arthritis drugs

Question 1

what is arthritis?

Answer 1

joint inflammation. it causes pain, and affects mobility. currently affects 10% of the worlds population.

Question 2

action of type 1 collagen?

Answer 2

located in the bone. involved with osteoblast differentiation from bone marrow.

Question 3

location and function of type 2 collagen?

Answer 3

located in cartilage - it maintains integrity of cartilage.

Question 4

where is aggrecan located?

Answer 4

synovial membrane

Question 5

location of matrix metalloproteinases?

Answer 5

synovial tissue. it degrades ECM proteins to enable growth.

Question 6

describe osteoarthritis

Answer 6

disease affecting the synovial joints. it is characterized by loss of cartilage and bone from articulating surfaces.

Question 7

why is cartilage degraded?

Answer 7

due to the upregulation of cytokines.

Question 8

risk factors for osteoarthritis?

Answer 8

obesity, age >40, collagen gene mutations, metabolic disorders, previous joint injury/disease, gender (common in women due to decrease in oestrogen after menopause).

Question 9

what is arachidonic acid?

Answer 9

a constituent of the cell membrane, derived from linoleic acid in the diet

Question 10

where is PGI2 synthesised?

Answer 10

vascular endothelial cells

Question 11

what causes a reduction in prostaglandins E2 and I2?

Answer 11

blocking COX enzyme

Question 12

describe COX-1 enzyme?

Answer 12

a constitutive enzyme (expressed all the time). It regulates blood flow/ clotting and renal function, and protects the GI mucosa.

Question 13

function of COX-2?

Answer 13

inducible and produced when needed. it produces inflammatory cells, and is also involved in ovulation and uterine contractions during labour.

Question 14

examples of NSAIDs?

Answer 14

aspirin, ibuprofen, diclofenac, meloxicam, indomethacin, celecoxib

Question 15

actions of NSAIDs?

Answer 15

antipyretic - inhibits PG action on hypothalamus, analgesic - reduces sensitivity of neurons to bradykinin
anti-inflammatory - reduces vasodilation and decreases permeability of venules.

Question 16

where is aspirin absorbed?

Answer 16

stomach and small intestine

Question 17

problems with NSAIDs?

Answer 17

gastric ulcers, impairs coagulation, risk of GI bleeding, risk of CV events in patients with CV disease/hypertension, may induce asthma attack, angioedema, urticarial or rhinitis

Question 18

how are NSAIDs administered?

Answer 18

tablets, suspensions, gels, injection

Question 19

examples of COX-2 inhibitors?

Answer 19

celecoxib, etoricoxib, etodolac.

Question 20

side effects of COX-2 inhibitors?

Answer 20

headache, dizziness, skin rash, peripheral odema

Question 21

what is misoprostol?

Answer 21

a synthetic prostaglandin given alongside NSAIDs, that preserves mucous lining of GI tract and inhibits gastric acid secretion that stimulates increased mucus production and protects against ulceration.

Question 22

side effects of misoprostol?

Answer 22

diarrhoea and vaginal bleeding

Question 23

mechanisms of paracetamol?

Answer 23

analgesic and antipyretic. supresses PG production and stimulates serotenergic pathways involved in the inhibition of pain sensation.

Question 24

problems with too much paracetamol ?

Answer 24

chronic use of large doses can lead to kidney damage and toxic doses can lead to fatal liver damages

Question 25

alternative drug treatments for osteoarthritis?

Answer 25

strontium ranelate, bisphosphonates, glucosamine sulphate, dunosomab

Question 26

what is rheumatoid arthritis?

Answer 26

joint inflammation in the synovial membrane, tendon sheaths and bursae.

Question 27

symptoms of rheumatoid arthritis?

Answer 27

swollen and stiff joints, pain

Question 28

examples of glucocorticoids?

Answer 28

beclomethasone, budesonide, prednisolone, dexamethasone, cortisone

Question 29

examples of mineralocorticoid?

Answer 29

aldosterone

Question 30

side effects of oral corticosteroids?

Answer 30

Buffalo hump
Moon face
Increased abdominal fat
Thinning of skin
Increased risk of infection
Poor wound healing
Muscle wasting
Osteoporosis
Hypertension

Question 31

examples of DMARDS?

Answer 31

sulfasalazine, penicillamine, gold compounds, anti-malarials

Question 32

side effects of sulfasalazine?

Answer 32

GI upset, headache, skin reactions, leukopenia (reduced WBC count)

Question 33

side effects of penicillamine?

Answer 33

rashes, stomatitis, anorexia, taste disturbance, fever, nausea and vomiting

Question 34

examples of immunosupressants?

Answer 34

methotrexate, ciclosporin, azathioprine, leflunomide

Question 35

mechanism of immunosupressants?

Answer 35

inhibit DNA synthesis, or T cell activation

Question 36

examples of anti-cytokines (biologic agents)

Answer 36

etenercept, infliximab, rituximab, abatacept

Question 37

side effects of anti-cytokine drugs?

Answer 37

May develop latent disease, opportunistic infection,
Nausea,
Abdominal pain, worsening heart failure,
Hypersensitivity.