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PHTH 561: Pharmacology > Drugs for Arthritis Disorders & Osteoporosis > Flashcards

Drugs for Arthritis Disorders & Osteoporosis Flashcards

1
Q

What is arthritis?

A

-A general term that refers to a group of more than 100 disorders affecting the joints
-Inflammation, pain, and stiffness in the joint

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2
Q

What are different types of arthritis?

A

-Osteoarthritis
-Rheumatoid arthritis
-Psoriatic arthritis
-Gout
-Ankylosing spondylitis

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3
Q

What is rheumatoid arthritis?

A

-Autoimmune disorder
-The body’s immune system attacks the joints

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4
Q

What are signs and symptoms of rheumatoid arthritis?

A

-Often affects joints symmetrically
-Commonly affects wrists, fingers, knees, feet, and ankles
-Usually starts at middle age
-Joints may be swollen, warm, and puffy
-Morning stiffness > 30 minutes
-Systemic inflammation
-Pain worse after periods of inactivity
-May be accompanied by fever, fatigue, and weight loss

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5
Q

What drugs can be used to treat RA?

A

-Disease modifying antirheumatic drugs (DMARDS)
-NSAIDs
-Corticosteroids
-Biologic agents

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6
Q

What is osteoarthritis?

A

-Degenerative disorder
-Wear and tear of the joint cartilage

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7
Q

What are the signs and symptoms of osteoarthritis?

A

-Usually affects weight bearing joints (hips, knees, spine)
-Usually starts at middle age or older adults
-Morning stiffness < 30 minutes
-Reduced ROM
-Inflammation localized to affected joint
-No systemic symptoms

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8
Q

What drugs can be used to treat osteoarthritis?

A

-Acetaminophen
-NSAIDs
-PT
-Weight management
-Joint injections
-Surgery

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9
Q

What is typically the first-line treatment for pain relief in osteoarthritis?

A

Acetaminophen

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10
Q

What is the most significant concern with high doses of acetaminophen?

A

Liver toxicity

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11
Q

What are common side effects from acetaminophen?

A

-Nausea or vomiting
-Loss of appetite
-Allergic reactions like skin rash, itching, or hives

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12
Q

What is the maximum recommended daily dose of acetaminophen?

A

4,000mg for adults but lower limits are often recommended

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13
Q

What are the most common NSAIDs used for osteoarthritis?

A

-Ibuprofen
-Naproxen sodium
-Celecoxib
-Diclofenac
-Meloxicam

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14
Q

What is the mechanism of action of hyaluronic acid injections for osteoarthritis?

A

-Hyaluronic acid is a polysaccharide similar to the natural joint fluid that lubricates the joint
-When injected into the joint, it acts as a lubricant and shock absorber
-Helps to reduce pain and friction in the joint

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15
Q

What are the side effects of hyaluronic acid injections?

A

-Pain at the injection site
-Joint stiffness
-Headache

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16
Q

What is the mechanism of action of chondroitin sulfate for osteoarthritis?

A

-Chondroitin sulfate is one of the building blocks of cartilage
-It is believed to help prevent the breakdown of cartilage and stimulate its repair mechanism
-Also thought to have anti-inflammatory properties and improve the consistency of synovial fluid

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17
Q

What are side effects of chondroitin sulfate?

A

-Stomach pain
-Nausea
-Diarrhea
-Constipation
-Headache
-Swelling of the eyelids or legs

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18
Q

What are physical therapy considerations when working with patients with osteoarthritis that are taking medication?

A

-Medication schedule
-Monitor for overuse
-Educate on medication limits
-Check for side effects
-Patient feedback

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19
Q

What is the prevalence of rheumatoid arthritis?

A

1% of the population and is more common in women

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20
Q

What is the pathogenesis of RA?

A

-Antigen presenting cells process and present antigens to T cells, which may stimulate B cells to produce antibodies and osteoclasts to destroy and remove bone
-Macrophages stimulated by immune response can stimulate T cells and osteoclasts to promote inflammation
-Activated T cells and macrophages release factors that promote tissue destruction, increase blood flow, and result in cellular invasion of synovial tissue and fluid

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21
Q

What are the main pro-inflammatory cytokines that are involved in the pathogenesis of RA?

A

-Interleukin-1 (IL-1)
-Tumor necrosis factor-⍺ (TNF-⍺)

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22
Q

What is the difference between traditional Disease Modifying Anti-Rheumatic Drugs (DMARDs) and targeted DMARDs?

A

-Traditional DMARDs restrict your immune system broadly
-Targeted DMARDs block precise pathways inside immune cells

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23
Q

How are biologic drugs produced? How do they work?

A

-Produced by living cells
-Work on individual immune proteins called cytokines

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24
Q

What is the general strategy of biologic drugs for RA?

A

-Inhibit autoimmune response underlying RA
-Inhibition of cytokines
-Inhibit cellular activation

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25
Q

What is the mechanism of action of Methotrexate for RA?

A

Inhibits dihydrofolate reductase enzyme, which reduces nucleotide synthesis

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26
Q

What are the adverse effects of Methotrexate?

A

-Hepatic fibrosis
-Rash
-Thrombocytopenia
-Leukopenia

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27
Q

What is the mechanism of action of hydroxychloroquine for RA? What are the adverse effects?

A

-Not well understood
-Thought to be an immunomodulator
-Retinal damage
-Rash

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28
Q

What is the mechanism of action of Leflunomide for RA? What are the adverse effects?

A

-Inhibits pyrimidine synthesis
-Hepatitis

29
Q

What is the mechanism of action of Sulfasalazine for RA? What are the adverse effects?

A

-Not well understood
-Rash
-Photosensitivity

30
Q

What are common TNF-⍺ blockers used for RA?

A

-Etanercept
-Infliximab
-Adalimumab
-Certolizumab
-Golimumab

31
Q

What are adverse effects of TNF-⍺ blockers?

A

-Local injection site reactions
-Infection
-Immune reactions
-Malignancy

32
Q

What are common non-TNF-⍺ biologics that are used to treat RA?

A

-Rituximab
-Abatacept
-Tocilizumab
-Baricitinib
-Anakinra

33
Q

What are physical therapy considerations for patients on medications for RA?

A

-DMARDs can cause fatigue or reduced tolerance to exercise
-Injection site
-Steroids can increase risk of fx
-Pain masking: monitor for signs of overuse
-Understanding interactions of medications and PT

34
Q

What is osteoporosis?

A

A bone disease characterized by a decrease in bone density and an increases risk of fractures

35
Q

What is the prevalence of osteoporosis?

A

-10 million diagnosed with osteoporosis
-34 million with low bone density
-1.5 million fractures annually

36
Q

What are risk factors for osteoporosis?

A

-Postmenopausal women
-Old age
-Medications
-Endocrine disorders
-Inflammatory arthropathy
-Hematopoietic disorders
-Nutrition disorders

37
Q

What is used to diagnose osteoporosis and measure bone density?

A

Dual X-ray absorptiometry (DEXA)

38
Q

What are the different bone cell types?

A

-Osteogenic cell: bone stem cell
-Osteoblast: bone forming cell
-Osteoclast: bone resorption
-Osteocyte: maintains bone tissue

39
Q

How does parathyroid hormone effect bone density?

A

-In low and intermittent doses, it increases bone formation
-In excess doses, it increases bone resorption

40
Q

What stimulates the release of parathyroid hormone? What does this cause?

A

-Low Ca2+ levels in the blood trigger the release of PTH which increases bone resorption to release calcium from bone tissue
-PTH release increases renal reabsorption of Ca2+

41
Q

How does vitamin D effect bone formation?

A

It stimulates intestinal absorption of Ca2+ and phosphate

42
Q

How does calcitonin effect bone tissue?

A

Lowers blood levels of Ca2+ and phosphate by inhibiting osteoclast activity

43
Q

What is involved in normal bone homeostatis?

A

-PTH binds to receptors on osteoblasts
-Osteoblasts secrete RANKL and OPG (decoy receptor for RANKL)
-Osteoclasts are activated by RANKL
-There is a balance between osteoblast activity and osteoclast activity

44
Q

What is involved in osteoporsis bone formation and resorption physiology?

A

-Osteocytes upregulates RANKL and down regulates OPG synthesis
-RANKL binds to osteoclasts and increases osteoclast proliferation
-Activated osteoclasts cause significant resorption

45
Q

What are some common drugs that are used to treat osteoporosis?

A

-Bisphosphonates
-Selective estrogen receptor modulators (SERMs)
-Calcitonin
-RANKL inhibitors
-Parathyroid hormone (low doses)
-Calcium and vitamin D supplements

46
Q

What is the mechanism of action of bisphosphonates?

A

-Binds to osteoclasts and promotes apoptosis
-Binds to hydroxyapatite and prevents osteoclast activity

47
Q

What are common bisphosphonates used to treat osteoporosis?

A

-Alendronate
-Risedronate
-Ibandronate
-Zoledronic acid

48
Q

What are side effects of bisphosphonates?

A

-GI disturbances: acid reflux
-Osteonecrosis of the jaw
-Atypical femur fractures

49
Q

What are special instructions for patients taking bisphosphonates? Why?

A

-Swallow whole with water 30 minutes before breakfast
-Sit or stand upright for 30 minutes after taking the tablet
-To avoid gastric reflux

50
Q

What is the mechanism of action of selective estrogen receptor modulators (SERMs)?

A

Mimic estrogen in bone, reducing bone resorption without stimulating breast or uterine tissue

51
Q

What are common side effects of SERMs?

A

-Hot flashes
-Leg cramps
-Increased risk of venous thromboembolism

52
Q

What is a common SERM used to treat osteoporosis?

A

Raloxifene

53
Q

What is the mechanism of action of calcitonin?

A

Inhibits osteoclast activity

54
Q

What are common side effects of calcitonin?

A

-Nasal irritation (with nasal spray)
-Hot flashes

55
Q

What is a common calcitonin used to treat osteoporosis?

A

-Miacalcin
-Salmon calcitonin

56
Q

What is the mechanism of action of parathyroid hormone analogs?

A

Stimulates osteoblast activity

57
Q

What are common side effects of parathyroid hormone analogs?

A

-Leg cramps
-Dizziness
-Nausea

58
Q

What are common parathyroid hormone analogs used to treat osteoporosis?

A

-Teriparatide
-Abaloparatide

59
Q

What is the mechanism of action of monoclonal antibodies for osteoporosis?

A

Binds and inhibits RANKL, reducing osteoclast activity

60
Q

What are some common side effects of monoclonal antibodies used to treat osteoporosis?

A

-Skin reaction at the injection site
-Osteonecrosis of the jaw
-Hypocalcemia

61
Q

What is a common monoclonal antibody that is used to treat osteoporosis?

A

Denosumab (Prolia, Xgeva)

62
Q

How does low levels of vitamin D effect PTH?

A

Low levels of vitamin D can stimulate the parathyroid gland to produce more PTH (secondary hyperparathyroidism)

63
Q

What is the role of calcium in bone?

A

It forms hydroxyapatite crystals, which gives bone its hardness

64
Q

What are PT considerations for patients taking bisphosphonates?

A

-Be aware of GI issues
-Have pt take medication at least 1 hour prior to session
-Rare risk of atypical femur fracture or osteonecrosis of the jaw

65
Q

What are PT considerations for patients taking SERMs?

A

-Hot flashes or leg cramps
-Watch for signs of venous thromboembolism

66
Q

What are PT considerations for patients taking calcitonin?

A

Monitor for nasal irritation side effects

67
Q

What are PT considerations for patients taking parathyroid hormone analogs?

A

Monitor for leg cramps and dizziness

68
Q

What are PT considerations for patients taking monoclonal antibodies?

A

-Monitor for joint pain: back and/or arm or leg pain
-Pts may have low calcium levels

PHTH 561: Pharmacology (7 decks)

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