Pharmacology of Arthritis Flashcards
(41 cards)
what is the ladder of pain management
- non-opioid (aspirin, paracetamol) +/- adjuvant
2. weak opiod for mild-moderate pain (+/- non opioid +/– adjuvant)
Indications for NSAID use
inflammatory arthritis
mechanical msk pain
pleuritic/pericardial pain
Do NSAIDS help cure inflammatory arthritis
No
just dampen down inflammation
side effects of NSAIDS
peptic ulceration
renal impairment
increased cardiovascular risk (if taken regularly over long period of time)
exacerbation of asthma
What is the best treatment choice for newly diagnosed rheumatoid arthritis
Methotrexate!!!!!! (first line DMARD)
Start on steroids at the same time to target inflammation
when should methotrexate be started
within 3 months of symptoms starting
what are biologic drugs
next step on for patients who dont respond to standard DMARD therapy
Limitations with DMARDS
slow acting - weeks to months
no pain relief- purely anti-inflammatory
when is the window of opportunity of intervention for inflammatory arthritis
EARLY to prevent loss of function, if u wait to long normal joint function can never be regained
some common DMARDS
methotrexate
sulfazalazine
leflunomide
hydroxychloroquine
when cant u use methotrexate
IN PREGNANCY
how is methotrexate given
oral or injection
methotrexate side effects
nausea pneumonitis leucopenia/thrombocytopenia hepatitis most ulcers/rasah
therefore needs to be monitored regularly
what is leflunomide
similar to methotrexate
main difference is long held life so required wash out
also tetragenic and needs washed out so avoided in women of child baring age
what are sulfasalazine adverts effects
nausea RASH neuropenia hepatitis reduced sperm count (reversible)
what does hydroxychoroquine do
no effect on joint damage
used more in connective tissue disease
what are biologic drugs
drugs designed to target specific aspects of the immune system found to be implicated in inflammatory arthritis
often first tine
targets for biologics
TNF
IL6
IL 17, 12 and 23
CD 20 B cells
what are more effective, DMARDS or biologics
biologics
only given to those who qualify, v expensive
What is Anti- TNF
biologic
v expensive
for RA, psoriatic arthritis and ankylosing spondylitis
how is anti-TNF given
subcutaneous injection
what does anti-TNF do
targets TNF which is a key cytokine in inflammation
who qualifies for anti-TNF
those with high disease activity
a high DAS28 score
use of 2 DMARDS which they’ve not responded to
what are some side effects of anti-TNF
increased infection risk
increased skin cancer risk
reactivation of latent TB
exacerbation of heart failure
