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Pharmacology 2 > Arthritis Drugs > Flashcards

Arthritis Drugs Flashcards

0
Q

What is osteoarthritis characterised by?

A

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

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1
Q

Which joints does osteoarthritis effect?

A

Synovial joints

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2
Q

What are five risk factors for osteoarthritis

A 
Female
Previous joint injury/disease
Genetics
Obesity 
Over 40
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3
Q

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

A

Matrix metalloproteinases

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4
Q

What three things does rheumatoid arthritis cause?

A

Synovial membrane inflammation
Bursae
Inflamed tendon sheaths

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5
Q

What type of disorder is rheumatoid arthritis?

A

Autoimmune

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6
Q

Which two prostaglandins cause vasodilation?

A

PGD2/PGI2

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7
Q

What does PGE2 cause?

A

Vasodilation, pyrogenic and anti inflammation effects

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8
Q

What does COX 1 regulate?

A

Blood flow, kidney function

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9
Q

What is COX 2 in response to?

A

Cytokines

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10
Q

What are the three actions of NSAID’s?

A

Antipyretic
Analgesic
Anti inflammatory

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11
Q

How do NSAIDs work as antipyretics?

A

Inhibit actions of PGs on the hypothalamus

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12
Q

How do NSAIDs have analgesic effects?

A

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

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13
Q

How do NSAIDs have an anti inflammatory effect?

A

Reduce vasodilation and reduce permeability of venues.

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14
Q

What is an other action of NSAIDs?

A

May scavenge oxygen radicals and decrease tissue damage.

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15
Q

What does aspirin inhibit?

A

NFkB expression - decreases transcription of genes for inflammatory mediators

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16
Q

What are five problems with NSAIDs?

A

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.

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17
Q

Why is there are problem with NSAID’s?

A

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

18
Q

What is the problem with aspirin?

A

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

19
Q

Name a cox2 selective drug

A

Meloxicam

20
Q

Where can aspirin be absorbed?

A

In the stomach

21
Q

What drug can aspirin interact with and how?

A

Increases bioavailability of warfarin can cause bleeding

22
Q

Is paracetamol an NSAID?

A

No

23
Q

What can chronic use of large doses of paracetamol cause?

A

Kidney damage

24
Q

What is a toxic dose of paracetamol?

A

10-15g

25
Q

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

A

24-48 hours later

26
Q

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

A 
Strengthening joints, exercise, physio.
Weight loss.
Suitable footwear and pacing.
Joint supports/braces.
Thermotherapy/TENS
27
Q

What five ways (drugs) might you treat osteoarthritis?

A 
Paracetamol + oral NSAID with PPI
Topical NSAID Or capsaicin
Opioid analgesic
Intra-articular corticosteroid injection
Joint replacement surgery
28
Q

How would you diagnose rheumatoid arthritis?

A

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

29
Q

What five treatment options are there for rheumatoid arthritis?

A 
NSAIDs / opioid analgesics
Glucocorticoids
Immunosuppressants
Disease modifying antirheumatic drugs 
Anticytokines
30
Q

What are glucocorticoids used short term for?

A

To manage flare ups

31
Q

What are the main types of action of glucocorticoids?

A

Anti inflammatory

Immunosuppressive

32
Q

Name three natural steroids?

A

Hydrocortisone
Corticosterone
Aldosterone (mineralocorticoid)

33
Q

Which steroids give mixed gluco/mineralocprticoid activity?

A

Prednisolone, prednisone

34
Q

Which steroids give glucocorticoid activity?

A

Dexamethasone, betamethasone, beclomethasone, budesonide

35
Q

Which steroid gives mainly mineralocorticoid activity?

A

Fludrocortisone

36
Q

Name 2 short acting steroids

A

Cortisone and hydrocortisone

37
Q

Name an intermediate acting steroid

A

Prednisolone

38
Q

Name a long acting steroid

A

Dexamethasone

39
Q

How do steroids act on nucleus receptors?

A

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

40
Q

What are the glucocorticoid actions in arthritis?

A

Decreased transcription of cytokines eg IL2

Increased synthesis of anti-inflamm proteins eg protease inhibitors

41
Q

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

A

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

42
Q

What must you not do if on steroids?

A

Stop treatment abruptly - addisonian crisis.

43
Q

What are the general problems with immunosuppressants?

A

Increase risk of infections

Increase risk of cancer.

Pharmacology 2 (14 decks)

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