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MSK > Pharmacology of Arthritis > Flashcards

Pharmacology of Arthritis Flashcards

1
Q

What is the first line step in managing pain in arthritis

A

Non opioid (aspirin, paracetamol, NSAID)

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2
Q

What is the second line step in managing pain in arthritis

A

Weak opioid (codeine)

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3
Q

What is the third line step in managing persistent pain in arthritis

A

Strong opioid (morphine)

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4
Q

What are the indications of NSAIDs

A

Inflammatory arthritis, mechanical MSK pain, pleuritic or pericardial pain

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5
Q

What are the adverse effects of NSAIDs

A

peptic ulceration, renal impairment, increased Cv risk, exacerbation of asthma, rash, oesophagitis GI symptoms

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6
Q

What does DMARDs stand for

A

diseae modifying anti rheumatic drugs

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7
Q

Ideally when should DMARD therapy be started in Rheumatoid Arthritis?

A

Within 3 months of symptoms starting

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8
Q

What describes DMARD therapy

A

early and aggressive

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9
Q

How fast are DMARDs

A

slow - weeks to months

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10
Q

How do DMARDs work

A

pure anti inflammatory with no direct analgesic effect

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11
Q

What do DMARDs reduce the rate of

A

joint damage

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12
Q

what are commonly used DMARDs

A

Methotrexate
Sulphasalazine
Leflunomide
Hydroxychloroquine

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13
Q

Is methotrexate safe in pregnancy

A

NO - must be stopped 3 months before trying to conceive. harms foetus

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14
Q

What are the main DMARDs of choice in Tayside

A

Methotrexate and sulfasalazine

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15
Q

How can methotrexate be given

A

orally or by sub cut injection

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16
Q

What is methotrexate used in

A

RA, psoriatic arthritis, Connective Tissue Disease and Vasculitis

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17
Q

What are the adverse effects of methotrexate

A 
Leucopenia / thrombocytopenia 
Hepatitis / cirrhosis (alcohol intake must be limited)
Pneumonitis
Rash / mouth ulcers
Nausea / diarrhoea
Needs monitoring of FBC and LFTs
18
Q

What are other DMARDs used in tayside

A

leflunomide and hydroxychloroquine

19
Q

What are the adverse effects of sulfasalazine

A 
Nausea
Rash / mouth ulcers
Neutropenia
Hepatitis
Reversible low sperm count
Monitoring of FBC and LFTs
20
Q

When is hydroxychloroquine used

A

in connective tissue disease such as SLE (helps skin, joints and general malaise) Sjogren’s syndrome and RA

21
Q

what is a rare side effect of HCQ

A

retinopathy

22
Q

What do biologic drugs target

A

specific aspects of immune system found to be implicated in inflammatory arthritis

23
Q

What is more effective - DMARDs or Biologics

A

Biologics

24
Q

When can a biologic be prescribed

A

after the failure of 2 DMARDs, or in ankylosing spondylitis after the failure of 2 NSAIDs

25
Q

What is Anti TNF therapy licensed for

A

RA, psoriatic arthritis and ankylosing spondylitis

26
Q

How is anti tnf therapy given

A

majority by sub cut injection

27
Q

Anti TNF therapy drugs

A 
Etanercept
Adalimumab
Certolizumab 
Infliximab
Golimumab
28
Q

What are the adverse effects of anti tnf therapy

A

Risk of infection (esp TB)
Question over risk of malignancy (esp skin cancer)
Contraindicated in certain situations e.g. pulmonary fibrosis, heart failure

29
Q

The other biologics…

A

Rituximab - monoclonal antibody against B (CD20) lymphocytes
Tocilizumab – inhibits interleukin 6
Abatacept - CTLA-4 Ig -blocks full activation of T lymphocytes
Ustekinumab – inhibits IL12 and IL23
Secukinimab – inhibits IL17
Tofacitinib/baricitinib – Janus kinase inhibitors

30
Q

What are the two components of gout treatment

A

acute episode treatment and prophylaxis

31
Q

How is an acute episode of gout treated

A

NSAIDs, colchicine, steroids

32
Q

When is allopurinol given

A

started 4-6 weeks after acute flare, as if started during can make the gout worse!!

33
Q

What is allopurinol

A

xanthine oxidase inhibitor - it is a urate lowering drug

34
Q

What are the adverse effects of allopurinol

A

rash (vasculitis). azathioprine interaction, rarely bone marrow aplasia

35
Q

What are other urate lowering drugs

A

Febuxostat and Uricosurics

36
Q

What is common side effect of colchichine

A

diarrhoea

37
Q

When is febuxostat used

A

those who cannot tolerate allopurionol - avoid in patients with ischaemic heart disease

38
Q

What are the indications for corticosteroids

A

Inflammatory arthritis, Polymyalgia rheumatica / giant cell arteritis, Vasculitis

39
Q

corticosteroids adverse effects

A 
Weight gain - centripetal obesity
Muscle wasting
Skin atrophy
Osteoporosis
Diabetes
Hypertension
40
Q

corticosteroids adverse effects

A 
Cataract
Glaucoma
Fluid retention
Adrenal Suppression
Immunosuppression
Avascular necrosis of the femoral head
41
Q

What is the general rule when giving corticosteroids

A

use lowest possible dose and for shortest time possible

42
Q

what is methotrexate

A

a folate antagonist

MSK (14 decks)

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