DRUGS: GOUT/OA/RA

Question 1

pain killers/anti inflammatory meds used for gout

Answer 1

NSAIDs: naproxen, indometacin, celecoxib
steroid: prednisolone

Question 2

Allopurinol MOA, use

Answer 2

MOA: anti-hyperuricemic agent–> decrease uric acid production

Use: GOUT, chronic erosive arthritis, kidney stones

Question 3

Allopurinol S/E, cautions

Answer 3

skin rash, jaundice
n&v, abdo pain, diarrhoea
fever, sore throat
dak urine

allopurinol hypersensitivity syndrome (AHS)
severe cutaneous adverse reaction (SCAR) [risk: renal impairment, thiazide therapy]

Question 4

probenecid MOA, use

Answer 4

Use: GOUT (increasing attack frequency, contraindicated for allopurinol)

MOA: inhibit proximal tubule anion transport, inhibit uric acid reabsorption, increase uric acid secretion

Question 5

probenecid S/E, cautions

Answer 5

n&v
painful urination
lower back pain
rash, allergic reactions

increase fluid intake to prevent renal stone formation
maintain urine pH >6 (administer alkaline eg K citrate)

Question 6

colchicine use, MOA

Answer 6

use: GOUT

MOA: anti inflammatory. inhibit leukocyte migration & phagocytosis, inhibit prostaglandin production

relieves pain & inflammation in 24-46h

Question 7

colchicine S/E

Answer 7

diarrhoea, n&v, abdo pain
muscle weakness
unusual bleeding
change in urine amount
pale lips

Question 8

OSTEOARTHRITIS pain meds/NSAIDs

Answer 8

paracetamol, diclofenac (nonselective), celecoxib (COX-2 inhibitor), corticosteroids

Question 9

intra articular hyaluronic acid use, MOA

Answer 9

use: OSTEOARTHRITIS

MOA: shock absorption, traumatic energy dissipation, protective coating of cartilage, lubrication, decrease pain & stiffness

Question 10

methotrexate class, use, MOA

Answer 10

class: conventional systemic (CS) DMARD

use: RHEUMATOID ARTHRITIS
- long–term efficacy, acceptable toxicity, low cost
- combined with other DMARDs for optimal effect
- SC, IM, oral (variable absorption)

MOA: increase extracellular adenosine –> antiproliferative effect on T cells, inhibits macrophage function

Question 11

Methotrexate S/E

Answer 11

n&v
mouth & GI ulcers
hair thinning
leukopenia, hepatic fibrosis, pneumonitis

Question 11

how to minimise methotrexate s/e

Answer 11

concomitant folic acid 12-24 hours after (giving @ same time affects drug absorption)

Question 11

Hydroxychloroquine class, use

Answer 11

class: csDMARD

use: RHEUMATOID ARTHRITIS
- best tolerated

Question 11

Hydroxychloroquine S/E

Answer 11

n&v, stomach pain
dizziness
hair loss
ocular toxicity

Question 11

Tofacitinib class, use

Answer 11

class: targeted synthetic DMARD

use: RHEUMATOID ARTHRITIS
- combined with MTX for mod-severe RA
- monotherapy if intolerant to MTX

Question 12

Tofacitinib S/E

Answer 12

• cytopenia (neutrophils, lymphocytes, platelets, NK)
• immunosuppression → opportunistic infections (eg herpes zoster)
• anaemia
• HDL

Question 13

Which DMARDs cannot be used together

Answer 13

tsDMARDs (Tofacitinib) & bDMARDs (Infliximab)

Question 14

Infliximab class, use

Answer 14

class: biological DMARD

use: RHEUMATOID ARTHRITIS
- poor response to tsDMARDs
- combine with MTX for optimal effecct

Question 15

Infliximab S/E, contraindications

Answer 15

resp & skin infection
↑ risk for lymphoma
optic neuritis
exacerbate: multiple sclerosis, leukopenia, aplastic anemia

contraindication: live vaccines, hep B
monitor: screen for latent/active TB