F - MSK: Drugs for Arthritis and Gout Flashcards
WONT TEST ALL THE DRUGS IN DETAIL: must know generally!!!
Drugs for Arthritis and Gout:
Rheumatoid arthritis:
* csDMARDs: methotrexate
* tsDMARDs: tofacitinib
* bDMARDs: infliximab
Gout and Hyperuricaemia:
* Uric acid synthesis inhibitors:
allopurinol
* Uricosuric agents: probenecid
* Leucocyte motility inhibitors:
colchicine
Osteoarthritis:
* Intra-articular hyaluronic acid
Drugs for Gouty Arthritis
Treatment of
acute attacks
* NSAIDs (inc. coxibs)/corticosteroids
* have anti‐inflammatory and analgesic
* Colchicine
* reduces leucocyte migration into joints
Do not start during acute attacks
Uric acid synthesis inhibitors
* e.g., allopurinol and febuxostat
* inhibit uric acid synthesis
* Uricosuric agents
* e.g., probenecid
* increase uric acid excretion
both used to Prevent recurrence
What can be done to reduce the risk of precipitating acute gouty attack when starting uric acid synthesis inhibitors or uricosuric agents?
Combine with low dose NSAID or colchicine
mechanisms of action of colchicine
Binds tubulin
Prevent tubulin polymerization into microtubules
Inhibits leukocyte migration and phagocytosis
Inhibits leukotriene B4 (LTB4) and prostaglandin (PG) production
Relieves pain and inflammation of acute gouty attack within 24-36 hours
What are the adverse effects of colchicine?
Diarrhoea and GIT disturbance.
At higher doses, binding tubulin and preventing microtubule polymerization prevents cell proliferation.
abdominal pain, muscle weakness, unusual bleeding, pale lips, and change in urine amount
MOA of Uric acid synthesis inhibitors? Name the 1st line drug used.
‐Anti‐hyperuricemic agents
‐↓Uric Acid Production
THREE risk factors for allopurinol causing severe cutaneous adverse reaction
Renal impairment
HLA‐B*58:01 genotype
Thiazide therapy
Side effects of allopurinol
skin rash, nausea & vomiting, diarrhea, fever, sore throat, stomach pain, dark urine, jaundice
When are Uricosuric Agents used? Name the 1st line drug used.
Whats the MOA of probenecid?
‐inhibits proximal tubule anion transport
‐inhibits uric acid re‐absorption
‐increases uric acid excretion
Precautions:
‐take plenty of fluid to minimize renal stone formation
‐keep urine pH >6.0 by administration of alkaline (e.g., potassium citrate
- Side effects:
‐Nausea & vomiting, painful urination, lower back pain, allergic reactions, rash
What does SYSADOA stand for? Name.
Symptomatic Slow-acting Drug for Osteoarthritis
Intra-articular hyaluronic acid
mechanisms of action of intra-articular hyaluronic acid
Hyaluronic acid (HA) is a large glycosaminglycan (naturally in synovial fluid)
● Shock absorption, traumatic energy dissipation, protective coating of cartilage, lubrication, reduces pain & stiffness
