Pharmacology in Arthritis Flashcards Preview

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Flashcards in Pharmacology in Arthritis Deck (77):
1

Disease modifying drugs in arthritis

DMARDS, Biologics

2

DMARDS used in Arthritis?

Methotrexate
Sulfasalazine
Hydroxychloroquine

3

Biologics used in arthritis?

Anti-TNF
Rituximab
Tocilizumab

4

Name a pure analgesic

Paracetemol
(anti-pyretic, little anti-inflamm effect)

5

Analgesics

Co-codamol
Dihydrocodeine
Tramadol
Amitryptiline
Gabapentin

6

Properties of NSAIDS

Anti-inflammatory
Analgesic
Antipyretic
Antiplatelet

7

Adverse effects of NSAIDS?

Ulceration, oesophagitis, gastritis etc
Renal impairment
Increased cardiovascular events (Cox 2 inhibitors + others)
Fluid retention
Wheeze
Rash

8

Are DMARDS slow acting?

Yes (weeks - months)

9

Do DMARDS have any analgesic effect?

No! Purely anti-inflammatory
Improve standard laboratory tests of inflammation e.g.ESR, CRP
Reduce rate of joint damage

10

What kind of drug might improve standard laboratory tests of inflammation (e.g. ESR and CRP)

DMARDS

11

How quickly do you want to try and get someone with arthritis onto DMARDS?

Within 3 months of symptoms

12

Vaccines and DMARDS?

Vaccines should be given before DMARDS are started
-Live vaccines should not be given

13

DMARDS of choice?

Sulfasalazine, methotrexate
(remember DMARD combination therapy!! both together!!)
Make it intensive!

14

Methotrexate is an antagonist of what?

Folate

15

How can methotrexate be given?

Orally or subcutaneously

16

What is thrombocytopenia?

Deficiency of platelets, this can cause bleeding into tissues, bruising and slow blood clotting after injury

17

Adverse effects of methotrexate

TERATEGENIC (STOP 3MONTHS BEFORE
Myelotoxicity, fibrosing alveolitis
Leucopenia / thrombocytopenia
Hepatitis / cirrhosis (alcohol intake must be limited)
Pneumonitis
Rash / mouth ulcers
Nausea / diarrhoea
Needs monitoring of FBC and LFTs

18

Why should alcohol intake be limited when on methotrexate?

Methotrexate can cause cirrhosis/hepatitis

19

Why do you need to monitor LFTS and FBC when you're on methotrexate?

Methotrexate can cause cirrhosis/hepatitis, leucopania and thrombocytopenia (and others)

20

What is sulfasalazine?

An azo ester of sulfapyridine and 5-aminosalicylic acid

21

Which DMARD can cause neutropenia?

Sulfasalazine

22

Which DMARD can cause reversible oligozoospermia?

Sulfasalazine

23

Effects of Hydroxycloroquine

No effect on joint damage
Used in connective tissue diseases such as SLE (helps skin, joints and general malaise), Sjogrens and RA

24

Rare adverse effect of hydroxychloroquine?

Retinopathy

25

Name a DMARD which can help in SLE and its effects

Hydroxychloroquine (helps skin, joints and general malaise)

26

Side effects of sulfasalazine?

Oligospermia
Myelotoxicty, hepatotoxicity, hypersensitivity reactions
Nausea
Neutropania
Hepatitis
Rash/Mouth Ulcers

27

Anti-TNF that can be given intravenously?

Infliximab

28

Subcutaneous Anti-TNF therapies?

Etanercept
Adalimumab
Certolizumab
Golimumab

29

What can anti-TNF therapy be used in?

Rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis

30

Contra-indications to anti-TNF therapy?

Pulmonary fibrosis, heart failure

31

Co-codamol?

Analgesic

32

Dihydrocodeine?

Analgesic

33

Tramadol?

Analgesic

34

Amitryptiline?

Analgesic

35

Gabapentin?

Analgesic

36

Folate antagonist

Methotrexate

37

How is methotrexate administered?

Methotrexate can be administers orally or subcutaneously

38

What is methotrexate used in?

RA, psoriatic arthritis, connective tissue disease and vasculitis

39

Methotrexate side effects

Myelotoxicity, fibrosing alveolitis
TERATOGENIC
Leucopenia / thrombocytopenia
Hepatitis / cirrhosis (alcohol intake must be limited)
Pneumonitis
Rash / mouth ulcers
Nausea / diarrhoea
Needs monitoring of FBC
and LFTs

40

Side effects of sulfasalazine?

Nausea
Rash, mouth ulcers
Hepatitis
Neutropenia
Oligozoospermia

41

Side effect of anti-malarial drugs?

Retinopathy

42

Side effect of ciclosporin?

Nephrotoxicity, hypertension

43

Can NSAIDS cause renal impairment?

yesh

44

NSAID adverse effects

-gastric ulcers
-oesophagitis
-bowel ulceration
-dysphagia
-gastritis
-Renal impairment
-Increased cardiovascular events (Cox 2 inhibitors + others)
-Fluid retention
-Wheeze
-Rash

45

How do you make anti-TNF therapy more effective?

Give in combination with DMARDS

46

When is anti-TNF contraindicated?

Pulmonary fibrosis, heart failure

47

Ustekinumab?

IL12 and IL13 inhibitor

48

CTLA-4 Ig (blocks full activation of T cells)

Abatecept

49

What does abatacept do?

Blocks full activation of T cells
(CTLA-4)

50

Inhibits interleukin 6?

Tocilizumab

51

Monoclonal antibody against CD20?

Rituximab

52

Side effects of colchicine?

Diarrhoea and vomitting

53

Urate lowering drugs

Allopurinol
Febuxostat
Uricosurics

54

What do allopurinol and febuxostat do?

Stop the conversion of xanthine to uric acid
(allopurinol is a xanthine oxidase inhibitor)

55

Name a xanthine oxidase inhibitor?

Allopurinol

56

Why do you not prescribe allopurinol initially for acute attacks?

Rapid reductio in uric acid could result in exacerbation of gout. Always co-prescribe anti-inflammatory for the first couple of weeks

57

Which drug may inhibit warfarin metabolism?

Allopurinol

58

Which drug could cause marrow aplasia?

Allopurinol

59

Side effects of allopurinol?

Rash (commoner in elderly)
AZATHIOPRINE INTERACTION
May inhibit warfarin metabolism
Rarely, marrow aplasia

60

Which drug can allopurinol react with?

Azathioprine

61

When would you give febuxostat?

For someone who can't tolerate allopurinol

62

Which drug can you give if someone can't tolerate allopurinol?

Febuxostat

63

When is the rash from allopurinol more common?

In old people and people with renal impairment

64

Uricosurics

Probenecid
Sulphinpyrazone
Azapropazone
Benzbromarone

65

Metabolic effects of corticosteroids?

Salt and water retention
Increased gluconeogenesis
Increased hepatic glycogen deposition
Increased protein breakdown

66

Effects of corticosteroids on the eyes?

Glaucoma, cataratcs

67

Side effects of leflunomide

Leflunomide (DMARD)
-nausea, diarrhoea and mouth ulcers

68

Corticosteroids and adrenal suppression?

Corticosteroids can cause adrenal suppression

69

PTH

Squamous cell carcinoma

70

ACTH

Small cell

71

P63

Squamous cell

72

TTF-1

Small cell and adeoncarcinoma

73

Cavitates, central necrosis
Keratin

Squmaous cell carcinoma

74

Biologics for ankylosing spondylitis

IA
Infliximab
Adalimumab

75

Biologics for SLE

Rituximab
Belimumab

76

Biologics for psoriatic arthritis

Etanercept
Ustekinab

77

When is anti-TNF contraindicated?

Pulmonary fibrosis
Heart failure