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Pharmacodynamics > Inflammatory Arthritis > Flashcards

Inflammatory Arthritis Flashcards

1
Q

What is a rheumatoid factor?

A

This is a protein which is produced by your immune system which can ATTACK healthy tissue too.

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2
Q

What substance levels increases during inflammation?

A 
ESR = Erthyocyte Sedation Rate
CRP = C - Reactive Protein
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3
Q

What does ESR measure?

A

The degree of inflammation in the joints.

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4
Q

What does seropositive mean?

A

Antibodies which are present in the blood which can help with identifying the disease.

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5
Q

What antibodies are released during the inflammation process ?

A

Anti - CCP

RF (rheumatoid factor)

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6
Q

How does synovial joint inflammation occur?

A

This is when the synovium membrane is inflammed due to overuse of the joint. The pain remains in one spot.

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7
Q

What is the synovium?

A

This is connective tissue which LINES the inside of thee joint capsule.

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8
Q

How much of the population does RA affect?

A

0.5 - 1% of the population.

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9
Q

How does cartilage destruction occur?

A

Occurs due to enzymatic action and granulation tissue.

This is known as FOCAL BONE EROSIONS.

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10
Q

What is ligament laxity?

A

This is when the ligaments are loose.

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11
Q

What does periarticular osteoporosis mean?

A

This is past inflammation around a certain joint.

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12
Q

Why is there an increase in synovial fluid?

A

Increased release of prostaglandins and leukotrienes.

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13
Q

What are the risk factors of rheumatoid arthritis?

A

Genetics
Gender = more common in women
Lifestyle = smoking // overweight
Infection

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14
Q

Why is smoking such a big issue in causing rheumatoid arthritis?

A

Causes loss of bone density FASTER.

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15
Q

What does the ACR // EULAR panel do?

A

Create criteria for determining arthritis.

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16
Q

What are the 4 main domains used in determining rheumatoid arthritis?

A

Joint Involvement
Duration of synovitis
Acute phase reactants
Serology

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17
Q

What does joint involvement mean in terms of domain 1?

A

Analyses the large // medium // small joints.

Analyses the number of joints.

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18
Q

What does duration of synovitis mean in terms of domain 2?

A

Usually 3 -6 months of synovitis means that they are a definite sufferer of rheumatoid arthritis.

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19
Q

What does acute phase reactants mean in terms of domain 3?

A

C - reactive protein and Erythrocyte sedimentation rate are inflammatory markers.
They are important mediators in the inflammatory process.

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20
Q

What does serology mean in terms of domain 4?

A

It is the study of blood serum.

Analysis of rheumatoid factors alongside anti - citrullinated protein antibody.

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21
Q

What are the current tests available in the clinic for RA?

A 
Rheumatoid factor
Anti - CCP antibodes 
ESR
CRP
DAS scores
Ultrasound // MRI // X - Rays
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22
Q

What is DAS?

A

Disease Activity Score - Rates the pain alongside tender joints and swollen levels.
Out of 28 due to 28 joints being assessed.
Score ranges from 2.0 to 10.0

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23
Q

What is the ‘safe’ score for DAS?

A

< 2.6 indicates remission.

24
Q

Which 2 substances in high quantity determine you have a severe case of RA?

A

Rheumatoid Factor

Anti - CCP antibodies.

25
Q

When a patient is in pain but breastfeeding too - what would the first treatment of choice be?

A

Ibuprofen // Diclofenac

26
Q

Give some examples of NSAIDS - non cox 2 selective ones.

A 
Ibuprofen 
Naproxen 
Diclofenac
Indomethacin 
Piroxicam
27
Q

Give some examples of NSAIDS - non cox 1 selective ones.

A

Celecoxib

Meloxicam

28
Q

Why is non cox - 2 selective ones better?

A

These are the MOST efficacious.

29
Q

What is used alongside cox - 2 inhibitor to ensure it is cost - effective?

A

Proton Pump - Inhibitor

30
Q

What happens when Cox - 2 pathways are targeted?

A

Anti - Inflammatory effects WITHOUT the GI side effects.

Leads to MORE thrombo - embolic events.

31
Q

What class of drugs is told to be avoided for patients at a higher risk of cardiac events?

A

Coxibs.

32
Q

What is the main cause of GI morbidity with NSAIDS?

A

Gastric Erosions // Ulcer

33
Q

What are the two main areas in the body where adverse effects of NSAIDS are felt?

A

GI tract

Renal

34
Q

What are the adverse effects experienced by NSAIDS in the GI tract?

A

Dyspepsia = Indigestion
Nausea
Vomiting
Haemorrhage

35
Q

What are the adverse effects experienced by NSAIDS in the renal area?

A

Renal Failure
Nephritis
Nephrotoxicity

36
Q

What is the main cause of adverse effects experienced by GI tract?

A

Increase mucosal blood flow

Inhibit gastric acid secretion

37
Q

What is the main cause of adverse effects experienced by the renal system?

A

Decreased creatinine clearance
Mediated vasodilation of renal medulla // glomeruli
Inhibition of prostaglandins and prostacyclin

38
Q

What are the other side effects of NSAIDS?

A

Bronchospasm
Skin Rash
Allergic reactions

39
Q

What is bronchospasm?

A

This is the SUDDEN contraction of the muscles in the walls of the bronchioles.

40
Q

What are the causes of other side effects of NSAIDS?

A

Hypersensitivity

41
Q

What is the name given to an x-ray where there is NO joint space?

A

Pencil and Cut deformity.

42
Q

What is the purpose of corticosteroids?

A

They try to control and relieve inflammation EARLIER on in the diagnosis of the disease.

43
Q

What is given as a follow - up medication if corticosteroids do not relieve the pain?

A

Methotrexate.

44
Q

What form of medication is methotrexate?

A

It is a DMARD = disease - modifying anti - rheumatic drugs.

45
Q

What is monotherapy?

A

This is when only ONE DMARD is used.

46
Q

What is combination therapy?

A

This is when 2 // more therapies are used together in order to give BETTER results.

47
Q

What pathways does DMARDS inhibit?

A

Inhibits quite important pathways in the body.

They inhibit the pyrimidine and purine metabolism.

48
Q

What is the purpose of leflunomide?

A

It is a clinically used pyrimidine inhibitor.

49
Q

What is the purpose of the drugs cyclosporin and tacrolimus?

A

This a drug used to deal with transplant rejection.

50
Q

Name some examples of DMARDS.

A

Methotrexate
Azathioprine
Sulphasalazine

51
Q

What is the mechanism of action of methotrexate?

A

INHIBITS the dihydrofolate reductase

52
Q

What are the adverse effects of methotrexate?

A

Bone Marrow toxicity
Hepatic toxicity
Pulmonary involvement
Mouth ulcers

53
Q

What do the drugs: ‘Anti - TNFa therapies // rituximab // t - cell modulators’ have in common?

A

They are all biological treatments = used for high disease activity.
However, they can be mentally debilitating on patients.

54
Q

What is the purpose of the Tumour Necrosis Factor?

A

Drives the inflammatory pathway.
It blocks the co-factors from being produced.
It’s also LESS likely to be rejected by the body.

55
Q

What drug in combination with TNF produces effective results?

A

Methotrexate

56
Q

What are the 3 anti - TNF (alpha) drugs widely available?

A

Infliximab
Ethanercept
Adalimumab

Pharmacodynamics (21 decks)

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