Pharmacology

Question 1

Types of NSAID

Answer 1

Ibuprofen Niproxen

Question 2

Indications for NSAID use

Answer 2

Inflammatory arthritis, gout, mechanical muscoskeletal pain, pericardial/pleuritic pain.

Question 3

NSAID side effects

Answer 3

Peptic ulcer, Small/large bowel ulcer, gastritis, dyspepsia, oesophagitis.

Question 4

NSAID contraindications

Answer 4

Renal impairment, fluid retention , increased CV risk, wheeze, rash

Question 5

DMARDs

Answer 5

Disease Modifying Anti Rheumatic Drugs
Only anti-inflammatory action
Weeks to months before effective

Question 6

Common DMARDs

Answer 6

Methotrexate, sulphasalazine, hydroxychloroquine

Question 7

Methotrexate

Answer 7

First line in most cases, folate antagonist

Question 8

Methotrexate administration

Answer 8

Orally or subcutaneously

Question 9

Methotrexate uses

Answer 9

Rheumatoid, psoriatic arthritis, Connective tissue disorder, vasculitis

Question 10

Methotrexate side effects

Answer 10

Leucopenia, thrombocytopenia, hepatitis/cirrhosis, pneumonitis, mouth ulcers, Nausea, diarrhoea and requires monthly blood samples.

Question 11

Methotrexate in the young

Answer 11

It is teratogenic so must be removed three months before conception.

Question 12

Sulphasalazine

Answer 12

Used in conjunction with methotrexate in early inflammatory arthritis

Question 13

Sulphasalazine side effects

Answer 13

Nausea, rash, mouth ulcers, reversible oligozoospermia (low sperm count), hepatitis, neutropenia so requires monthly blood tests

Question 14

Hydroxychloroquine

Answer 14

No effect on joint damage but used in connective tissue disorders like SLE or sjogrens.
Recognised but rarely used in retinopathy

Question 15

Sodium aurothiomalate

Answer 15

Given IM

Glomerulonephritis, mouth ulcers, rash, bone marrow suppression

Question 16

Anti-TNF

Answer 16

Used in rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis

Question 17

Anti TNF criteria

Answer 17

High disease activity score

Previous ineffective use of DMARDs

Question 18

Anti TNF names

Answer 18

Infliximab, adalimumab

Question 19

Anti TNF risks

Answer 19

Increased risk of infection
Reactivation of latent TB
Increased risk of malignancy especially skin

Question 20

Anti TNF contraindications

Answer 20

Don’t use in heart failure and Pulmonary fibrosis

Question 21

Monoclonal antibody against CD 20 B cells

Answer 21

Rituximab

Question 22

Il-6 blocker

Answer 22

Tocilizumab

Question 23

CTLA-4 Ig blocking T cell activation

Answer 23

Abatacept

Question 24

IL-12 IL-23 blocker

Answer 24

Ustekinumab

Question 25

Il-17 blocker

Answer 25

Secukinimab

Question 26

Acute Gout

Answer 26

Colchicine, NSAIDs, Steroids

Question 27

Gout prophylaxis

Answer 27

Allopurinol, febuxostat, uricosurics

Question 28

Allopurinol mode of action

Answer 28

Xanthine oxidase inhibitor

Question 29

Allopurinol side effects

Answer 29

2-4 weeks post acute as rapid reduction in uric acid levels can cause worsening of acute symptoms.
Rash and vasculitis is elderly and renal impaired
Rarely causes marrow aplasia

Question 30

Allopurinol contraindications

Answer 30

Can interact with azathioprine

Question 31

Febuxostat

Answer 31

Xanthine oxidase inhibitor for those who can’t tolerate allopurinol.
Caution with iscaemic heart disease

Question 32

Uricosurics

Answer 32

Probenecid, Sulphinpyrazone

Question 33

Corticosteroids

Answer 33

Used in Rheumatoid arthritis, Polymyalgia rheumatic, Giant cell arteritis, Vasculitis, Connective tissue disorders

Question 34

Corticosteroid side effects

Answer 34

Weight gain, muscle wasting, skin atrophy, osteoporosis diabetes, hypertension.

Question 35

Corticosteroids contraindications

Answer 35

Glaucoma, immunosupression, avascular necrosis, fluid retention, adrenal suppression.