bones n joints

Question 1

What is the approach to treating osteoarthritis?

Answer 1

Anti-inflammatory and polysaccharide SYSADOA

Question 2

SYSADOA: Name, moa

Answer 2

Intra-articular hyaluronic acid
Natural aminoglycosan in synovial fluid. Serves as shock absorption and protective coating for cartilage, also induces HA biosynthesis

Question 3

Example of COX-2 selective NSAID, clinical indications

Answer 3

Celecoxib

Osteoarthritis, gout

Question 4

What is the approach to treating gout?

Answer 4

Anti-inflammatory and urate-lowering therapy (ULT)

Question 5

Nonselective NSAID used in osteoarthritis

Answer 5

Paracetamol

Question 6

Nonselective NSAID used in gout

Answer 6

Naproxen

Question 7

Colchicine: Class, moa, adr, duration of onset, contraindications

Answer 7

Anti-inflammatory for gout
Binds to tubulin to prevent polymerization into microtubules
Inhibits phagocytosis and leukocyte migration
Relieves pain in 12-24h
Diarrhoea, abdominal pain
Hepatotoxicity

Question 8

What are some hyperurecemic drugs?

Answer 8

Loop diuretics: Furosemide
DCT diuretics: Thiazides
NSAIDs: Low dose aspirin
Autoimmune: Ciclosporin A, tacrolimus
TB: Pyrazinamide, Ethambutol
Lipid-lowering: Niacin
Parkinson's: Levodopa
COPD: Theophylline

Question 9

Xanthine oxidase inhibitors: Class, name, moa, adr, contraindications

Answer 9

ULT drugs
Allopurinol
Decrease uric acid production from purines
RISK OF SJS in allopurinol hypersensitivity syndrome
Severe cutaneous adverse reaction (SCAR)
Renal impairment in HLA-B5801 antigen
Nausea, vomiting, dark urine, jaundice

Question 10

Uricosuric agents: Class, name, moa, adr

Answer 10

ULT drugs
Probenecid
Increase uric acid excretion by inhibiting reabsorption at PCT
Risk of kidney stones- must take with plenty of fluids
Nausea, vomiting, painful urine

Question 11

Is gout more common in men or women?

Answer 11

Men

Question 12

Is rheumatoid arthritis more common in men or women?

Answer 12

Women

Question 13

What is the approach to treating rheumatoid arthritis?

Answer 13

Anti inflammatory, nbDMARDs, tsDMARDs, bDMARDs

Question 14

Anti-inflammatory drugs for RA

Answer 14

NSAIDs + PPI for immediate pain relief, glucocorticoids to halt progression of disease

Question 15

nbDMARDs: Name, moa, adr, contraindications

Answer 15

Methotrexate- First line
Folic acid analogue. Inhibits AICAR transformylase to increase adenosine, lower inflammatory cytokines. Also inhibits dihydrofolate reductase.
Administer with folinic acid 12-24h after taking to rescue from methotrexate toxicity
Hair thinning, GI ulcers,
Myelosuppression, hepatic fibrosis, pneumonitis

Question 16

tsDMARDs: Name, moa, adr, contraindications

Answer 16

Tofacitinib
Targets JAK-STAT pathway. Prevent phosphorylation of STAT and subsequent transcription of cytokine genes
Given with methotrexate for severe RA
Immunosuppresant, increases risk of opportunistic infections (TB, Herpes zoster)
Increased risk of hyperlipidemia
Do not combine with bDMARDs

Question 17

bDMARDs: 3 types and names

Answer 17

IL-1R antagonist: Anakinra
IL-6R antagonist: Tocilizumab
anti TNF-a mAb: Adalimumab

Question 18

Adalimumab adr

Answer 18

Respi, skin infection
Risk of lymphoma, optic neuritis, leukopenia
Contraindicated with live vaccines, latent/active TB