLE NSAIDs for arthritis & mild serositis. antimalarials for fatigue, lupus skin dz, arthritis & serositis. topical steroids for skin dz. high dose steroids for cytopenias, severe plum dz, vasulitis & neurospcyh manifestations
when to use anti-CD20 like rituximab in SLE when pt is having life-threatening complications like nephritis. also cyclophosphamide, azathioprine (OJO with allopurinol = inc myelosuppression) or mycophenolate mofetil
post-menopausal osteoporosis EtOH and smoking cessation. fall prevention strategies. calcium & vitamin D supplementation. bisphosphonates like alendronate, rPTH like teriparatide, estrogen or SERM and calcitonin
Created by: sirprakes
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