Pharmacology arthritis

Question 1

Paracetamol is dangerous in overdose T/F

Answer 1

T

Question 2

Step 1 RA

Answer 2

Non-opiod ( e.g. aspirin, paracetamol or NSAIDs) +- adjuvant

Question 3

Step 2 RA

Answer 3

Weak opiod for mild to moderate pain (e.g. codine)
+- non-opioid
+- adjuvant

Question 4

Step 3 RA

Answer 4

Strong opiod for moderate to severe pain (e.g morphine)
+- non-opiod
+- adjuvant

Question 5

What are the side effects of NSAIDs

Answer 5

peptic ulcer
dyspepsia
oesophagitis
small/large bel ulceration
renal impairment
Increased cardiovascular risk
Exacerbation of asthma
fluid retention
rash

Question 6

In a patient with newly diagnosed RA which is the best treatment choice?

Answer 6

Methotrexate(about 6 weeks to take effect)

can be given orally or subcut

Question 7

What are DMARDS

Answer 7

SLOW ACTING
PURE ANTI-INFLMMATORY
NO DIRECT ANALGESIC EFFECT
NAUSEA COMMON, CAN CAUSE HEP

Question 8

When are DMARDs indicated

Answer 8

JOITN INFLAMMATION- where treating it will provide more benefit than the side effects

Question 9

What is the problem with pregnancy and methotrexate

Answer 9

Teratogenic- must be stopped 3 months before conception for men and women

Question 10

What are methotrexate adverse effects?

Answer 10

Leucopenia/thrombocytopenia
Hepatitis/cirrhosis
Pneumonitis
Rash/mouth ulcers
Nausea/diarrhoea
Needs monitoring of FBC and LFTs

Question 11

What are the adverse effects of sulfasalazine?

Answer 11

nausea
RASH/MOUTH ULCERS
nEUTROPENIA
hEPATITIS
reversible oligozoospermia

Question 12

What is the negative of leflunomide?

Answer 12

Very long half life so requires wash out

Question 13

What are biologics?

Answer 13

Drugs designed to target specific aspects of immune system found to be implicated in inflammatory arthritis

Question 14

Biologics are more effective than DMARDs T/F

Answer 14

T

Question 15

Biologics are cheaper than DMARDs T/F

Answer 15

F

Question 16

What is Anti-TNF therapy licensed for?

Answer 16

RA
Psoriatic arthiritis
ankylosing spondylitis

Question 17

What is the criteria for Anti-TNF

Answer 17

DAS 28 (5.1 or higher)
Use of previous standard DMARDs

Question 18

Anti-TNF

Answer 18

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

Question 19

What are the two components to gout treatment

Answer 19

Acute episode

Prophylaxis

Question 20

Which is used to treat gout in the long term and SHOULD NOT TRAET AN ACUTE FLATRE

Answer 20

Allopurinol

Question 21

What should be used in an acute episode of gout?

Answer 21

Colchicine ( diarrhoea common)
NSAIDs
Steroids, either oral or IM

Question 22

What do you use as gout prophylaxis

Answer 22

Allopurinol
Febuxostat
Uricosurics

Question 23

What must you not co-prescribe

Answer 23

azothioprne and allopurinol

Question 24

Indications for corticosteroids

Answer 24

Connective tissue disease
Polymyalgia rheumatoica/ giant cell arteritis
Vasculitis
RA

Question 25

Corticosteroids ( 5 fun facts)

Answer 25

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

Question 26

If on 3 DMARDs and have high disease acitity what would you add in?

Answer 26

Start anti-TNF therapy

Question 27

Sulphasalazine is safe in pregnancy T/F

Answer 27

T

Question 28

Once pregnant, inflammatory arthritis may improve.

Answer 28

T