Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pharmacodynamics > Inflammatory Arthritis > Flashcards

Inflammatory Arthritis Flashcards

1
Q

What is rheumatoid arthritis?

A

A chronic inflammatory autoimmune disease characterised by inflammation of the synovial joints.
This results in use-related pain, stiffness and loss of movement in the affected joints.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is rheumatoid factor?

A

Is a protein produced by the immune system that can attack healthy tissue in the body.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What increases in the blood when there is inflammation in the body?

A 
CRP = C-reactive protein
ESR = Erthyrocyte sedimentation rate (ESR)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What does the ESR indicate?

A

The inflammatory activity in the body.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What does the CRP measure?

A

Blood test marker for inflammation in the body,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Explain the synovial joint inflammation process.

A

increased production of inflammatory proteins leads to enzymes activated that destroys the lining of the joint.
Which exposes the underlying bone resulting in pain.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the synovium?

A

connective tissue that lines inside of the joint capsule.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the risk factors of RA?

A

Genetics - predisposition
Lifestyle - smoking (causes faster loss of bone density), overweight
Gender - Women are more likely to develop RA than men.
Infection - Bacterial and viral DNA has been found in synovial membrane

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what % of the population does RA affect?

A

0.5 - 1% of population, predominately women.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what are the 4 domains (criteria) in determining rheumatoid arthritis?

A
  • Joint involvement
  • Duration of synovitis
  • Acute phase reactants
  • Serology
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the current tests available for RA?

A 
Rheumatoid factor 
Anti-CCP antibodies
ESR
CRP
DAS scores
Ultrasound/MRI and X-rays to assess synovitis/angiogenesis/erosions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is a DAS score?

A

Disease Activity Score is a measure of disease activity in RA.
- Count the number of swollen joints (out of 28)
- Count the number of tender joints (out of 28)
The score ranges between 2.0 - 10.0

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What DAS score is considered ‘in remission’

A

less than < 2.6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What DAS score indicates low disease activity?

A

less than < 3.2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What does a DAS score greater than 5.1 imply?

A

active disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What substances in the blood indicates RA?

A

Anti-CCP antibodies

Rheumatoid factor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What do NSAID drugs act on?

A

Inhibit COX-1 and COX-2 inhibitors of the inflammatory pathway.
Also has an impact on the gastro-protective pathways

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What pain relief would be the first treatment choice for a patient who is breastfeeding?

A

Ibuprofen

Diclofenac

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

List non-selective Cox NSAIDs -

A 
Ibuprofen 
Naproxen 
Diclofenac
Indomethacin 
Piroxicam
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

List Cox-2 selective NSAIDs -

A

Celecoxib

Meloxicam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Why are patients with a higher risk of cardiac events not recommended Cox-2 selective NSAIDs?

A

COX-2 has a role in platelet function - inhibition of COX-2 LEADS TO MORE FREQUENT THROMBO-EMBOLIC EVENTS. = more myocardial infarctions
should only be used short term

22
Q

What is the main cause of GI morbidity with NSAIDs use?

A

Gastric erosions

Gastric ulcers

23
Q

Where are the adverse effects of NSAIDs?

A

Renal

GI tract

24
Q

Why is non cox-2 selective NSAIDs better?

A

More efficacious

25
Q

What other drug is given with Cox-2 inhibitor (cost-effective)

A

Proton pump inhibitor

26
Q

What happens when NSAIDs target the cox-2 pathway?

A

Anti-inflammatory effects without GI side effects.

Leads to more thrombosis-embolic events

27
Q

What are the adverse effects of NSAIDs in the GI tract?

What is the cause of this?

A

Dyspepsia (indigestion)
Nausea
Vomiting
Haemorrhage

Inhibition of protective action of PG’s on gastric mucosa
PGE2 and PGI2 inhibit gastric acid secretion

28
Q

What are the adverse effects of NSAIDs on Renal function, what is its cause?

A

Renal failure
Nephritis
Nephrotoxicity
Due to the inhibition of PGE2 and PGI2 mediated vasodilation of renal medulla and glomeruli and decreased creatinine clearance

29
Q

What are the other side effects of NSAIDs and the cause

A

Bronchospasm
Skin rash
Allergic reactions

Due to hypersensitivity

30
Q

What is bronchospasm?

A

Airways (bronchial tubes) go into spasm and contract

Due to irritation, inflammation or an allergic reaction of the airways

31
Q

Why are corticosteroids used in RA?

A

Corticosteroids are anti-inflammatory and immunosuppressive, they can provide fast, temporary relief while waiting for DMARDs and biologics to take effect

32
Q

What is methotrexate?

A

DMARD (Disease modifying anti-rheumatic drugs)

it inhibits dihydrofolate reductase

33
Q

What is monotherapy?

A

The treatment of disease with a single drug.

In the case of RA, treatment with one DMARD

34
Q

What is combination therapy?

A

When 2 or more drug therapies are given together to improve the outcome

35
Q

Give examples of DMARDs:

A

Methotrexate
Sulphasalazine
Leflunomide
Azathiprine

36
Q

What are the adverse effects of methotrexate that need close monitoring?

A

Bone marrow toxicity
Hepatic toxicity
Pulmonary involvement - pneumonitis
Mouth ulcers

37
Q

What does the tumour necrosis factor (TNF) do?

A

Drives the inflammatory pathway.

Blocks the co-factors from being produced

38
Q

What are the 3 anti- TNF (alpha) drugs that are widely used/ available?

A

Infiximab
Adalimumab
Ethanercept

39
Q

What is rheumatoid factor?

A

IgM antibody to IgG
Can be detected in certain assays

Its also found in 5% of healthy controls

It can be found in other conditions such as infections and malignancy

RF is a feature of polyclonal B cell activation

40
Q

What are some properties of Anti-CCP antibodies? (made of)

A

detects the citrullination of arginine in proteins.

arginine residue (+ve charged) is changed to citrulline residue (neutral) mediated by Peptidylarginine deiminase (PAD) enzymes

Sensitive test for RA, if detected it could mean a patient has a more erosive and aggressive disease

41
Q

What is thromboxin A2 involved in? (COX 1 & 2)

A

Platelet aggregation

42
Q

What is PGI2 involved in?(COX 1 & 2)

A

Gastro-protection

43
Q

What is PGE2 involved in?(COX 1 & 2)

A

Inflammation and pain

44
Q

What are the Leukotrienes involved in?

A

Inflammation and the development of gastric lesions

45
Q

What are the main effects of NSAIDs in the gut?

A

Reduce mucus and bicarbonate production

46
Q

Why are corticosteroids used in RA?

A

They bind to the corticosteroid receptor
The complex translocates to nucleus
Binds to the glucocorticoid response element
Increases trascription of anti-inflammatory genes.
inhibits pro-inflammatory mediators

47
Q

What is the target of the biologic Tocilizumab?

A

Anti-IL-6

48
Q

What is the target of the biologic Rituximab?

A

B cell depletion

49
Q

What is the target of the biologic Anakinra?

A

Anti-IL-1

50
Q

What is the total cost of RA in the Uk per year?

A

£3.8 - £4.75 billion

Pharmacodynamics (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions