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Musculoskeletal, skin, and connective tissue ` phaRmaCology Musculoskeletal, skin, and connective tissue ` phaRmaCology section iii 487
Teriparatide
mEChanism Recombinant PTH analog. osteoblastic activity when administered in pulsatile fashion.
CliniCal UsE Osteoporosis. Causes bone growth compared to antiresorptive therapies (eg, bisphosphonates).
adVERsE EFFECts risk of osteosarcoma (avoid use in patients with Paget disease of the bone or unexplained
elevation of alkaline phosphatase). Avoid in patients who have had prior cancers or radiation
therapy. Transient hypercalcemia.
Gout drugs
Chronic gout drugs (preventive)
Probenecid Inhibits reabsorption of uric acid in proximal Prevent A Painful Flare.
convoluted tubule (also inhibits secretion of
penicillin). Can precipitate uric acid calculi. Purines
Allopurinol Competitive inhibitor of xanthine oxidase
conversion of hypoxanthine and xanthine Hypoxanthine
to urate. Also used in lymphoma and leukemia Xanthine
to prevent tumor lysis–associated urate oxidase Allopurinol,
nephropathy. concentrations of xanthine Xanthine Febuxostat
oxidase active metabolites, azathioprine, and Xanthine
oxidase
6-MP.
Plasma
Pegloticase Recombinant uricase catalyzing uric acid to uric acid
allantoin (a more water-soluble product).
Febuxostat Inhibits xanthine oxidase.
Acute gout drugs
Tubular secretion Tubular reabsorption
NSAIDs Any NSAID. Use salicylates with caution (may
decrease uric acid excretion, particularly at Diuretics, Probenecid,
low doses). low-dose salicylates high-dose salicylates
Glucocorticoids Oral, intra-articular, or parenteral.
Urine
Colchicine Binds and stabilizes tubulin to inhibit
microtubule polymerization, impairing
neutrophil chemotaxis and degranulation.
Acute and prophylactic value. GI,
neuromyopathic side effects.
TNF-α inhibitors
dRUg mEChanism CliniCal UsE adVERsE EFFECts
Etanercept Fusion protein (decoy receptor Rheumatoid arthritis, psoriasis,
for TNF-α + IgG Fc), ankylosing spondylitis Predisposition to infection,
1
produced by recombinant including reactivation of
DNA. latent TB, since TNF is
Etanercept intercepts TNF. important in granuloma
Infliximab, Anti-TNF-α monoclonal Inflammatory bowel disease, formation and stabilization.
adalimumab, antibody. rheumatoid arthritis, Can also lead to drug-induced
certolizumab, ankylosing spondylitis, lupus.
golimumab psoriasis
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