Pharmacology of arthritis Flashcards
(27 cards)
What are some analgesics used in the treatment of arthritis?
Co-codamol Dihydrocodeine Tramadol Amitryptiline Gabapentin Paracetamol
What are features of NSAIDs?
Anti-inflammatory
Analgesic
Antipyretic
Antiplatelet (aspirin v others)
What are some examples of NSAIDs?
Aspirin Ibuprofen Naproxen Diclofenac Indometacin Etodolac Celecoxib
What are some of the adverse affects of NSAIDs?
Dyspepsia Oesophagitis Gastritis Peptic Ulcer Rash Wheeze Fluid retention
What are DMARDs?
Disease modifying anti-rheumatic drugs which are pure anti-inflammatorys with no direct analgesic effect
Most are slow acting (weeks) and need to be monitored carefully for side effects
What is the ideal time to get someone started on DMARDs in RA from onset of symptoms?
3 months
What precaution is undertaken to counter the immunosuppressant effect of DMARDs?
Vaccinations are given before starting the drugs
What are some examples of DMARDs?
Methotrexate
Sulphasalazine
Hydroxychloroquine
What is the first choice DMARD in most patients?
Methotrexate
What is methotrexate?
Folate antagonist
What conditions is methotrexate used in?
RA
Connective tissue disease
Psoriatic arthritis
Vasculitis
What are the adverse effects of methotrexate?
Leucopenia / thrombocytopenia Hepatitis / cirrhosis (alcohol intake must be limited) Pneumonitis Rash / mouth ulcers Nausea / diarrhoea Needs monitoring of FBCand LFTs Teratogenic
How long should patient on methotrexate wait after stopping the drug before conceiving?
3 months for both men and women
What is sulfasalazine?
An azo ester of sulfapyridine and 5-aminosalicylic acid
When is sulfasalazine used?
In combination with methotrexate in early inflammatory arthritis
As an alternative when a patient is trying to concieve
What are the adverse effects of sulfasalazine?
Nausea Rash / mouth ulcers Neutropenia Hepatitis Reversible oligozoospermia Monitoring of FBC and LFTs
When is hydroxychloroquine used?
Connective tissue disease
RA
What are some Anti-TNF drugs?
Infliximab (IV)
Etanercept
Adalimumab
Certolizumab
When are anti-TNF drugs used?
RA, psoriatic arthritis and ankylosing spondylitis if DMARDs have failed or cannot be tolerated
What is the most effective use of anti-TNF drugs?
In combination with DMARDs
When is the use of anti-TNF drugs contraindicated?
Pulmonary fibrosis
Heart failure
What are patients on anti-TNF drugs particularly at risk of?
Infection, especially TB
What are the criteria for use of anti-TNF?
High disease activity score
Use of previous standard DMARDs
Other than anti-TNF, give some other examples of biologic drugs.
Rituximab - monoclonal antibody against B (CD20) lymphocytes
Tocilizumab – inhibits Interleukin 6
Abatacept - CTLA-4 Ig -blocks full activation of T lymphocytes
Ustekinumab – Inhibits IL12 and IL23
