Applied Pharmacology - Arthritis Drugs

Question 1

What are the risk factors for osteoarthritis? (5)

Answer 1

Obesity
Age >40
Female sex
Previous joint injury
Genetics

Question 2

What do prostaglandins do?

Answer 2

Increase power of histamine and bradykinin

Question 3

Which COX enzyme is common in most tissues?

Answer 3

COX 1

Question 4

What induces COX 2? (3)

Answer 4

Injury, infection, cytokines

Question 5

Name 5 NSAIDs

Answer 5

Aspirin
Ibuprofen
Diclofenac
Meloxicam
Indomethacin

Question 6

What actions do NSAIDs have? (4)

Answer 6

Antipyretic
Analgesic
Anti-inflammatory
May scavenge free radicals

Question 7

What are the adverse effects of NSAIDs

Answer 7

Gastric problems
Impair coagulation
Risk of CV events

Question 8

Name a COX 2 selective drug

Answer 8

Meloxicam

Question 9

Who are celecoxib and etoricoxib prescribed to?

Answer 9

Patients at high risk of gastric ulcers

Question 10

What are the side effects of celecoxib and etoricoxib? (4)

Answer 10

Headache
Rash
Peripheral Oedema
Dizziness

Question 11

Name a synthetic prostaglandin

Answer 11

Misoprostol

Question 12

What is the purpose of giving misprostol with arthritis meds?

Answer 12

Preserve GI tract

Question 13

Side effects of misprostol? (2)

Answer 13

Diarrhoea, vaginal bleeding

Question 14

Who should precautions be taken with when giving misprostol?

Answer 14

Women of childbearing age

Question 15

What are the effects of paracetomol? (4)

Answer 15

Antipyretic
Analgesic
Decreases prostaglandin production
May involve COX-3

Question 16

What are the risks of large paracetomol doses?

Answer 16

Kidney damage

Liver damage

Question 17

Name 4 treatments for osteoarthritis that aren’t drugs

Answer 17

Exercise
Weight loss
TENs machine
Suitable Footwear

Question 18

What other treatments are there for OA? (4)

Answer 18

Topical NSAIDs
Paracetomol
Opioids
Steroid injections

Question 19

What does strontium ranelate do? (3)

Answer 19

Promotes osteoblast activity
Reduces osteoclast activity
Prevents fractures

Question 20

What risks does stronium ranelate carry? (2)

Answer 20

Increases risk of MI

Increases risk of thrombotic events

Question 21

Name 4 glucocorticoids

Answer 21

Dexamethasone
Beclomethasone
Betamethasone
Budesonide

Question 22

Name a mineralocorticoid

Answer 22

Fludrocortisone

Question 23

Name 2 short acting steroids

Answer 23

Cortisone

Hydrocortisone

Question 24

Name an intermediate acting steroid

Answer 24

Prednisolone

Question 25

Name a long acting steroid

Answer 25

Dexamethasone

Question 26

How are short acting steroids administered?

Answer 26

Daily cream x 2 or intra-articular injection

Question 27

How are intermediate acting steroids administered?

Answer 27

Daily Oral tablet or intra-articular injection

Question 28

How are long acting steroids adminstered

Answer 28

intra-articular injection

Question 29

Describe 4 actions of glucocorticoids

Answer 29

Decrease transcription of cytokines Decrease circulating lymphocytes Decrease arachidonic-acid release Increase synthesis of anti-inflammatory proteins

Question 30

What does DMARD stand for?

Answer 30

Disease Modifying Anti-Rheumatic Drugs

Question 31

Name 3 DMARDs

Answer 31

Sulfasalazine Gold Compounds Penicillamine

Question 32

What are the effects of Sulfasalazine

Answer 32

Scavenges free radicals | Causes remission in active RA

Question 33

What are the side effects of Sulfasalazine? (4)

Answer 33

headache, skin reactions, leukopenia, GI disturbance

Question 34

How does penicillamine work?

Answer 34

Decreases fibroblast activity | Decreases immune response

Question 35

Side effects of penicillamine?

Answer 35

rashes, stomatitis, anorexia, taste disturbance,

Question 36

Name 2 Gold Compounds

Answer 36

Auranofin | Na Auranofin

Question 37

Side effects of gold compounds? (6)

Answer 37

Skin rash, flu, mouth ulcers, encephalopathy, peripheral neuropathy

Question 38

When are anti-malarials used in arthritis treatment?

Answer 38

As a last resort

Question 39

Name an anti-malarial

Answer 39

Chloroquine

Question 40

How do anti-malarials help in arthritis

Answer 40

Apoptosis of T lymphocytes, stops the destruction in joints

Question 41

What are the side effects of anti-malarials? (4)

Answer 41

Nausea, vomiting, dizziness, blurred vision

Question 42

Name 2 anti-cytokines

Answer 42

Adalimumab | Etenercept

Question 43

What are anti-cytokines?

Answer 43

Engineered anti-bodies,used as last resort

Question 44

Side effects of anti-cytokines?

Answer 44

Nausea, latent disease, oppurtunistic infection

Question 45

Name 5 immunosuppresants

Answer 45

``` Ciclosporin Azathioprine Methotrexate Leflunomide Cyclophosphamide ```

Question 46

How does ciclosporin work?

Answer 46

Reduces T cell proliferation

Question 47

Side effects of ciclosporin? (6)

Answer 47

Nephrotoxicity, Hepatotoxicity, HTN, nausea & vomiting, gum hypertrophy, GI problems

Question 48

How does azathioprine work?

Answer 48

INterferes with purine metabolism, decreasing DNA synthesis

Question 49

How does methotrexate work? (2)

Answer 49

Folic acid antagonist, inhibits DNA synthesis | Inhibits T cell activation

Question 50

Side effects of methotrexate? (3)

Answer 50

Blood dyscrasias, liver cirrhosis, folate deficiency

Question 51

How does leflunomide work?

Answer 51

Inhibits activated T cells

Question 52

What are the side effects of leflunomide? (3)

Answer 52

Diarrhoea, alopecia, increase liver enzymes >> risk of hepatotoxicity

Question 53

How does Cyclophosphamide work?

Answer 53

Liver activates to phosphoramide mustard and acrolein

Question 54

Side effects of cyclophosphamide? (2)

Answer 54

Increases Risk of infection, risk of cancer