Arthritis Drugs

Question 0

What is osteoarthritis characterised by?

Answer 0

Loss of cartilage and bone from articulating surfaces - due to trauma, problem with mechanism fixing the joint.

Question 1

Which joints does osteoarthritis effect?

Answer 1

Synovial joints

Question 2

What are five risk factors for osteoarthritis

Answer 2

Female
Previous joint injury/disease
Genetics
Obesity 
Over 40

Question 3

What is the name of the enzyme that breaks down collagen?

Answer 3

Matrix metalloproteinases

Question 4

What three things does rheumatoid arthritis cause?

Answer 4

Synovial membrane inflammation
Bursae
Inflamed tendon sheaths

Question 5

What type of disorder is rheumatoid arthritis?

Answer 5

Autoimmune

Question 6

Which two prostaglandins cause vasodilation?

Answer 6

PGD2/PGI2

Question 7

What does PGE2 cause?

Answer 7

Vasodilation, pyrogenic and anti inflammation effects

Question 8

What does COX 1 regulate?

Answer 8

Blood flow, kidney function

Question 9

What is COX 2 in response to?

Answer 9

Cytokines

Question 10

What are the three actions of NSAID’s?

Answer 10

Antipyretic
Analgesic
Anti inflammatory

Question 11

How do NSAIDs work as antipyretics?

Answer 11

Inhibit actions of PGs on the hypothalamus

Question 12

How do NSAIDs have analgesic effects?

Answer 12

Reduce sensitivity of bradykinins (effective against muscular/skeletal pain)

Question 13

How do NSAIDs have an anti inflammatory effect?

Answer 13

Reduce vasodilation and reduce permeability of venues.

Question 14

What is an other action of NSAIDs?

Answer 14

May scavenge oxygen radicals and decrease tissue damage.

Question 15

What does aspirin inhibit?

Answer 15

NFkB expression - decreases transcription of genes for inflammatory mediators

Question 16

What are five problems with NSAIDs?

Answer 16

Gastric ulcers, GI bleeding in elderly, induce asthma attack, angioedema, urticaria or rhinitis, impair coagulation, risk of CV events in patients with cardiac disease/hypertension.

Question 17

Why is there are problem with NSAID’s?

Answer 17

Because they inhibit cox1 and cox2. Cox1 produces many beneficial PG’s - production of GI mucus, cv function.

Question 18

What is the problem with aspirin?

Answer 18

Inhibits all cox and is irreversible. Platelets have no nucleus and cannot create new enzymes.

Question 19

Name a cox2 selective drug

Answer 19

Meloxicam

Question 20

Where can aspirin be absorbed?

Answer 20

In the stomach

Question 21

What drug can aspirin interact with and how?

Answer 21

Increases bioavailability of warfarin can cause bleeding

Question 22

Is paracetamol an NSAID?

Answer 22

No

Question 23

What can chronic use of large doses of paracetamol cause?

Answer 23

Kidney damage

Question 24

What is a toxic dose of paracetamol?

Answer 24

10-15g

Question 25

When could potential fatal liver damage occur after an overdoes of paracetamol?

Answer 25

24-48 hours later

Question 26

What five treatment options for osteoarthritis would be considered before drugs?

Answer 26

``` Strengthening joints, exercise, physio. Weight loss. Suitable footwear and pacing. Joint supports/braces. Thermotherapy/TENS ```

Question 27

What five ways (drugs) might you treat osteoarthritis?

Answer 27

``` Paracetamol + oral NSAID with PPI Topical NSAID Or capsaicin Opioid analgesic Intra-articular corticosteroid injection Joint replacement surgery ```

Question 28

How would you diagnose rheumatoid arthritis?

Answer 28

Symptoms present - refer to specialist - MRI, x-Ray, ultra sound. Blood tests - FBC, RF, INFLAMM. MARKERS, physical exam.

Question 29

What five treatment options are there for rheumatoid arthritis?

Answer 29

``` NSAIDs / opioid analgesics Glucocorticoids Immunosuppressants Disease modifying antirheumatic drugs Anticytokines ```

Question 30

What are glucocorticoids used short term for?

Answer 30

To manage flare ups

Question 31

What are the main types of action of glucocorticoids?

Answer 31

Anti inflammatory | Immunosuppressive

Question 32

Name three natural steroids?

Answer 32

Hydrocortisone Corticosterone Aldosterone (mineralocorticoid)

Question 33

Which steroids give mixed gluco/mineralocprticoid activity?

Answer 33

Prednisolone, prednisone

Question 34

Which steroids give glucocorticoid activity?

Answer 34

Dexamethasone, betamethasone, beclomethasone, budesonide

Question 35

Which steroid gives mainly mineralocorticoid activity?

Answer 35

Fludrocortisone

Question 36

Name 2 short acting steroids

Answer 36

Cortisone and hydrocortisone

Question 37

Name an intermediate acting steroid

Answer 37

Prednisolone

Question 38

Name a long acting steroid

Answer 38

Dexamethasone

Question 39

How do steroids act on nucleus receptors?

Answer 39

Attaches to receptor on cell membrane, travels to nucleus and DNA, turns off gene, decreased protein production.

Question 40

What are the glucocorticoid actions in arthritis?

Answer 40

Decreased transcription of cytokines eg IL2 | Increased synthesis of anti-inflamm proteins eg protease inhibitors

Question 41

What is a method of reducing the side effects of steroids?

Answer 41

Lower plasma concentrations - choose a route of admin to achieve this eg topical

Question 42

What must you not do if on steroids?

Answer 42

Stop treatment abruptly - addisonian crisis.

Question 43

What are the general problems with immunosuppressants?

Answer 43

Increase risk of infections | Increase risk of cancer.