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Pharmacology (5th year) > Arthritis > Flashcards

Flashcards in Arthritis Deck (34):
1

Features of rheumatoid arthritis`

>4 features for at least 6 weeks
- morning stiffness
- arthritis in >3 joint areas
- arthritis of hand joints
- symmetric arthritis
- rheumatoid nodules
- serum rheumatoid factor
- radiographic changes

2

Features of osteoarthritis

- advanced age
- different joints affected
- synovial fluid less active
- radiological features
- typical patterns of presentation

3

Features of acute gouty arthritis

- painful inflamed single joint
- synovial fluid analysis shows negative bifringement needles
- complete resolution of symptoms between attacks

4

How to choose therapy for RA

- level of disease
- stage of therapy
- regulatory restricrtions
- patient preference

5

Non-selective NSAIDS for symptomatic relief

- Ibuprofen
- Indomethacin
- Naproxen

6

Cox-2 selective NSAID

Celecoxib

7

Weak opioids

- codeine phosphate
- tramadol

8

Strong opioids

- pethidine
- morphine

9

How do glucocorticosteroids work as anti-inflammatories?

- increase neutrophils
- decrease lymphs, monos, eosino, and basos
- inhibit tissue macrophages
- inhibit phospholipase A2
- suppress mast cell degranulation
- decrease histamine release

10

Adverse effects of steroids

- neuropathy
- hypertension
- osteoporosis
- diabetes
- immunosuppression
- cataracts
- mood disturbance

11

How many intra-articular steroid injections per year max?

4

12

Intra-articular steroid preparations

- methylprednisone
- betamethasone
- dexamethasone

13

DMARDS for RA

- methotrexate
- chloroquine
- sulfasalazine
- azathioprine
- cyclosporine
- TNF a blocking agents

14

MOA of methotrexate

Inhibitrs the activity of key enzymes
- interferes with carbon metabolism, purine and pyrimidine synthesis
- leads to increased adenosine release

15

Contraindications for methotrexate

- pre-existing blood dyscrasias
- existing renal or hepatic disease
- previous or existing herpes/varicella
- serous effusion
- pregnancy or lactation

16

Adverse effects of methotrexate

- BM suppression
- mucosal ulceration
- hepatotoxicity
- dermatological (alopecia, skin rashes)
- nephropathy
- hyperuricaemia
- headaches, drowsiness,

17

Other instructions for patients taking methotrexate

- take folic acid supplementation
- avoid live virus vaccines
- family planning
- drug interactions with NSAIDS and anti-epileptics

18

Role of sulfasalazine in RA

- reduces radiological progression of RA
- use in conjunction with methotrexate

19

Adverse effects of sulfasalazine

- nausea and vomiting, headache, rash
- haemolytic anaemia
- methaemoglobinaemia

20

Adverse effects of chloroquine

- irreversible retinal damage
- haemolysis in G6PD def

21

Drug treatment of OA

- paracetamol
- NSAIDS
- adjuvants
- intra-articular steroids
- weak opioids

22

Non-drug treatment of OA

- physio
- exercise
- weight loss
- assistive devices
- braces and insoles
- surgery

23

Management of acute gouty attack

- NSAIDS
- Colchicine
- corticosteroids

24

Treatment of intercritical period in gout

- xanthine oxidas inhibitors
- probenecid (improve uric acid excretion

25

MOA of colchicine

Anti-inflammatory:
- binds intracellular tubulin, inhibiting leukocyte migration
- inhibition of leukotriene B4

26

Common AE of colchicine

- diarrhoea
- NV
- abdo pain

27

Uncommon AE of colchicine

- alopecia
- hypersensitivity
- BM suppression
- myopathy

28

CI of colchicine

- renal impairment

29

When should allopurinol not be used

In an acute attack or within 4 weeks

30

Common adverse effects of allopurinol

- hypersensitivity reaction
- severe toxic syndrome in patients with renal impairment

31

Uncommon AE of allopurinol

- GI disturbance
- drowsiness
- headache
- BM suppression
- peripheral neuropathy
- arthralgia
- jaundice

32

MOA of probenecid

Prevents uric acid from entering the proximal renal tubule via the OAT1/OAT3 transporter
- increases urinary excretion of uric acid

33

CI of probenecid

- renal stones
- blood dyscrasias
- ineffective if GFR <50

34

Drug interactions with probenecid

- penicillin