Arthritis Drugs Flashcards
(25 cards)
Name three NSAIDs
Aspirin
Ibuprofen
Diclofenac
Meloxicam
Indomethacin
What are the main actions of NSAIDs?
Antipyretic -inhibit actions of PGs on hypothalamus
Analgesic -reduce sensitivity of neurones to bradykinin. Effective against pain of muscular/skeletal origin
Anti-inflammatory -reduce vasodilation and permeability of venules
What are the complications associated with NSAIDs?
Risk of gastric ulcers
Impaired coagulation
Risk of CV events in patients with cardiac disease or hypertension
May induce asthma attack, angioedema, urticaria (skin rash) or rhinitis
What is the main cause of the side effects associated with NSAIDs?
The inhibition of the COX1 enzyme as well as COX2, which produces prostaglandins involved in many beneficial processes such as the production of GI mucus and platelet aggregation
Which NSAID has some COX2 selectivity and therefore has the least GI effects?
Meloxicam
Name the two most common COX2 inhibitors
Which patient group are these given to?
Celecoxib
Etoricoxib
Used mainly in patients at high risk of serious GI side effects but with little CV risk
Why is misoprostol given alongside NSAIDs?
It is a synthetic prostaglandin which inhibits gastric acid secretion and may stimulate increased mucus production, so it preserves the mucus lining and protects agains ulceration
How does aspirin interact with warfarin?
By displacing warfarin bound to plasma proteins (therefore activating it) which increases plasma warfarin and potentiates warfarin’ anticoagulant activity
Paracetamol is analgesic and antipyretic, why is it not classed as a NSAID?
It has no anti-inflammatory effect
It does not inhibit COX1 or COX2
What are the most commonly prescribed drugs for arthritis?
Non-steroidal anti-inflammatory drugs
In addition to medication, what treatments are used for osteoarthritis?
Exercise
Weight loss
Thermotherapy
Joint supports
Suitable footwear and pacing
Which drugs are used to treat osteoarthritis?
Paracetamol (possibly with an oral NSAID and proton pump inhibitor)
Topical NSAIDs or capsaicin
Opioid analgesic
Intra-articular corticosteroid injection
What treatments are used for rheumatoid arthritis?
NSAIDs /opioid analgesics
Glucocorticoids
Immunosuppressants
Disease modifying antirheumatic drugs
Anticytokines
In addition to drug therapy, how is rheumatoid arthritis managed?
Diet and complementary therapy (physiotherapy, occupational therapy)
Referral for surgery
When are glucocorticoids used in rheumatoid arthritis?
Short-term to mange flare-ups in patients with recent-onset or established disease
Long-term if other treatment options have failed
How are cortisone or hydrocortisone steroids administered and what is their duration of action?
Twice daily cream or intra-articular injection
Short acting (1-12 hours)
How is prednisolone administered and what is its duration of action?
Daily oral or intra-articular injection
Intermediate acting (12-36 hours)
How is dexamethasone administered and what is its duration of action?
Intra-articular injection every 3-21 days
Long acting (36-55 hours)
What are the actions of glucocorticoids that make them a suitable treatment for rheumatoid arthritis?
Anti-inflammatory and immunosuppressant actions:
Decrease transcription of pro-inflammatory cytokines
Decrease circulating lymphocytes
Inhibit phospholipase A2, which decreases the release of arachidonic acid
Increases synthesis of anti-inflammatory proteins
Which glucocorticoids are used to treat arthritis?
Beclomethasone
Budesonide
Prednisolone
What are the side-effects of oral corticosteroids?
Buffalo hump
Moon face
Hypertension
Increased abdominal fat
Thinning of skin
Increased risk of infection
Poor wound healing
Osteoporosis
Muscle wasting
Name the four main types of disease modifying antirheumatoid drugs
Sulfasalazine
Gold compounds
Penicillamine
Immunosuppressants
What are the side effects associated with ciclosporin?
Nephrotoxicity
Hepatotoxicity
Hypertension
Nausea and vomiting
Gum hypertrophy
GI problems
What are the main immunosuppressants used to treat rheumatoid arthritis?
Methotrexate
Ciclosporin
Azathioprine
Methotrexate
Leflunomide
Cyclophosphamide (only when other therapies have failed)
