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AAI > Pharmacology - Arthritis > Flashcards

Pharmacology - Arthritis Flashcards

1
Q

Automimmune disease causes

A

-antibodies against self (loss of self-tolerance)
-lead to tissue damage
-genetic factors
-can be precipitated by:
pregnancy, infection, diet, env?

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2
Q

Osteoarthritis characteristics

A
  • cartilage loss
  • most commonly affects knees, hips and small hand joints
  • link to overweight/obesity
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3
Q

Pain in OA

A
  • worsened by movement
  • eased by rest
  • worse at the end of the day
  • knees, hands, spine, hips
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4
Q

OA treatment

A

Painkillers
Steroid injections
NSAID/COX2 inhibitors
Surgery

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5
Q

COX1 vs. COX 2

A

COX1: PG production in GIT
COX2: involved in inflammation

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6
Q

Intra-articular

A
  • corticosteroid injection into joints
  • when pain is moderate to severe
  • can casue cartilage loss and injury –> do NOT use long-term
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7
Q

Rheumatoid Arthritis

A

-chronic inflammatory disorder

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8
Q

Rheumatoid Arthritis signs and symptoms

A 
joint damage/swelling
muscle wastage
joint deformity
pain
stiffness
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9
Q

RA lab results

A
  • elevated WBCs
  • faster erythrocyte sedimentation rate (ESR)
  • anemia
  • rheumatoid factor (antibodies to lgG)
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10
Q

Epidemiological risk factors

A
  • age (peak at 65-75)
  • gender (before menopause age, more females)
  • post-partum
  • stress
  • genetic
  • smoking
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11
Q

Pain in RA

A
  • improves with movement
  • worse on waking
  • affect small joints
  • affect both sides of body (bilateral joints)
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12
Q

Rheumatoid disease

A
  • systemic disease
  • eyes (50%)
  • skin nodules
  • vasculitis
  • lungs
  • salivary glands (reduced)
  • pericarditis (inflammation of pericardium)
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13
Q

RA treatment

A

symptomatic relief:

  • analgesia to reduce need for NSAIDs
  • NSAIDs + PPI

slow progression:

  • DMARD
  • Steroids
  • Biologicals
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14
Q

DMARDs stand for?

A

Disease Modifying Anti Rheumatic Drugs

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15
Q

DMARDs for RA

A
  • ideally start within 3 months
  • toxic: increase gradually then reduce cautiously when symptoms are controlled
  • no analgesic effect but ease pain due to less inflammation
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16
Q

DMARDa therapy

A

first line:

  • combination therapy (methotrexate + 1 other)
  • monotherapy with rapid dose titration

slow onset of action

used with glucocorticoids until effetive

17
Q

DMARDs counselling

A
  • improvement may take a few months
  • measue LFTs, FBC and U&E levels before treatment
  • continue to monitor
  • toxicity: lower dose
  • inflammation: increase dose
18
Q

DMARDs examples

A

methotrexate
sulfasalazine
leflunomide
IM gold

19
Q

Methotrexate mechanism and side effects

A
  • dihydrofolate reductase inhibitor
  • immunosuppressant
  • dose individual to patient
  • take weekly NOT daily
  • folic acid supplements (does not negate methotrexate anti-inflammatory effect)
  • pregnant no
  • GIT effects
  • post-dose ‘flu’ (more common with oral)
20
Q

MTX Counselling

A
  • weekly dose
  • folic acid not same day as MTX
  • regular blood tests
  • report side effects
  • contraception
  • patient information book about MTX
  • injection: sharps bins, disposal
21
Q

MTX ADME

A
  • dec. metabolism andexcretion with age

- ADR with NSAIDs

22
Q

Sulphasalazine

A
  • immunosuppressant
  • onset: 6 weeks
  • initially 500mg/day, inc daily, max 2-3g/day in divided doses
  • GI intolerance (nausea)
  • discolouration of urine and contact lenses
23
Q

Leflunomide

A

-immunosuppressant

24
Q

Leflunomide ADR

A
  • GI side effects

- teratogenic (male also) +2 years after stopping, present in breast milk

25
Q

Steroids in RA

A
  • im, ia, iv
  • bridge between starting/switching DMARDs
  • rapid symptom control compared with DMARDs
26
Q

Biologicals

A

TNFα-Blockers

  • licensed for moderate to severe RA
  • can be in combination with MTX
27
Q

TNFα-Blocker examples

A
  • adalimumab (40 mg sc)
  • infliximab (3 mg/kg iv at 2, 6 then 8 weeks)
  • etanercept (25 mg sc twice weekly)
28
Q

Rituximab

A
  • monoclonal antibody against CD20 on B-cells (removes them)

- high risk of allergy –> give pre-medication (ex: steroid, antihistamine) before each infusion)

29
Q

Sarilumab

A

monoclonal antibody against IL-6 receptor

inadequate response / intolerance to 1 or more DMARDs

30
Q

Abatacept

A

-prevent binding B7 protein and CD28 –> activation of T cells

not cost-effective –> not recommended by NICE

31
Q

Anakinra

A

Interleukin-1 inhibitors

low efficacy–> rejected by NICE

32
Q

Tofacitinib

A

Janus Kinase inhibitor

Janus kinase involved in cytokine signalling and gene transcription

rejected by NICE unless company reduce price

AAI (13 decks)

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