IC13

Question 1

Drug treatment for osteoarthritis

Answer 1

1. Paracetamol, NSAIDs, corticosteroids
2. Intra-articular hyaluronic acid

Question 2

Gouty arthritis: More prevalent in men or women?

Answer 2

Men

Question 3

Drugs that could induce hyperuricemia

Answer 3

• thiazide/ loop diuretics
• ciclosporin
• low dose aspirin

Question 4

Drugs for acute gouty attack

Answer 4

1. NSAID
2. Glucocorticoid e.g. prednisolone
3. Colchicine

Question 5

Drugs for prevention of gouty episode

Answer 5

1. Uric acid synthesis inhibitor e.g. xanthine oxidase inhibitors (allopurinol, febuxostat)
2. Uricosuric agent e.g. probenecid

Question 6

When should colchicine be given for acute gouty attack?

Answer 6

Within 24-36 of presentation

Question 7

Side effects of colchicine

Answer 7

Diarrhea, N/V, abdominal pain, unusual bleeding, pale lips, change in urine amt

Question 8

Side effects of allopurinol / febuxostat

Answer 8

Skin rash, N/V, diarrhea, fever, sore throat, stomach pain, dark urine, jaundice

Question 9

MOA of colchicine

Answer 9

1. Binds to tubulin
2. Prevent tubulin polymerisation into microtubules
3. Inhibits leukocyte migration and phagocytosis
4. Inhibits leukotriene B4 and prostaglandin production

Question 10

MOA of uricosuric agents

Answer 10

Inhibits solute carrier family 2 & 22 -> inhibits uric acid reabsorption & increases uric acid excretion

Question 11

MOA of xanthine oxidase inhibitor

Answer 11

Binds to xanthine oxidase -> reduces production of xanthine and uric acid

Question 12

Side effects of uricosuric agents

Answer 12

N/V, painful urination, lower back pain, allergic rxn e.g. rash

Question 13

When taking uricosuric agents, take ___

Answer 13

plenty of fluids (to minimise renal stone formation)

Question 14

Approach to therapy for RA

Answer 14

1. csDMARD (usually methotrexate)
2. non-JAK inhibitor (bDMARD)
3. JAK inhibitor

Question 15

RA is more common in men or women?

Answer 15

Women

Question 16

Types of bDMARD

Answer 16

1. Anti-TNF mAb (infliximab)
2. Anti-IL1 receptor (anakinra)
3. Anti-IL6 receptor mAb (tocilizumab)

Question 17

MOA: methotrexate

Answer 17

Major action: Incr adenosine levels
Minor action: Inhibits DHFR and TS
Overall effect: Anti-proliferative effects on T cells and inhibition of macrophage fn -> decr in inflammatory cytokines

Question 18

How to minimise side effects of methotrexate

Answer 18

Give folic acid/ folinic acid 12-24h after methotrexate

Question 19

Side effects of methotrexate

Answer 19

N/V, mouth and GI ulcer, hair thinning, leukopenia, hepatic fibrosis, pneumonitis

Question 20

What to use for rescue of methotrexate toxicity (due to DHFR inhibition)

Answer 20

Folinic acid/ folinate

Question 21

Which csDMARD have very long half-life (years)?

Answer 21

Leflunomide

Question 22

MOA of tofacitinib

Answer 22

Inhibits JAK pathway -> blocks cytokine production

Question 23

Side effects of tofacitinib

Answer 23

Immunosuppression, cytopenia, anaemia, hyperlipidemia

Question 24

bDMARDs cannot be combined with ____

Answer 24

tsDMARDs

Question 25

Contraindication for bDMARD

Answer 25

Live vaccination, hep B

Question 26

MOA for leflunomide

Answer 26

Inhibits dihydroorotate dehydrogenase -> decrease pyrimidine synthesis & growth arrest at G1 phase.
Inhibit T cell & B cell autoantibody production.