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AP Pharmacology > Arthritis Drugs > Flashcards

Arthritis Drugs Flashcards

1
Q

Whtat is arthritis?

A

Inflammation of the joints causing pain and affecting mobility.

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2
Q

What are the causes of osteoarthritis?

A

Wear and tear related to aging.

Trauma, disease or obesity

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3
Q

Where is most affected by rheumatoid arthritis?

A

The small joints, e.g. hands and feet.

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4
Q

Why does rheumatoid arthritis occur?

A

Because antibodies are targeted towards normal proteins in the connective tissue of joints and this results in the release of pro-inflammatory cytokines.

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5
Q

What do pro-inflammatory cytokines do?

A

They promote systemic inflammation

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6
Q

Which joints are most affected by osteoarthritis?

A

The synovial joints

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7
Q

What is osteoarthritis?

A

Loss of cartilage and bone from articulating surfaces. It alters the repair process after a trauma and insufficient repair takes place.

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8
Q

Give an example of a synovial joint

A

Wrist, elbow, shoulder, knee, fingers, feet and spine

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9
Q

Why is cartilage degraded?

A
  • Upregulation of cytokines
  • Interleukin 1B inhibits type II collagen synthesis of hyaline cartilage
  • An increase in matrix metalloproteins cause a breakdown of collage and cartilage degradation
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10
Q

Where is type I collagen found and what is it’s function?

A

Found in the bones. Its function is osteoblast differentiation from bone marrow.

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11
Q

Where is type II collagen found and what is its function?

A

Found in the cartilage and its function is to maintain the integrity of the cartilage

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12
Q

Where is aggrecan found and what is its function?

A

found in the synovial membrane and it degrades ECM proteins to enable growth.

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13
Q

What are the risk factors for arthritis?

A

Obesity, gender, age, previous joint injury/disease, metabolic disorders and genetics.

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14
Q

Why is arthritis more common in women?

A

Due to an decrease in oestrogen after menopause. Oestrogen inhibits osteoclasts which breakdown bone during remodelling and increase blood calcium.

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15
Q

What is arachidonic acid?

A

Aconstituent of the cell membrane derived fromn linoleic acid.

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16
Q

What does the COX1 enzyme do?

A

Protects the GI mucosa, controls renal blood flow and helps in the initiation of labour.

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17
Q

Where are COX2 enzymes found and when are they produced?

A

Produced when needed in inflammatory cells induced by injury, infection or cytokines.

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18
Q

What does the COX2 enzyme do?

A

Produces inflammatory mediators

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19
Q

Where is the COX3 enzyme found?

A

In the CNS of some species

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20
Q

All COX enzymes catalyse which reaction?

A

Arachidonic acid into prostaglandins and thromboxanes

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21
Q

What is the classification for the most widely prescribed drugs for arthritis?

A

NSAIDS (non steroidal anti inflammatory drugs)

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22
Q

Aspirin, ibuprofen, diclofenac, meloxicam and indomthacin are examples of…

A

NSAIDS

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23
Q

What are the actions of NSAIDS?

A

Antipyretics by inhibiting actions of prostaglandins on the hypothalamus, analgesics by reducing the sensitivity of the neurons to bradykinin and anti inflammatory by reducing vasodilation and decreasing the permeability of venules

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24
Q

What are the risks with NSAIDS?

A

Can cause gastric ulcers, impair coagulation, GI bleeding in elderly, risk of CV events in those with cardiac disease/hypertension and can induce asthma attack, angioedema, urticaria or rhinitis

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25
Q

What is angioedema?

A

Rapid swelling of dermis, subcutaneous tissues.

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26
Q

What is urticaria?

A

Skin rash (hives)

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27
Q

What causes the problems with NSAIDS?

A

They inhibit both the COX1 and COX2 enzymes and COX1 produces prostaglandins that are beneficial.

28
Q

Name an NSAID drug that is a selective COX2 inhibitor

A

Meloxicam, celecoxib, etoricoxib and etodolac

29
Q

Common side effects of COX2 inhibitors

A

Headaches, dizziness, rash and peripheral oedema.

30
Q

What is misoprostol?

A

A synthetic prostaglandin given alongside NSAIDs that preserves the mucous lining of the gi tract, protects against ulcerations.

31
Q

Why is paracetamol not considered an NSAID?

A

Because it has no anti inflammatory effect.

32
Q

Chronic use of large doses of paracetamol causes…

A

Kidney damage

33
Q

Toxic doses of paracetamol causes…

A

Fatal liver damage 24-48 hours after overdosing

34
Q

Treatment options for osteoarthritis

A

Exercise, weight loss, thermotherapy/TENS devices, joint supports or braces and suitable footwear.

35
Q

What drugs will be used to treat osteoarthritis?

A

Paracetamol
Topical NSAID or capsaicin.
Opioid analgesic
Intra articular corticosteroid injections

36
Q

What does strontium ranelate do?

A

It promotes osteoblast differentiation and inhibits osteoclast activity and reduces pain.

37
Q

Where is aspirin absorbed?

A

In the small intestine and the stomach

38
Q

Why does aspirin damage the lining of the stomach?

A

Because it inhibits COX1 which is responsible for the production of the prostaglandins that protect the mucosa from the stomach acid.

39
Q

When is rheumatoid arthritis most commonly diagnosed?

A

Between ages 40 and 60

40
Q

What are the treatment options for rheumatoid arthritis?

A 
NSAIDS/ opioid analgesics for pain
Glucocorticoids 
Immunosuppressants
Disease modifying antirheumatic drugs (DMARDS) 
Anticytokines
41
Q

How are T cells activated?

A

By an abnormal interaction with B cells

42
Q

Activated T cells cause macrophages to secrete what?

A

Cytokines like TNF and interleukin 1 to stimulate fibroclasts and osteoclasts,

43
Q

How do immunosuppressant drugs work?

A

By reducing the production and activation of T cells.

44
Q

How do glucocorticoids work?

A

By suppressing the function of macrophages and therefore reducing the secretion of inflammatory cytokines.

45
Q

How do anticytokine drugs work?

A

By suppressing the activation of osteoclasts and fibroblasts.

46
Q

How do DMARDS work?

A

By acting directly on the joint to block the inflammatory processes.

47
Q

Glucocorticoids are naturally produced where in the body?

A

Adrenal cortex

48
Q

Example of a short acting steroid

A

Cortisone, hydrocortisone

49
Q

Example of a intermediate acting steroid

A

Prednisolone

50
Q

Example of a long acting steroid

A

Dexamethasone

51
Q

Drugs used to treat both asthma and arthritis

A

Becolometasone, budesonide and prednisolone due to the decrease in histame release

52
Q

Side effects of oral corticosteroids (cushingoid features)

A

Buffalo hump, Moon face, Increased abdo fat, hypertension, thinning skin, Inc risk of infection, poor wound healing, muscle wasting and osteoporosis

53
Q

Methotrexate is an example of a…

A

DMARD

54
Q

How does methotrexate work?

A

It is a folic acid antagonist and inhibits DNA synthesis. It also blocks growth and differentiation of rapidly dividing cells. And inhibits T cell activation.

55
Q

Which is the most common choice of DMARD in the UK?

A

Sulfasalazine

56
Q

Sulfasalazine is a complex of…

A

An NSAID (salicylate) and an antibiotic (sulphonamide)

57
Q

Why is sulfasalazine given as enteric coated tablets?

A

Because it is poorly absorbed orally.

58
Q

Ciclosporin, azothioprine and methotrexate are examples of…

A

Immunosuppressants

59
Q

Lefunomide and cyclophosphamide are examples of …

A

Immunosuppressants

60
Q

How do immunosupprassants work?

A

By inhibiting DNA synthesis or T cell activation

61
Q

Prednisolone, dexamethasone and fludrocortisone are examples of…

A

Corticosteroids

62
Q

How do corticsteroids work?

A

By blocking gene transcription and synthesis of inflammatory proteins .

63
Q

Sulfasalazine, pencillamine, gold compounds and anti-malarials are examples of…

A

DMARDS

64
Q

How do DMARDs work

A

A variety of mechanisms including free radical scavenging and decreasing interleukin1

65
Q

Etenercept, infliximab, rituximab and abatacept are examples of…

A

Anticytokines.

AP Pharmacology (13 decks)

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