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MSDN Week 6 - Coggle Diagram
MSDN Week 6
indomethacin (Indocin, Tivorbex)
common ADRs: headache
rare ADRs: SJS, GI bleeding, thrombosis, elevated LFTs, acute renal failure, HF, aplastic anemia
interactions: ASA/LMWH/SSRIs (additive GI toxicity and increased risk of bleeding), ACEIs/ARBs/BBs/loops/thiazides (decreased diuretic and anti-HTN efficacy via decreased renal prostaglandin production), cyclosporine/tacrolimus/lithium (increased risk of cyclosporine, lithium toxicity, unknown mechanism), ketorolac/pentoxifylline (additive GI toxicity and increased risk of bleeding), pemetrexed (decreased renal clearance and increased toxicity of pemetrxed), sulfonylureas (increased risk of hypoglycemia via inhibition of sulfonylurea metabolism), warfarin (competitive metabolism)
efficacy: osteoarthritis and RA: decreased pain and improved ROM
indications: ankylosing spondylitis, osteoarthritis, RA, acute pain (mild to moderate)
toxicity: CBC, LFTs, SCr, fecal occult blood tests if chronic use; seek medical attention if severe skin rash, black tarry stools, chest pains, yellowing of skin or eyes, or changes in urination
class: NSAID
counseling: take with food or milk to decrease GI upset
etodolac (Lodine)
indications: general pain, osteoarthritis, RA, juvenile RA
interactions: ASA/LMWH/SSRIs/NSAIDs/pentoxifylline (additive GI toxicity and increased risk of bleeding), ACEIs/ARBs/BBs/loops/thiazides (decreased diuretic and anti-HTN efficacy via decreased renal prostaglandin production), cyclosporine/tacrolimus (increased risk of cyclosporine, tacrolimus toxicity, unknown mechanism), pemetrexed (decreased renal clearance and increased toxicity of pemetrexed), sulfonylureas (increased risk of hypoglycemia via inhibition of sulfonylurea metabolism), warfarin (competitive metabolism)
class: NSAID
common ADRs: none
rare ADRs: SJS, GI bleeding, thrombosis, elevated liver functions, acute renal failure, CHF, aplastic anemia
efficacy: decreased pain, improved ROM
toxicity: CBC, LFTs, SCr, fecal occult blood tests if chronic use, severe skin rash, black tarry stools, chest pains, yellowing of eyes or skin, change in urination
counseling: take with food or milk to decrease GI upset
methylprednisolone (Medrol)
common ADRs: GI upset, hyperglycemia
rare ADRs: primary adrenocortical insufficiency, Cushing syndrome, decreased growth in children, increased risk of infection
CYP3A4/5 inhibitors/inducers, FQs (increased risk of tendon rupture, especially in elderly when used in combo), phenytoin (increases methylprednisolone metabolism; methylprednisolone can increase or decrease phenytoin levels), warfarin (steroids can increase or decrease INR in patients takin warfarin)
efficacy: improvement or resolution of clinical s/s; monitor for decrease in ESR, or improvement in PFT
indications: allergic states, dermatologic diseases, endocrine disorders, GI diseases, hematologic disorders, neoplastic diseases, NS, renal diseases, respiratory diseases, rheumatic disorders
toxicity: monitor for signs of hyperglycemia, osteoporosis, adrenocortical insufficiency, and infection; frequency and severity of ADRs are depending on the length of tx and dose
class: adrenal corticosteroid
counseling: for short term, inform patients to take doses with meals to prevent GI upset; for high-dose or longer-term tx, inform patients to monitor for signs of hyperglycemia, osteoporosis, adrenocortical insufficiency, and infection
methotrexate (Trexall)
common ADRs: myelosuppression, N/V, alopecia, stomatitis, photosensitivity, rash
rare ADRs: acute renal failure, liver failure, interstitial lung disease, SJS, secondary malignancies (lymphomas), opprotunistic infections
interactions: ASA/dantrolene/loops/NSAIDs/penicillins/PPIs/salicylates/
TMP/sulfisoxazole (competition for renal tubular secretion, increased methotrexate toxicity and nephrotoxicity), BCG vaccine/other live vaccines/immunostimulants (increased risk of infection from live vaccine), eltrombopag (inhibition of OATP1B1 by eltrombopag results in decreased methotrexate clearance and increased toxicity), leucovorin (leucovorin is a reduced folate that counteracts the anticancer effect of methotrexate)
efficacy: resolution of symptoms of psoriasis; decreased pain and improved ROM in RA; shrinkage or disappearance of tumor; methotrexate levels may be monitored and used to adjust leucovorin
indications: Non-Hodgkin lymphoma, psoriasis, RA, juvenile RA
toxicity: baseline and periodic CBC, SCr, LFTs, negative pregnancy test; seek medical attention if severe mouth ulcerations, fever > 101.5, SOB, changes in urination, yellowing of eyes or skin, unusual bruising or bleeding
class: antimetabolite
counseling: emphasize appropriate dosing schedule (weekly vs. daily); avoid pregnancy while taking (M and F); causes nausea and vomiting, ensure patients have antiemetics and know how to take them; avoid sun exposure; may take with food
celcoxib (Celebrex)
common ADRs: HTN, HA, GI distress, diarrhea
rare ADRs: SJS, GI ulcers/bleeding, thrombosis, elevated LFTs, acute renal failure
interactions: ASA/SSRIs (additive GI toxicity), CYP2C9 inhibitors/inducers, CYP2D8/2C8 substrates (decreased metabolism and increased toxicity of substrates), lithium (increased lithium levels, unknown mechanism), pemetrexed (decreased renal clearance and increased toxicity of pemtrexed), warfarin (both substrates for CYP2C9, competitive metabolism)
efficacy: decreased pain, improved ROM
indications: osteoarthritis, RA, ankylosing spondylitis, acute pain, primary dysmenorrhea
toxicity: CBC, LFTs, SCr, fecal occult blood tests, BP, severe skin rash, black tarry stools, swelling or weight gain, severe pain, yellowing of eyes or skin, changes in urination
class: COX-2 inhibitor
counseling: take with food or milk to decrease GI upset; may open capsule and pour into tsp of applesauce