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Pharmacology of Arthritis Flashcards

Dr S Silburn (60 cards)

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1
Q

name the medications used in arthritis

A

Analgesics e.g. paracetamol, opiates

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

Disease Modifying Anti-Rheumatic Drugs (DMARDs)

Biologics

Gout therapy

Corticosteroids

Special circumstances

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2
Q

what medication is under step 1 in pain control of arthritis?

A

non-opioid - aspirin, paracetamol or NSAID

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3
Q

what medication is under step 2 in pain control of arthritis?

A

weak opioid - codeine

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4
Q

what medication is under step 3 in pain control of arthritis?

A

strong opioid - morphine

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5
Q

give some examples of NSAIDs

A 
Ibuprofen
Naproxen
Diclofenac
Indometacin 
Etodolac
Celecoxib (Cox 2 inhibitor)
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6
Q

what are the indications you should prescribe a NSAID?

A

inflammatory arthritis
MSK pain
pleuritic/pericardial pain

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7
Q

what are the adverse effects in the use of NSAIDs?

A 
Dyspepsia
Oesophagitis
Gastritis
Peptic Ulcer
Small/large bowel ulceration

Renal impairment
Increased cardiovascular events (Cox 2 inhibitors + others)
Fluid retention
Wheeze
Rash
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8
Q

what is DMARDs short for?

A

Disease modifying anti-rheumatic drugs

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9
Q

DMARDs are ____ acting

A

slow acting - weeks to months

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10
Q

DMARDs are pure anti-inflammatories with no direct analgesic effect

true or false?

A

true

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11
Q

DMARDs require _______ _________ for adverse effects

A

regular monitoring

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12
Q

what are the 2 DMARDs of choice in RA?

A

MTX and sulfasalazine

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13
Q

what are the commonly used DMARDs? (4)

A

Methotrexate
Sulphasalazine
Leflunomide
Hydroxychloroquine

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14
Q

MTX is a ______ antagonist

A

folate

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15
Q

what 4 things do you use MTX for?

A

RA, psoriatic arthritis, connective tissue disease, vasculitis

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16
Q

what are the adverse effects of MTX?

A

Leucopenia / thrombocytopenia

Hepatitis / cirrhosis

Pneumonitis

Rash / mouth ulcers

Nausea / diarrhoea

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17
Q

what must be limited when taking MTX?

A

alcohol intake

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18
Q

what needs monitoring with MTX?

A

FBCs and LFTs

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19
Q

when must MTX be stopped?

A

Must be stopped in males and females at least 3 months before conception and throughout pregnancy

TERATOGENIC

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20
Q

Leflunomide is similar to MTX but has a very short half life

true or false?

A

false

leflunomide - very long half life, so requires wash out

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21
Q

when is sulfasalazine used in combination with MTX?

A

in early inflammatory arthritis

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22
Q

what are the adverse effects of sulfasalazine?

A 
Nausea
Rash / mouth ulcers
Neutropenia
Hepatitis
Reversible oligozoospermia
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23
Q

what requires monitoring when taking sulfasalazine?

A

FBC and LFTs

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24
Q

does Hydroxychloroquine have an effect on joint damage?

A

no

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25
when is HCQ used?
connective tissue disease such as SLE (helps skin, joints and general malaise) Sjogren’s syndrome and RA
26
what is the recognised but rare side effect of HCQ?
retinopathy
27
what is the other name given to sodium aurothiomalate?
gold
28
ow is the gold given?
IM
29
what are the adverse effects of gold?
bone marrow suppression, glomerulonephritis, rash , mouth ulcers
30
what must you monitor when prescribing gold? what are you looking for?
Monitor FBC plus urine for proteinuria.
31
name some targets for biologics use?
Tumour Necrosis factor (TNF) CD 20 B cells Interleukin 6 Interleukin 17, 12 and 23
32
Anti-TNF therapy is licensed for what 3 conditions?
RA | psoriatic arthritis ankylosing spondylitis
33
Anti-TNF is more effective in combination with what?
DMARDs
34
how is Anti-TNF given?
sub-cutaneously
35
how much do DMARDs cost?
£10000 pa
36
name some anti-TNF drugs (6)
Etanercept Adalimumab Certolizumab Infliximab Golimumab Biosimilars: Benepali
37
when must you only prescribe anti-TNF?
high disease activity score - DAS28 use of previous standard DMARDs
38
what are the adverse effects of anti-TNF?
risk of infection - TB | malignancy - skin cancer
39
when is Anti-TNF contraindicated?
pulmonary fibrosis | heart failure
40
rituximab is a biologic against...
monoclonal antibody against B (CD20) lymphocytes
41
Tocilizumab inhibits...
IL-6
42
Abatacept blocks what?
CTLA-4 Ig -blocks full activation of T lymphocytes
43
Ustekinumab inhibits...
inhibits IL12 and IL23
44
Secukinimab inhibits...
IL17
45
Tofacitinib/baricitinib inhibits...
Janus kinase
46
name the 2 components to treatment of gout?
acute episode | prophylaxis
47
what drugs are used in the treatment of an acute episode of gout? (3)
Colchicine NSAIDs Steroids, either oral or IM
48
what is the common side effect of colchicine?
diarrhoea
49
what drugs are used in the prophylaxis of gout? (3)
Allopurinol Febuxostat Uricosurics
50
what do Allopurinol, Febuxostat and Uricosurics lower?
urate
51
Allopurinol is a ________ _______ inhibitor
Xanthine oxidase
52
what are the adverse effects of allopurinol?
rash - vasculitis (commoner in elderly and renal impairment) marrow aplasia
53
what other drug does allopurinol interact with?
azathioprine
54
what is the other drug that is also a xanthine oxidase inhibitor that you use in those who cannot tolerate allopurinol?
febuxostat
55
you must use febuxostat with caution in those with ________ _____ disease
ischaemic heart disease
56
name the uricosuric drugs used in gout
Probenecid Sulphinpyrazone Azapropazone Benzbromarone
57
what conditions indicate the use of corticosteroids? (4)
Connective tissue disease Polymyalgia rheumatica / giant cell arteritis Vasculitis Rheumatoid arthritis
58
what are the modes of administration in corticosteroids?
``` Oral Intra-articular Soft tissue injections Intramuscular Intravenous ```
59
what are the adverse effects of corticosteroid use?
``` Weight gain - centripetal obesity Muscle wasting Skin atrophy Osteoporosis Diabetes Hypertension ``` ``` Cataract Glaucoma Fluid retention Adrenal Suppression Immunosuppression Avascular necrosis of the femoral head ```
60
whats the difference between 3 penises and a joke?
your mum can't take a joke

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