Year 2 Arthritis drugs

Question 1

How does aspirin work?

Answer 1

Inhibits NFkB expression -> reducing inflammatory mediator gene transcription

Question 2

How do celecoxib, diclofenac and ibuprofen work?

Answer 2

Reduce IL-6 and TNF-a in SF

Question 3

Which drug has some COX2 selectivity?

Answer 3

Meloxicam

Question 4

Name COX2 inhibitors?

Answer 4

Celecoxib Etoricoxib

Question 5

When are celecoxib or etoricoxib given?

Answer 5

To patients with ^ risk of GI problems but little CV risk

Question 6

Common side effects of celecoxib and etoricoxib?

Answer 6

Headache, dizziness, skin rash, peripheral oedema

Question 7

How does paracetamol work?

Answer 7

-Supresses PG production - Involve COX3 in CNS

Question 8

How does strontium ranelate?

Answer 8

-^ osteoblack and decrease osteoclast -reduce pain - prevents fractures

Question 9

Strontium ranelate problems?

Answer 9

^ MI risk & thrombotic events

Question 10

What do glucocorticoid drugs do?

Answer 10

• metabolic effects - anti-inflammatory -immunosuppressive

Question 11

Which natural steroids show both MC&GC activities?

Answer 11

Hydrocortisone Corticosterone

Question 12

Which natural steroid shows only MC activities

Answer 12

Aldosterone

Question 13

Which synthetic steroids show both MC&GC activites?

Answer 13

Prednisolone Prednisone

Question 14

Which synthetic steroids show only GC activites?

Answer 14

Dexamethasone Betamethasone Beclomethasone Budesonide

Question 15

Which synthetic steroids show mainly MC activites?

Answer 15

Fludrocortisone

Question 16

What is fludrocortisone used for?

Answer 16

Addison’s disease (adrenal insufficiency)

Question 17

What is the most common 1st choice DMARD?

Answer 17

Sulfasalazine

Question 18

How does Sulfasalazine work? How is it given?

Answer 18

Collects free radicals. Enteric-coated tablet

Question 19

Side effects of Sulfasalazine?

Answer 19

GI upset, headache, skin reactions, leukopenia.

Question 20

How does penicillamine work? How is it given?

Answer 20

Reduce IL-1 generation & fibroblast proliferation. Orally.

Question 21

Side effects of penicillamine?

Answer 21

Rashes, stomatitis, anorexia, taste disturbance.

Question 22

How does gold compounds (sodium auronofin) work? Given?

Answer 22

Inhibits IL-1 + TNF-a. Reducing pain and swelling. Deep IM injection

Question 23

Side effects of gold compounds (sodium auronofin)?

Answer 23

Skin rashes, flu-like, mouth ulcers, blood disorders, encephalopathy, peripheral neuropathy& hepatitis..

Question 24

How do anti-malarials work?

Answer 24

^intracellular vacuoles interfering with antigen presenting. Apoptosis in T-lymphs.

Question 25

Side effects of anti-malarials?

Answer 25

N+V, dizziness, vision blurring.

Question 26

How do anticytokine drugs work?

Answer 26

-Engineered recombinant antibodies.

Question 27

What are these drugs, adalimumab, etenercept, infliximab? Targets?

Answer 27

Anticytokine drugs, TNF.

Question 28

What are these drugs Rituximab, Abatacept, Natalizumab? Targets?

Answer 28

Anticytokine drugs. Leukocyte Rs.

Question 29

What type of drug is tocilizumab? Target?

Answer 29

Anticytokine drug. Blocks IL-6 Rs.

Question 30

Side effects of anticytokine drugs?

Answer 30

Develop latent disease (TB, hep b). Infections, nausea, pain, worsening heart failure.

Question 31

What are the immunosuppressant's?

Answer 31

Ciclosporin Azathioprine Methotraxate Leflunomide Cyclophosphamide

Question 32

How does ciclosporin work?

Answer 32

Immunosuppressant but no effect on inflammation. Inhibits IL-2 gene transcription

Question 33

Side effects of ciclosporin?

Answer 33

Nephrotoxicity, hepatotoxicity, hypertension, n&v, gum hypertrophy, GI problems.

Question 34

How does azathioprine work?

Answer 34

Cytotoxic: interferes with purine metabolism, targets cells in induction phase of immune response. Suppresses bone marrow.

Question 35

How does methotrexate work?

Answer 35

Faster than others. Folic acid antagonist -\>inhibits DNA synthesis& T cell activation.

Question 36

Side effects of methotrexate?

Answer 36

Blood dyscrasias, liver cirrhosis, folate deficiency.

Question 37

How does leflunomide work?

Answer 37

Inhibits activated T cells. Orally.

Question 38

Leflunomide side effects?

Answer 38

Diarrhoea, alopecia, ^ liver enzymes.

Question 39

How does cyclophosphamide work?

Answer 39

Only used when others failed. Activated to phosphoramide mustard+acrolein.

Question 40

Misoprostol? When given? Effects? Side effects?

Answer 40

Synthetic PG. Given with NSAIDs. Protected GI tract, Diarrhoea. Abortions.

Question 41

Omeprazole

Answer 41

Proton pump inhibitor, reduce acid secretion.

Question 42

Gold compounds examples

Answer 42

Sodium autothiomalate, auranofin

Question 43

Anti-malarials examples

Answer 43

Chloroquine, hydroxychloroquine.

Question 44

What is glucosamine sulphate?

Answer 44

?benefit. Major constituent of ECM. No overall sig dif. X Nice.

Question 45

Matrix metalloproteinases degrade?

Answer 45

Type II collagen

Question 46

Cathepsin-B splits?

Answer 46

Aggrecan

Question 47

Blocking COX -\> Blocks ... & what result?

Answer 47

PGI2 increasing platelet aggregation.

Question 48

Prostaglandins cause?

Answer 48

Vasodilation

Question 49

Prostaglandins potentate effects of?

Answer 49

Histamine and bradykinin

Question 50

How are NSAIDs analgesic?

Answer 50

Reduce neuron sensitivity to bradykinin

Question 51

How are NSAIDs anti-inflam?

Answer 51

↓bradykinin -\> ↓ vasodilation -\> ↓venule permeability

Question 52

What (4) prevent further joint damage?

Answer 52

Glucocorticoids, immunosuppressants, DMARDs, anticytokines.

Question 53

What pro-inflam cytokines are expressed with joint destruction?

Answer 53

TNF, IL-1B, IL-6.

Question 54

What do macrophages secrete?

Answer 54

Cytokines (TNF and IL-1)

Question 55

What does TNF stimulate?

Answer 55

Fibroblasts

Question 56

What does IL-1 stimulate?

Answer 56

Osteoclasts

Question 57

What do fibroblasts do?

Answer 57

release matrix-degrading metalloproteinases

Question 58

Two ways anti-inflam/immune suppressants work

Answer 58

X phospholipase A2 -\> ↓arachidonic acid. & ↓pro-inflam cytokine transcript

Question 59

Card on steroids

Answer 59

\>1 month. Suppression of normal steroid synthesis, excessive neg feedback.