Drug Therapy for Rheumatoid Arthritis, Gout, and Calcium Levels PDF

Drug Therapy for Rheumatoid Arthritis, Gout and Calcium Levels Drugs for Rheumatoid Arthritis Overview: An autoimmune inflammatory disorder Appears at younger age (30 – 40 years) Inflamed synovial membranes cause joint stiffens and pain; symmetrical, worse in the morning. Described as “crippling.” H...

Drug Therapy for Rheumatoid Arthritis, Gout and Calcium Levels Drugs for Rheumatoid Arthritis Overview: An autoimmune inflammatory disorder Appears at younger age (30 – 40 years) Inflamed synovial membranes cause joint stiffens and pain; symmetrical, worse in the morning. Described as “crippling.” Has systemic manifestations Treated with physical therapy, exercise and surgery (joint replacement) Drug therapy (categories already covered in class): o NSAIDs (both first and second generation) o Glucocorticoids—usually for short term to relieve symptoms, may delay progression but does not cure. Can be given oral or intra-articular. Disease Modifying Antirheumatic drugs (DMARDs)—starting these sooner because they reduce destruction and slow disease. Nonbiologic (traditional) methotrexate (low dose)—considered a first choice drug; acts within 3 – 6 weeks; 80% of patients improve with this drug. Toxicity is hepatic, bone marrow suppression, GI ulcers and pneumonitis. In high doses, this is a cancer medication. Sulfasalazine—also used for inflammatory bowel diseases such as ulcerative colitis. Side effects are n/v/d/a Biologic agents—immunosuppressive drugs, often used in combination with methotrexate etanercept—tumor necrosis factor antagonist. Delays progression of joint damage. Increases risk of serious infections 2 Drugs for Gout 307 Overview: Recurrent inflammatory disorder with joint pain especially in the big toe Hyperuricemia Specific drug therapy o NSAIDS—indomethacin (also used for arthritis) and then colchicine (specific for gout) o Reduce hyperuricemia—allopurinol Drugs to General information: Regulate Calcium important for function of skeletal system, Calcium nervous system, muscular system, and cardiovascular and Bone system. Metabolism Calcium dietary sources: milk, tofu Calcium mostly in bone (98%) and also in blood 883 Hypocalcemia—neuromuscular condition causes spasms, tetany, convulsions. Drugs: Calcium salts are used to initially treating hypocalcemia, along with vitamin D which regulates calcium and phosphorus. Called rickets in children and osteomalacia in adults Calcitonin-salmon—similar to the natural form which prevents bone destruction and decreases plasma levels of calcium. Available as a nasal spray. Bisphosphonates: Prototype: alendronate Used to treat osteoporosis. Given oral weekly. Adverse effect: esophagitis, so must be given on an empty stomach and be able to sit up afterwards. 2023