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MSK > Pharmacology of Arthritis > Flashcards

Pharmacology of Arthritis Flashcards

1
Q

What are the functions of NSAIDs?

A

Anti-inflammatory

Analgesic

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2
Q

What are examples of NSAIDs?

A 
Ibuprofen
Naproxen
Diclofenac
Indometacin
Etodolac
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3
Q

What are indications for NSAID use?

A

Inflammatory arthritis
Mechanical MSK pain
Pleuritic/ pericardial pain

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4
Q

What are some adverse effects of NSAIDs?

A 
Dyspepsia
Oesophagitis
Gastritis
Peptic ulcer
Small/ large bowel ulceration 
Renal impairement
Increased CV events
Fluid retention
Wheeze
Rash
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5
Q

When should a DMARD be used in inflammatory arthritis?

A

Within 3 months of symptom onset

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6
Q

Are DMARDs slow or fast acting?

A

Slow acting - weeks to months

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7
Q

What is the mode of DMARDs?

A

Pure anti-inflammatory with no direct analgesic effect

Modify the disease progression and reduce the rate of joint damage

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8
Q

What are the commonly used DMARDs?

A

Methotrexate
Sulphasalazine
Leflunomide
Hydroxychloroquine

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9
Q

What is the mode of action of methotrexate?

A

Folate antagonist

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10
Q

How can DMARDs be administered?

A

Orally

Subcutaneous

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11
Q

What is methotrexate used in?

A

RA
Psoriatic arthritis
CTD
Vasculitis

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12
Q

What are the adverse effects to methotrexate?

A 
Leucopenia/ thrombocytopenia
Hepatitis/ cirrhosis
Pneumonitis
Rash/ mouth ulcers
Nausea/ diarrhoea
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13
Q

What blood tests are required for methotrexate use?

A

FBC

LFTs

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14
Q

Can methotrexate be used in pregnancy?

A

No it is teratogenic

Must be stopped at least 3 months before conception in females AND males

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15
Q

Describe leflunomide?

A

Simliar efficacy and side effects to methotrexate

Also teratogenic but has a very long half life to wash out is required

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16
Q

When is sulfasalazine used?

A

Often used in combo with methotrexate in early inflammatory arthritis

17
Q

What are the adverse effects of DMARDs?

A 
Nausea
Rash/ mouth ulcers
Neutropenia
Hepatitis
Reversible oligozoospermia
18
Q

What monitoring needs to be done for patients on sulfasalazine?

A

FBC

LFTs

19
Q

What is the function of hydroxycholorquine?

A

No effect on joint damage

Used in CTD for skin, fatigue and joint pain

20
Q

In what conditions is hydroxychloroquine used?

A

SLE
Sjogren’s
RA

21
Q

What is a rare but serious adverse effect of hydroxychloroquine?

A

Retinopathy

22
Q

What are biologics?

A

Drugs designed to target specific aspects of the immune system found to be implicated in inflammatory arthritis

23
Q

What are common targets of biologics?

A

TNF
CD20 B cells
IL-6
IL-17, 12 and 23

24
Q

What is anti-tnf therapy licensed for?

A

RA
Psoriatic arthritis
Ankylosing spondylitis

25
Q

How is anti-tnf therapy administered?

A

Subcutaneous injection

26
Q

What are examples of anti-tnf therapies?

A

Etancercept

Infliximab

27
Q

In RA, who will qualify for anti-TNF therapy?

A

High disease DS28 score - 5.1 or higher

Use of previous DMARDs

28
Q

What are adverse effects of anti-TNF therapy?

A

RIsk of TB (always check for latent TB)
Increased risk of skin malignancy
Contraindicted in pulmonary fibrosiis and heart failure

29
Q

What drugs are used for the acute treatment of gout?

A

Colchicine
NSAIDs
Steroids - oral or IM

30
Q

What is a common adverse effect of colchicine?

A

Diarrhoea

31
Q

What drugs can be used for gout prophylaxis?

A

Allopurinol
Febuxostat
Uricosurics

32
Q

What is the mode of action of allopurinol?

A

Xanthine oxidase inhibitor

33
Q

What are the adverse effects of allopurinol?

A

Rash (vasculitis)

Azathioprine interaction causing marrow aplasia

34
Q

What is the mode of action and indication for febuxostat?

A

Xanthine oxidase inhibitor

Used in those who cannot tolerate allopurinol and those with renal impairment

35
Q

What are the indications of corticosteroid use in rheumatology?

A

CTDs
Polymyalgia rheumatica/ GCA
Vasculitis
RA

36
Q

How can corticosteroids be administered?

A 
PO
Intra-articular
Soft tissue injections
IM
IV
37
Q

What are the adverse effects of corticosteroids?

A 
Weight gain - centripetal 
Muscle wasting
Skin atrophy
Osteoporosis
Diabetes
Hypertension
Cataract
Glaucoma
Fluid retention
Adrenal suppression
Immunosuppression
AVN of femoral head
38
Q

How can you reduce corticosteroid toxicity?

A

Use lowest possible dose for as short a time as poss
Consider steroid sparing agents
Osteoporosis prophylaxis
Watch CV risk

MSK (34 decks)

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