Pharmacology arthritis Flashcards
Paracetamol is dangerous in overdose T/F
T
Step 1 RA
Non-opiod ( e.g. aspirin, paracetamol or NSAIDs) +- adjuvant
Step 2 RA
Weak opiod for mild to moderate pain (e.g. codine)
+- non-opioid
+- adjuvant
Step 3 RA
Strong opiod for moderate to severe pain (e.g morphine)
+- non-opiod
+- adjuvant
What are the side effects of NSAIDs
peptic ulcer dyspepsia oesophagitis small/large bel ulceration renal impairment Increased cardiovascular risk Exacerbation of asthma fluid retention rash
In a patient with newly diagnosed RA which is the best treatment choice?
Methotrexate(about 6 weeks to take effect)
can be given orally or subcut
What are DMARDS
SLOW ACTING
PURE ANTI-INFLMMATORY
NO DIRECT ANALGESIC EFFECT
NAUSEA COMMON, CAN CAUSE HEP
When are DMARDs indicated
JOITN INFLAMMATION- where treating it will provide more benefit than the side effects
What is the problem with pregnancy and methotrexate
Teratogenic- must be stopped 3 months before conception for men and women
What are methotrexate adverse effects?
Leucopenia/thrombocytopenia Hepatitis/cirrhosis Pneumonitis Rash/mouth ulcers Nausea/diarrhoea Needs monitoring of FBC and LFTs
What are the adverse effects of sulfasalazine?
nausea RASH/MOUTH ULCERS nEUTROPENIA hEPATITIS reversible oligozoospermia
What is the negative of leflunomide?
Very long half life so requires wash out
What are biologics?
Drugs designed to target specific aspects of immune system found to be implicated in inflammatory arthritis
Biologics are more effective than DMARDs T/F
T
Biologics are cheaper than DMARDs T/F
F
What is Anti-TNF therapy licensed for?
RA
Psoriatic arthiritis
ankylosing spondylitis
What is the criteria for Anti-TNF
DAS 28 (5.1 or higher) Use of previous standard DMARDs
Anti-TNF
Works by suppressing part of the immune system therefore increased risk of infection
Increased risk of skin can er
exacerbation of heart failure
reactivation of latent TB
What are the two components to gout treatment
Acute episode
Prophylaxis
Which is used to treat gout in the long term and SHOULD NOT TRAET AN ACUTE FLATRE
Allopurinol
What should be used in an acute episode of gout?
Colchicine ( diarrhoea common)
NSAIDs
Steroids, either oral or IM
What do you use as gout prophylaxis
Allopurinol
Febuxostat
Uricosurics
What must you not co-prescribe
azothioprne and allopurinol
Indications for corticosteroids
Connective tissue disease
Polymyalgia rheumatoica/ giant cell arteritis
Vasculitis
RA
Corticosteroids ( 5 fun facts)
Can cause loss of bone density
May contribute to the development of diabetes
Can be effective in rapidly controlling inflammatory disease
Should be used for a short a time as possible
They make you fat
If on 3 DMARDs and have high disease acitity what would you add in?
Start anti-TNF therapy
Sulphasalazine is safe in pregnancy T/F
T
Once pregnant, inflammatory arthritis may improve.
T
