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Pharmacology > Arthritis > Flashcards

Arthritis Flashcards

1
Q

What does ‘arthro’ mean?

A

Joint

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2
Q

What does ‘it is’ mean?

A

Inflammation

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3
Q

What does ‘osteo’ mean?

A

Bone

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4
Q

What is the primary cause of osteoarthritis?

A

Wear and tear

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5
Q

What are secondary causes of osteoarthritis?

A

Trauma
Disease
Obesity

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6
Q

What does ‘rheum’ mean?

A

Flowing in a stream

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7
Q

What type of joint does osteoarthritis affect?

A

Synovial

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8
Q

What happens in osteoarthritis?

A

Bone and cartilage are lost from articulating surfaces

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9
Q

Where is type 1 collagen found?

A

Bone

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10
Q

What is the function of type 1 collagen?

A

Osteoblast differentiation from bone marrow

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11
Q

Where is type 2 collagen found?

A

Cartilage

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12
Q

What is the function of type 2 collagen?

A

Maintains integrity of cartilage

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13
Q

Where is aggrecan found?

A

Synovial membrane

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14
Q

What is the function of aggrecan?

A

Maintains integrity of cartilage

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15
Q

Where is matrix metalloproteinases found?

A

Synovial tissue

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16
Q

What is the function of matrix metalloproteinases?

A

Degrade ECM proteins and enable growth

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17
Q

Why is cartilage degraded?

A

Upregulation of cytokines
IL-1B inhibits type 2 collagen synthesis of hyaline cartilage
Cathepsin-B can cleave aggrecan
increased matrix m = collagen breakdown

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18
Q

What causes the inflammatory response?

A

Prostaglandins

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19
Q

What catalyses the reaction of arachidonic acid to Pgs and Tx?

A

COX enzymes

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20
Q

What a COX a target for?

A

NSAIDs

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21
Q

What does NSAID stand for?

A

Non- steroidal anti-inflammatory drugs

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22
Q

What are some examples of NSAIDs?

A 
Aspirin
Ibuprofen
Diclofenac
Meloxicam
Indomethacin
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23
Q

What are the 3 actions of NSAIDs?

A

Antipyretic
Analgesic
Anti-inflammatory

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24
Q

What are some problems with NSAIDs?

A 
Risk of gastric ulcers
Impair coagulation
Caution in elderly
Risk of CV events
May induce asthma/angioedma
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25
Q

Why do NSAIDs have issues?

A

May inhibit COX 1 as well as COX 2

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26
Q

Name 2 COX2 inhibitors

A

Celecoxib

Etoricoxib

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27
Q

Why can misoprostol help?

A

Synthetic PG
Preserves mucous lining of GI
Protects against ulceration

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28
Q

What drug is often grouped with NSAIDs?

A

Paracetamol

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29
Q

What are the treatment options for osteoarthritis?

A 
Exercise
Weight loss
Joint support
Thermotherapy/TENS
Suitable footwear
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30
Q

In rheumatoid arthritis, where is the joint inflamed?

A

Synovial membrane
Tendon sheath
Bursae

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31
Q

What happens in rheumatoid arthritis?

A

Proliferation of synovial membrane & erosion of cartilage/bone

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32
Q

What kind of disorder is RA

A

Autoimmune

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33
Q

Which gender is RA more common in?

A

Female

34
Q

What are the presenting symptoms are RA?

A

Pain
Stiffness
Warmth
Redness

35
Q

How is RA diagnosed?

A

Imaging
Blood tests
Physical exam

36
Q

What are the treatment options for RA?

A 
NSAIDs/ opioid analgesics
Glucocorticoids
Immunosuppressants
DMARDs
Anticytokines
37
Q

What does DMARDs stand for?

A

Disease modifying antirhematic drugs

38
Q

Where are glucocorticoids naturally produced?

A

Adrenal glands

39
Q

What do glucocorticoids do?

A

Metabolism effects
Anti-inflammatory
Immunosuppressive

40
Q

What natural steroids show both glucocorticoid and mineralocorticoid action?

A

Hydrocortisone/corticosterone

41
Q

What natural steroid shows only mineralocorticoid action?

A

Aldosterone

42
Q

What synthetic steroids have mixed gluco/mineralocorticoid activity?

A

Prednisolone

Prednisone

43
Q

What synthetic steroids have glucocorticoid activity?

A

Dexamethasone
Betamethasone
Beclomethasone
Budesonide

44
Q

What synthetic steroid has mineralocorticoid activity?

A

Fludrocortisone

45
Q

Give an example of a short acting steroid

A

Cortisone

46
Q

Give an example of an intermediate acting steroid

A

Prednisolone

47
Q

Give an example of a long acting steroid

A

Dexamethasone

48
Q

What 3 drugs are used for asthma and arthritis?

A

Beclomethasone
Budesonide
Prednisolone

49
Q

What are some unwanted effects of oral corticosteroids?

A 
Buffalo hump
Moon face
Hypertension
Increased abdominal fat
Thinning skin
Poor wound healing
Osteoporosis
Muscle wasting
Increased risk of infection
50
Q

How can you reduce the side effects of corticosteroids?

A

Decrease plasma concentrations eg. use topical route

51
Q

What are the 4 most important DMARDs?

A

Sulpasalazine
Gold compounds
Penicillamine
Immunosuppressants

52
Q

What is sulfasalazine made up of?

A

Sulphonamide (antibiotic) & Salicylate (NSAID)

53
Q

How does sulfasalazine work?

A

Scavenging free radicals produced by neutrophils

54
Q

What are some side effects of sulfasalazine?

A

GI upset, headache, skin reactions, leukopenia

55
Q

What are some side effects of penicillamine?

A

Rashes, stomatisis, anorexia, taste disturbance, fever, nausea

56
Q

What should not be given alongside penicillamine?

A

Gold compounds

57
Q

What are the 2 gold compounds?

A

Auranofin & Sodium auranofin

58
Q

How is sodium auranofin given?

A

Deep I.M

59
Q

Where do gold compounds concentrate?

A 
Synovial cells
Liver cells
Kidney tubules
Adrenal cortex
Macrophages
60
Q

Over what period do the effects of gold compounds develop?

A

3-4 months

61
Q

What are the side effects of gold compounds?

A

Rashes, flu like symptoms, mouth ulcers, blood disorders, encephalopathy, peripheral neuropathy & hepatitis

62
Q

What are the 2 types of anti-malarials?

A

Chloroquine/hydroxychloroquine

63
Q

How long do the therapeutic effects of antimalarials take?

A

A month

64
Q

What are the side effects of antimalarials?

A

Nausea, dizziness, blurred vision

65
Q

What drugs are restricted to those who don’t respond well to DMARDS?

A

Anticytokine

66
Q

What are some examples of Anticytokine drugs?

A 
Adalimumab
Etenercept
Infliximab
Rituximab
Abatacept
Natalizumab
Tocilizumab
67
Q

How are anticytokines administered?

A

Sub cut or I.V

68
Q

What are some side effects of anticytokine drugs?

A 
Latent diseases (TB, Hep B)
Opportunistic infection
Nausea
Abdominal pain
Hypersensitivity
69
Q

What type of drug is ciclosporin?

A

Immunosuppressant

70
Q

What does cilcosporin have no effect on?

A

Acute inflammation

71
Q

What are the side effects of ciclosporin?

A 
Nephrotoxicity
Hepatotoxicity
Hypertension
Nausea
Gum Hypertrophy
GI issues
72
Q

What type of drug is Azathioprine?

A

Immunosuppressant

73
Q

How does azathioprine work?

A

Interfere with purine metabolism and decrease DNA synthesis

74
Q

What is the main effect of azathioprine?

A

Suppression of bone marrow

75
Q

What type of drug is methotrexate?

A

Immunosuppressant

76
Q

What is methotrexate often prescribed with?

A

DMARDs

77
Q

What are the side effects of methotrexate?

A

Blood abnormalities
Liver Cirrhosis
Folate deficiency

78
Q

What type of drug is Leflunomide?

A

Immunosuppressant

79
Q

What are the side effects of Leflunomide?

A

Diarrhoea, alopecia, increased liver enzymes

80
Q

What type of drug is cyclophosphamide?

A

Immunosuppressant

81
Q

Immunosuppressants and what other type of drug increases risk of cancer and infection?

A

Glucocorticoids

Pharmacology (7 decks)

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