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MSK > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

Describe the steps of pain control

A
  1. non opioid (eg aspirin, paracetamol or NSAID +/- adjuvant)
  2. weak opioid for mild to moderate pain (eg codeine)
  3. strong opioid for moderate to severe pain (eg morphine)
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2
Q

Describe NSAIDs

A
  • anti inflammatory

- analgesic

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3
Q

Name examples of NSAIDs

A
  • ibuprofen
  • naproxen
  • diclofenac
  • indometacin
  • etodolac
  • celecoxib (cox 2 inhibitor)
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4
Q

Name indications for NSAIDs

A
  • inflammatory arthritis
  • mechanical musculoskeletal pain
  • pleuritic / pericardial pain
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5
Q

Name some side effects of NSAIDs

A
  • peptic ulceration
  • renal impairment
  • increased CV risk
  • exacerbation of asthma
  • dyspepsia
  • oesophagitis
  • small / large bowel ulceration
  • fluid retention
  • wheeze
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6
Q

Ideally when should DMARD therapy be started in rheumatoid arthritis?

A

Within 3 months of symptoms starting

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7
Q

Describe the DMARDs

A
  • slow acting, weeks to months
  • pure anti-inflammatory with no direct analgesic effect
  • improve standard lab tests of inflammation
  • reduce rate of joint damage
  • most need regular monitoring for adverse effects
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8
Q

Name some commonly used DMARDs

A
  • methotrexate
  • sulphasalazine
  • leflunomide
  • hydroxychloroquine
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9
Q

Describe methotrexate

A
  • mode of action unknown
  • folate antagonist
  • first choice DMARD in most patients
  • can be given orally or subcutaneously
  • often used in combination
  • used in RA, psoriatic arthritis, connective tissue disease and vascultiis
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10
Q

Describe methotrexate adverse effects

A
  • leucopenia / thrombocytopenia
  • hepatitis / cirrhosis
  • pneumonitis
  • rash / mouth ulcers
  • nausea / diarrhoea
  • need monitoring of FBC and LFTs
  • co prescribed with folic acif
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11
Q

What is the most important side effect of methotrexate in females?

A
  • teratogenic
  • must be stopped in females of childbearing age at least 3 months before conception
  • generally safe to continue in males
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12
Q

Describe leflunomide

A
  • similar efficacy to methotrexate
  • similar side effects
  • also teratogenic
  • very long half life, so requires wash out
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13
Q

Describe sulfasalazine

A

Often used in combination with methotrexate in early inflammatory arthritis

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14
Q

Describe the adverse effects of sulfasalazine

A
  • nausea
  • rash / mouth ulcers
  • neutropenia
  • hepatitis
  • reversible oligozoospermia
  • monitoring of FBC and LFTs
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15
Q

Describe hydroxychloroquine

A
  • no effect on joint damage
  • used in connective tissue disease such as SLE (helps skin, joints and general malaise) sjogrens syndrome and RA
  • retinopathy; recognised but rare
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16
Q

Describe the biologics

A
  • drugs designed to target specific aspects of immune system found to be implicated in inflammatory arthritis
  • targets include; TNF, cd 20 b cells, IL 6, IL 17, 12 and 23
17
Q

Describe anti-TNF therapy

A
  • licensed for RA, psoriatic arthritis and akylosing spondylitis
  • about 1.5 times as effective as standard DMARDs
  • more effective in combination with DMARDs
  • majority given by sub-cutaneous injection
18
Q

Name some examples of anti-TNF

A
  • etanercept
  • adalimumab
  • certolizumab
  • infliximab
  • golimumab
  • biosimilars; benepali, amgevita
19
Q

Describe adverse effects of anti-tnf therapy

A
  • risk of infection (esp TB)
  • question over risk of malignancy (esp skin cancer)
  • contraindicated in certain situations eg pulmonary fibrosis, heart failure
20
Q

Describe treatment of an acute episode of gout

A
  • colchicine (diarrhoea common)
  • NSAIDs
  • steroids, either oral or IM
21
Q

Name some urate lowering drugs

A
  • allopurinol
  • febuxostat
  • uricosurics
22
Q

What is allopurinol?

A
  • xanthine oxidase inhibitor

- rapid reduction in uric acid level may result in exacerbation gout

23
Q

Describe febuxostat

A
  • also xanthine oxidase inhibitor
  • those who cannot tolerate allopurinol
  • renal impairment
  • avoid in patients with ischaemic heart disease
24
Q

Name the uricosurics

A
  • probenecid
  • sulphinpyrazone
  • azapropazone
  • benzbromarone
25
Q

Describe indications for corticosteroids

A
  • inflammatory arthritis
  • polymyalgia rheumatica / giant cell arteritis
  • vasculitis
26
Q

Describe modes of administration of corticosteroids

A
  • oral
  • intra-articular
  • soft tissue injections
  • intramuscular
  • IV
27
Q

Describe the adverse effects of corticosteroids

A
  • weight gain; centripetal obesity
  • muscle wasting
  • skin atrophy
  • osteoporosis
  • diabetes
  • hypertension
28
Q

Describe the adverse effects of corticosteroids

A
  • cataract
  • glaucoma
  • fluid retention
  • adrenal suppression
  • immunosuppression
  • avascular necrosis of the femoral head

MSK (10 decks)

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