Learning Objectives

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Topics
Non-opioid Analgesics Non-steroidal Anti-inflammatory Drugs (NSAIDs) Disease-modifying Antirheumatic Drugs (DMARDS)
Slow-acting Antirheumatic Drugs (SAARDS) Drugs for Treating Gout

The medical student should know and be able to discuss:

  • Mechanisms controlling body temperature and know the basic mechanisms of local pain, edema, fever and both acute and chronic inflammation
  • COX I versus COX II
For aspirin (acetylsalicylic acid), the following:
Structure

Mechanisms of anti-inflammatory, analgesic and antipyretic effects

cyclooxygenase versus lipoxygenase

Factors that influence absorption and elimination

Hepatic metabolism

Dose-dependent pharmacokinetics

Contraindications

Side effects and consequences of irreversible inhibition of cyclooxygenase inhibition

Toxicity and treatment of overdose

Adverse interactions with other drugs (e.g., anti-coagulants, hypoglycemic drugs, alcohol)

Basic pharmacology and toxicology of NSAIDs
  • ibuprofen
  • indomethacin
  • ketoprofen
  • naproxen
  • piroxicam
  • which NSAIDs need only be given once or twice daily
  • which NSAIDs can be given with warfarin or tolbutamide
  • rationale for misoprostol as adjunct therapy with aspirin and NSAIDs
  • how acetaminophen differs pharmacologically and toxicologically from aspirin
  • the metabolism of acetaminophen, the role of cytochrome P450 in activating acetaminophen to a reactive metabolite, and the use of N-acetylcysteine in treating acetaminophen hepatotoxicity
  • Aspirin and NSAIDs in the treatment of rheumatoid arthritis
  • Basic pharmacology and toxicology of slow-acting drugs for treating rheumatoid arthritis
  • Chloroquine
  • Gold (aurothioglucose)
  • D-Penicillamine
  • Immunosuppressive drugs
    • methotrexate
    • cyclophosphamide
    • cyclosporin
  • IL-1 and TNF: targets of new treatments of rheumatoid arthritis
  • why glucocorticoids (e.g., prednisone) have limited use in the treatment of rheumatoid arthritis
  • Cause and pathophysiology of acute gouty arthritis and chronic tophaceous gout
  • different mechanisms of action of allopurinol, colchicine, indomethacin, probenecid and sulfinpyrazone in the treatment of gout
  • dangerous side effects of colchicine
  • indomethacin and ibuprofen (NSAIDs other than aspirin) as therapeutic options instead of colchicine to treat the inflammation of acute gouty arthritis, and why aspirin (except in high, doses) cannot be used for this purpose
  • why the uricosuric agents, probenecid and sulfinpyrazone, increase the risk of renal calculi, and what steps are taken to reduce this risk
  • potential adverse drug interactions with allopurinol (e.g., with mercaptopurine)
Some Important Drugs
  • Acetaminophen
  • Allopurinol
  • Aspirin
  • Auranofin
  • Aurothioglucose
  • Azathoprine
  • Indomethacin
  • Ketoprofen
  • Methotrexate
  • Chloroquine
  • Colchicine
  • Corticosteroids
  • Cyclophosphamide
  • Diclofenac
  • Etodolac
  • Diflunisal
  • Ibuprofen
  • Meclofenamate
  • Nambumetone
  • Naproxen
  • D-Penicillamine
  • Phenylbutazone
  • Piroxicam
  • Probenecide
  • Sulfasalazine
  • Sulfinpyrazone
  • Sulindac