Drugs for Arthritis

Question 1

types of arthritis

Answer 1

OA
RA
psoriatic
gout
ankylosing spondylitis
inflammation/pain/stiffness

Question 2

OA characteristics

Answer 2

degenerative to articular cartilage
WB joints
middle age
pain less than 30 min in morning
bone spurs
reduced ROM
cartilage breakdown
inflammation localized
pain worse w activity
no systemic symptoms
manage w acetaminophen, NSAIDs, PT, exercise, weight management

Question 3

RA characteristics

Answer 3

autoimmune, body attack joints
symmetrical
middle age
morning pain for hours
joints swollen/warm
joint deformity
systemic inflammation
worse after inactivity
fatigue/fever/weight loss
DMARDs, NSAIDs, corticosteroids
antibodies

Question 4

main drugs to manage OA

Answer 4

analgesics
joint protection/restoration with hyaluronic acid and chondroitin sulfate

Question 5

acetaminophen clinical use

Answer 5

first line treatment for OA pain relief

Question 6

acetaminophen MOA

Answer 6

reduce PG production in brain

Question 7

acetaminophen side effects

Answer 7

nausea/vomiting
lose of appetite
allergic rxn

Question 8

acetaminophen toxicity

Answer 8

liver toxicity with overuse due to toxic intermediate not being cleared fast enough

Question 9

NSAIDs commonly used for OA

Answer 9

ibuprofen/advil
Naproxen/aleve
Celecoxib/celebrex
diclofenac/voltaren, solaraze
meloxicam/mobic

Question 10

NSAIDs MOA

Answer 10

COX NZ inhibitor preventing PG synthesis mediating inflammation and pain

Question 11

NSAIDs side effects

Answer 11

GI: ulcer, bleeding, heart burn, stomach upset
CV: increased risk of heart attack/stroke, prolonged bleeding
renal: renal failure/fluid retention

Question 12

hyaluronic acid MOA

Answer 12

similar to synovial lubricant fluid
injected into joint to act as lubricant and shock absorber

Question 13

hyaluronic acid side effects

Answer 13

pain at injection site
joint stiffness
headache

Question 14

chondoitin sulfate MOA

Answer 14

building block of cartilage, prevent breakdown of cartilage and stimulate its repair, anti inflammatory properties
improve synovial fluid consistency

Question 15

chondroitin sulfate side effects

Answer 15

stomach pain
nausea
diarrhea
constipation
headache
swelling

Question 16

PT considerations for those taking analgesics

Answer 16

med schedule: time for optimal pain relief, be cautious of overdoing activity
monitor for overuse: overdoing activity causing strains
avoid overdosing
check side effects: avoid strenuous activity after taking hyaluronic for a few days
ask pt’s feedback on actvity

Question 17

pro-inflammatory cytokines of RA

Answer 17

interleukin-1 IL-1
tumor necrosis factor -a
TNF-a

Question 17

RA pathogenesis

Answer 17

cytokines are activated by immune response, T cells activated which make B cells active to produce antibodies resulting in bone removal by autoimmune response
activated T cells and macrophages promote inflammation

Question 18

RA treatment options

Answer 18

NSAIDs
glucocorticoids used sparingly
DMARDs: disease modifying anti rheumatic drugs

Question 19

DMARDs traditional vs targeted

Answer 19

traditional: restrict immune system broadly
targeted: block precise pathways inside immune cells
both inhibit RA autoimmune response

Question 20

hydroxychloroquine

Answer 20

immunomodulation for RA

Question 21

methotrexate

Answer 21

for RA
inhibit dihydrofolate reductase enzyme to reduce nucleotide synthesis

Question 22

lefunomide

Answer 22

inhibit pyrimidine synthesis
for RA

Question 23

biologic DMARDs for RA: TNF a blockers

Answer 23

etanercept
inflicimab
adalimumab
certolizumab
golimumab
monoclonal antibodies -mabs

Question 24

DMARD TNF-a suffix

Answer 24

most are -mab

Question 25

Non-TNF-a Biologics for RA

Answer 25

rituximab
abatacept
tocilizumab
baricitinib
anakinra
block different interleukins, kinases, tcells, b cells

Question 26

PT considerations for pts on DMARDs

Answer 26

reduced immune response
fatigue/reduced exercise tolerance
injection site reactions
increased risk of fracture
analgesic use