Pharmacology of Arthritis

Question 1

Pure analgesics such as paracetamol, have what properties?

Answer 1

Analgesic
Little anti-inflam activity
Anti-pyretic

Question 2

What is co-codamol made with?

Answer 2

Codeine and paracetamol

Question 3

What type of drug is amitryptiline?

Answer 3

Anti-depressant

Question 4

What type of drug is Gabapentin?

Answer 4

Anti-convulsant

Question 5

Give some side effects of opiod drugs?

Answer 5

dizzy 
Nausea 
vomiting 
sleepy 
confused

Question 6

Give some side effects of long term opiod drug use?

Answer 6

constipation 
itching 
weight gain 
lack of sex drive 
reduced fertility 
erectile dysfunction 
irregular periods 
decreased ability to fight infection

Question 7

What is the effect of NSAID on inflammation?

Answer 7

Symptomatic relief of inflammation but does not decrease inflammation to where the disease actually stops

Question 8

Give some examples of NSAIDs?

Answer 8

Naproxen
Ibruprofen
Diclofenac

Question 9

List some side effects of NSAIDs.

Answer 9

dyspepsia and peptic ulcers 
oesophagitis 
gastritis 
small/ large bowel ulceration 
rash 
wheeze (avoid in asthmatics)
fluid retention

Question 10

What is DMARDs onset of action like?

Answer 10

Slow acting - weeks to months

Question 11

What should be given over the lag phase of DMARDs?

Answer 11

Steroids

Question 12

Do DMARDs show any analgesic effect?

Answer 12

No

Question 13

How quickly should patients who present with RA be started on DMARDs?

Answer 13

Aim for within 3 months of symptom onset - patients do not present at the onset of symptoms

Question 14

What should be given prior to starting DMARDs?

Answer 14

Vaccinations - flu & pneumococcal

Question 15

Are DMARDs normally started individually?

Answer 15

No, normally methotrexate an sulphasalazine are started together

Question 16

What does Methotrexate work as in the body?

Answer 16

folate antagonist

Question 17

How is MTX given?

Answer 17

Oral

Subcutaneously if GI SE of oral MTX

Question 18

What conditions is MTX used in?

Answer 18

RA
Psoriatic arthritis
CTD
Vasculitis

Question 19

Give some side effects of MTX.

Answer 19

Leucopenia/ thrombocytopenia
Hepatitis/ cirrhosis
rash and mouth ulcers
pneumonitis

Question 20

Is MTX teratogenic?

Answer 20

Yes, should be stopped in males and females at least 3 months before conception

Question 21

Are there any contraindications to giving MTX?

Answer 21

Pre-existing pulmonary fibrosis

Question 22

What is sulphasalazine made of?

Answer 22

Azo-ester of sulphapyridine and 5-aminosalicylic acid

Question 23

What is the main worrying SE of sulphasalazine?

Answer 23

Neutropenia

Question 24

When is hydroxychloroquin used?

Answer 24

CTD
SLE
Sjogren’s syndrome
RA

Question 25

What should HCQ be avoided in?

Answer 25

psoriatic arthritis

Question 26

Why should azathioprine never be used with allopurinol?

Answer 26

Irreversible agranulocytosis occurs

Question 27

In the UK, currently what is Anti-TNF licensed for?

Answer 27

RA Psoriatic arthritis ankylosing spondylitis

Question 28

Are Anti-TNF drugs, more effective when used in combination with DMARDs or alone?

Answer 28

In combination with DMARDs