Drugs And Arthritis Flashcards
(148 cards)
0
Q
Celecoxib is an example of a COX2 inhibitor, true or false
A
True
1
Q
Influximab, etenercept and rituximab are examples of anticytokines, true or false
A
True
2
Q
The enzyme COX2 produces prostaglandins that are involved in the production of mucous, true or false
A
False
3
Q
Sulfasalazine is an example of a DMARD, true or false
A
True
4
Q
Methotrexate is a cytotoxic folic acid agonist, true or false
A
False
5
Q
Paracetamol has no antipyretic effect, but does have analgesic and anti inflammatory, true or false
A
False
6
Q
Side effects of steroid include:
- Osteoporosis
- Decreased risk of infection
- Suppression of normal steroid synthesis due to excessive negative feedback which may precipitate acute adrenal failure
A
1 and 3
7
Q
NSAIDs have pyretic actions, true or false
A
False
8
Q
NSAIDs have analgesic actions, true or false
A
True
9
Q
Misoprostol is a synthetic PG given alongside NSAIDs, true or false
A
True
10
Q
NSAIDs have anti inflammatory actions by increasing vasodilation and increasing permeability of venules, true or false
A
False
11
Q
What does ‘itis’ mean?
A
Inflammation
12
Q
Which disease affects synovial joints?
A
Osteoarthritis
13
Q
Where does osteoarthritis commonly occur
A
Knee, shoulder, wrist, ankle, finger
14
Q
What is secreted by the synovium and is responsible for the breakdown of collagen
A
Matrix metalloprotinases
15
Q
Obesity, gender (female), age (>40), previous joint injury and genetics are all risk factors for which disease?
A
Osteoarthritis
16
Q
Which disease causes joint inflammation, especially in the synovial membrane, tendon sheath and bursae
A
Rheumatoid arthritis
17
Q
What causes the following symptoms?
Swollen joints, morning stiffness (>30mins), pain
A
Rheumatoid arthritis
18
Q
Which disease affects joints bilaterally
A
Rheumatoid arthritis
19
Q
Which disease is an autoimmune disorder, antibodies are produced against the cartilage causing it to breakdown
A
Rheumatoid arthritis
20
Q
Which disease is 3 times more common in women
A
Rheumatoid arthritis
21
Q
RA affects joints, but where else can it effect
A
Other tissues, salivary glands, heart
22
Q
What is an eicosanoid and consists of 20 carbon atoms
A
Arachnid onion acid
23
Q
What is arachidonic acid derived from
A
Linoleic acid (found in veg oils, nut oils and butter)
24
What does phospholipase A2 (PLA2) do?
Strips arachidonic acid away from the cell membrane
25
What strips arachidonic acid away from the cell membrane
Phospholipase A2
26
Arachidonic acid is a sub straight for which enzyme
COX
27
COX causes arachidonic acid to be broken down into what?
Prostaglandins, thromboxanes, macrophages
28
When arachidonic acid is broken down by COX it potentials the effects of histamine and bradykinin - what does this do?
Increases permeability of venules - leading to oedema
| Increases sensitivity of C fibres (chronic dull pain)
29
Which COX enzyme is expressed in most tissues all the time?
COX1
30
Which COX enzyme protects GI mucosa
COX 1
31
Which COX enzyme controls renal blood flow?
COX1
32
Which COX enzyme is found in inflammatory cells, induced by injury, infection and cytokines
COX2
33
Which COX enzyme produces inflammatory mediators
COX2
34
What catalyses the reaction: arachidonic acid --> PGs and Txs
All COX enzymes
35
Where is COX3 found?
The CNS of some species
36
What inhibits the COX enzymes, decreasing production of PGs, decreasing production of inflammatory mediators and decreasing inflammation
NSAIDs
37
True or false, meloxicam is an NSAID
True
38
What type of drug is indomethacin
NSAID
39
What are NSAIDs derived from
Salaclic acid
40
Which NSAID is derived from propyonic acid
Ibuprofen
41
True or false, NSAIDs have antipyretic, analgesic and anti inflammatory effects
True
42
How do NSAIDs have an analgesic effect?
Reduce the sensitivity of neurons to bradykinin
43
NSAIDs are effective against pain of what origin?
Muscular/skeletal
44
How do NSAIDs have an antipyretic effect?
Inhibit the actions of prostaglandins on the hypothalamus
45
Which drugs only suppress the signs and symptoms of inflammation
NSAIDs
46
Which drug inhibits NFkB expression, decreasing transcription of genes for inflammatory mediators
Aspirin
47
Which drugs may induce asthma attack in asthmatics, cause angioedema, urticaria or rhinitis?
NSAIDs
48
Who are NSAIDs contraindicated for?
Elderly
Patients with cardiac disease/hypertension
49
Which NSAID has COX2 selectivity
Meloxicam
50
COX2 inhibitory NSAIDs; celecoxib and etoricoxib are used mainly in which patients
Patients at high risk of serious GI side effects, but little CV risk
51
What are the common side effects of COX2 inhibitory NSAIDs celecoxib and etoricoxib
Headache, dizziness, skin rash, peripheral oedema
52
Is paracetamol an NSAID
No
53
Why is misoprostol given alongside NSAIDs
Preserves the mucous lining of the GI tract by increasing production of mucous and blocking the acid pump
54
What are some side effects of misoprostol
Diarrhoea
Vaginal bleeding
55
Is misoprostol indicated for pregnant women?
No, it stimulates uterine contractions
56
What can be given as an alternative to misoprostol (synthetic prostaglandin) alongside NSAIDs?
Proton pump inhibitor eg. Omeprazole
57
Can aspirin be used in patients who are taking warfarin
No, aspirin displaces the warfarin bound to plasma cells, therefore potentials warfarins anticoagulant activity
58
Does paracetamol have an anti inflammatory effect
No
59
What is a toxic dose of paracetamol?
10-15g
60
What disease might a patient be taking strontium ranelate for
Osteoarthritis
61
What does the drug strontium ranelate do?
Promote osteoblast differentiation/inhibit osteoclast activity
62
Why is strontium ranelate restricted to the treatment of severe osteoarthritis?
It increases risk of MI and thrombotic events
63
What do osteoclasts do?
Strip calcium from the bone
64
Where are glucocorticoids naturally produced in the body?
Adrenal cortex
65
What pain relief is recommended for rheumatoid arthritis?
NSAIDs or opioid analgesics
66
What hormone is released from the hypothalamus during steroid synthesis
Corticotropin releasing hormone
67
Which hormone is released from the anterior pituitary and acts on the adrenal cortex during steroid synthesis
Adrenocorticotropin hormone
68
Which two steroids are naturally produced by the adrenal cortex
Cortisone
| Hydrocortisone
69
Which natural steroid only shows mineralocorticoid actions
Aldosterone
70
Hydrocortisone and cortisone are natural steroids, do they exhibit glucocorticoid actions, mineralocorticoid actions or both
Both
71
Overstimulation of mineralocorticoid receptors by cortisone/hydrocortisone would cause
Severe hypertension
72
Hydrocortisone/cortisone have mineralocorticoid properties, these can be inactivated by enzymes in MC sensitive tissues, where might these be found
Kidney
73
Which synthetic steroid has mainly mineralocorticoid actions
Fludrocortisone
74
Which steroid, with mainly mineralocorticoid activity, might be used to treat Addison's disease
Fludrocortisone
75
What type of steroid activity does Fludrocortisone have
Mineralocorticoid
76
Dexamethasone, betamethasone, beclomethasone and budesonide are all steroids with which type of activity
Glucocorticoid
77
Which two steroids exhibit mixed glucocorticoid and mineralocorticoid activity
Prednisolone
| Prednisone
78
Prednisone and prednisolone and steroids which have which type of activity
Mixed glucocorticoid and mineralocorticoid activity
79
Which two steroids are short acting
Cortisone
| Hydrocortisone
80
How would you administer cortisone
Twice daily cream or intra-Articular injection
81
How is hydrocortisone administered
Twice daily cream
Intra articular injection
82
Which steroid is intermediate acting?
Prednisolone
83
What is the duration of action of prednisolone
Intermediate acting
84
How is prednisolone administered
Daily oral or intra articular injection
85
Which steroid is long acting
Dexamethasone
86
What is the route of administration of Dexamethasone
Intra articular injection every 3-21 days
87
True or false, steroids are lipid soluble
True
88
What has anti inflammatory and immunosuppressant actions in rheumatoid arthritis
Glucocorticoids
89
Glucocorticoids have immunosuppressant actions in rheumatoid arthritis, how?
Decrease transcription do cytokines (eg. IL-2)
90
Glucocorticoids have anti inflammatory actions in rheumatoid arthritis, how?
Increase synthesis of anti inflammatory proteins (eg. Protease inhibitors)
91
Which glucocorticoids are used in the treatment of asthma and arthritis
Beclomethasone
Budesonide
Prednisolone
92
True or false, hypotension a cushingoid feature is a common side effect of oral corticosteroids
False, hypertension is a cushingoid feature
93
Which of the following is not a cushingoid feature seen as a result of taking oral corticosteroids
Buffalo hump Increased abdo fat
Muscle wastage Moon face
Osteoporosis Good wound healing
Poor wound healing Increased infection risk
Good wound healing
94
How can you reduce the side effects associated with oral corticosteroids
Choose a different route of admin to decrease systemic concerntration
Eg. Topical
95
Why must patients who have been taking steroid treatment not stop suddenly
Synthetic steroids inhibit natural production of steroids, could cause Addison's crisis
96
Sulfasalazine, penicillamine and aurothiomalate are all types of what drugs
DMARDs disease modifying anti rheumatoid drugs
97
Which drug is the common 1st drug of choice DMARD in the uk
Sulfasalazine
98
What is the route of administration of sulfasalazine
Enteric coated tablet
99
Which DMARD causes the side effects GI upset, headache, skin reactions and leukopenia
Sulfasalazine
100
Which DMARD is a complex of salicylate (NSAID) and sulphonamide (abx)
Sulfasalazine
101
How does the DMARD sulfasalazine work
Scavengers free radicals (which cause damage to joints) produced by neutrophils
102
How is the DMARD penicillamine administered
Orally
103
When is the peak plasma concerntration of the DMARD penicillamine
1-2 hours
104
Can penicillamine be used in conjunction with sodium aurothiomalate
No, cannot be used with gold compounds as it is a metal chelator, it combines with the metal and reduces its activity
105
Which DMARD produces the following side effects
| Rashes, stomatitis, anorexia, taste disturbances, fever, n&v
Penicillamine
106
Which DMARD works by decreasing IL-1 generation, decreasing fibroblast proliferation and decreasing the immune response
Penicillamine
107
How is the DMARD sodium aurothiomalate administered
Deep IM injection
108
How is the DMARD auranofin administered
Orally
109
What are the serious side effects associated with the use of gold compounds for treating rheumatoid arthritis
Encephalopathy
Peripheral neuropathy
Hepatitis
110
How long does it take for the effects of aurothiomalate to work
3-4 months
111
Which DMARD is often used when other treatments fail
Anti malarials (chloroquine/hydroxychloroquine)
112
Which DMARDs have side effects which include n&v, dizziness and blurring of vision
Chloroquine/hydroxychloroquine
113
How long does it take for the therapeutic effects of chloroquine to work in rheumatoid arthritis
About 1 month
114
Anticytokines are proteins, how does this effect their administration
Cannot be given orally, as they would be digested
115
How are anticytokine drugs administered
Sub cut or IV injection
116
Which patients is he use of anticytokine drugs restricted to in rheumatoid arthritis
Those who don't respond well to other DMARDs
117
Which DMARDs are engineered recombinant antibodies
Anticytokine drugs
118
What type of drugs are the following; etenercept, infliximab, abatacept, adalimumab, natalizumab
Anti cytokines
119
How to the anticytokine drugs rutiximab, abatacept and natalizumab work
Target leukocyte receptors disrupting the immune signalling
120
Which anticytokine drugs target TNF
Adalimumab, etenercept, infliximab,
121
Which DMARDs can be given with methotrexate
Anti cytokines
122
Which DMARDs may cause the development of latent disease, for example TB, hep B, herpes zoster
Anticytokines
123
True or false, rheumatoid arthritis is an autoimmune disorder
True
124
Which drug is a potent immunosuppressant but has no effect on acute inflammation
Ciclosporin
125
Which immunosuppressant given to people with RA inhibits IL-2 gene transcription, decreasing T cell proliferation
Ciclosporin
126
How does the immunosuppressant ciclosporin work
Inhibits IL-2 gene transcription, decreasing T cell proliferation
127
Would ciclosporin be administered orally
No, it is poorly absorbed orally; capsules or oral solutions
128
Which drug can cause; nephrotoxicity, hepatotoxicity, hypertension, n&v, gum hypertrophy, GI problems
Ciclosporin
129
Why can ciclosporin cause toxic effects in the kidneys and liver
It accumulates in high concentration in tissues
130
Which immunosuppressant is cytotoxic, interfering with purine metabolism which decreases DNA synthesis
Azathioprine
131
Which phase of the immune response does azathioprine work at
The induction phase
132
What is the main specific effect of the drug azathioprine
Suppression of bone marrow
133
How does methotrexate work
Folic acid antagonist, which inhibits DNA synthesis
134
Which cells does methotrexate target
Blocks the growth and differentiation of rapidly dividing cells
135
Which drug is often prescribed with a DMARD
Methotrexate
136
Should methotrexate be used in pregnancy
No, can cause folate deficiency
137
Which immunosuppressant is a specific inhibitor of activated T cells
Leflunomide
138
What is the route of administration of leflunomide
Oral, long half life
139
Which immunosuppressant has side effects including, diarrhoea, alopecia, increase in liver enzymes (risk of hepatotoxicity)
Leflunomide
140
Which drugs side effects include blood dyscrasias (abnormalities) and liver cirrhosis and folate deficiency
Methotrexate
141
When is cyclophosphamide used to treat RA
When all other therapies have failed
142
Which immunosuppressant used to treat RA is a pro drug
Cyclophosphamide
143
When the immunosuppressant cyclophosphamide is administered orally it is activated in the liver to what
Phosphoramide mustard and acrolein
144
The pro drug cyclophosphamide is activated in the liver to phosphoramide mustard and acrolein, what can acrolein caus
Haemorrhagic cystitis (bleeding from the kidney) can be prevented by administering with very large volumes of fluid
145
True or false, glucocorticosteroids and other immunosuppressants increase the risk of infection and increase risk of cancer
True
146
In the treatment of RA how effective is hydroxychloroquine, and what else might this drug be used for
50% effective, antimalarial
147
What type of drug is etenercept, how is it usually administered
Anticytokine, subcut Twice a week
