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Musculoskeletal > Pharmacology in Arthritis > Flashcards

Pharmacology in Arthritis Flashcards

1
Q

Disease modifying drugs in arthritis

A

DMARDS, Biologics

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2
Q

DMARDS used in Arthritis?

A

Methotrexate
Sulfasalazine
Hydroxychloroquine

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3
Q

Biologics used in arthritis?

A

Anti-TNF
Rituximab
Tocilizumab

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4
Q

Name a pure analgesic

A

Paracetemol

anti-pyretic, little anti-inflamm effect

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5
Q

Analgesics

A 
Co-codamol
Dihydrocodeine
Tramadol
Amitryptiline
Gabapentin
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6
Q

Properties of NSAIDS

A

Anti-inflammatory
Analgesic
Antipyretic
Antiplatelet

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7
Q

Adverse effects of NSAIDS?

A 
Ulceration, oesophagitis, gastritis etc
Renal impairment
Increased cardiovascular events (Cox 2 inhibitors + others)
Fluid retention
Wheeze
Rash
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8
Q

Are DMARDS slow acting?

A

Yes (weeks - months)

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9
Q

Do DMARDS have any analgesic effect?

A

No! Purely anti-inflammatory
Improve standard laboratory tests of inflammation e.g.ESR, CRP
Reduce rate of joint damage

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10
Q

What kind of drug might improve standard laboratory tests of inflammation (e.g. ESR and CRP)

A

DMARDS

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11
Q

How quickly do you want to try and get someone with arthritis onto DMARDS?

A

Within 3 months of symptoms

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12
Q

Vaccines and DMARDS?

A

Vaccines should be given before DMARDS are started

-Live vaccines should not be given

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13
Q

DMARDS of choice?

A

Sulfasalazine, methotrexate
(remember DMARD combination therapy!! both together!!)
Make it intensive!

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14
Q

Methotrexate is an antagonist of what?

A

Folate

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15
Q

How can methotrexate be given?

A

Orally or subcutaneously

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16
Q

What is thrombocytopenia?

A

Deficiency of platelets, this can cause bleeding into tissues, bruising and slow blood clotting after injury

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17
Q

Adverse effects of methotrexate

A 
TERATEGENIC (STOP 3MONTHS BEFORE 
Myelotoxicity, fibrosing alveolitis
Leucopenia / thrombocytopenia 
Hepatitis / cirrhosis (alcohol intake must be limited)
Pneumonitis
Rash / mouth ulcers
Nausea / diarrhoea
Needs monitoring of FBC and LFTs
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18
Q

Why should alcohol intake be limited when on methotrexate?

A

Methotrexate can cause cirrhosis/hepatitis

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19
Q

Why do you need to monitor LFTS and FBC when you’re on methotrexate?

A

Methotrexate can cause cirrhosis/hepatitis, leucopania and thrombocytopenia (and others)

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20
Q

What is sulfasalazine?

A

An azo ester of sulfapyridine and 5-aminosalicylic acid

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21
Q

Which DMARD can cause neutropenia?

A

Sulfasalazine

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22
Q

Which DMARD can cause reversible oligozoospermia?

A

Sulfasalazine

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23
Q

Effects of Hydroxycloroquine

A

No effect on joint damage

Used in connective tissue diseases such as SLE (helps skin, joints and general malaise), Sjogrens and RA

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24
Q

Rare adverse effect of hydroxychloroquine?

A

Retinopathy

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25
Q

Name a DMARD which can help in SLE and its effects

A

Hydroxychloroquine (helps skin, joints and general malaise)

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26
Q

Side effects of sulfasalazine?

A 
Oligospermia
Myelotoxicty, hepatotoxicity, hypersensitivity reactions
Nausea
Neutropania
Hepatitis
Rash/Mouth Ulcers
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27
Q

Anti-TNF that can be given intravenously?

A

Infliximab

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28
Q

Subcutaneous Anti-TNF therapies?

A

Etanercept
Adalimumab
Certolizumab
Golimumab

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29
Q

What can anti-TNF therapy be used in?

A

Rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis

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30
Q

Contra-indications to anti-TNF therapy?

A

Pulmonary fibrosis, heart failure

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31
Q

Co-codamol?

32
Q

Dihydrocodeine?

33
Q

Tramadol?

34
Q

Amitryptiline?

35
Q

Gabapentin?

36
Q

Folate antagonist

A

Methotrexate

37
Q

How is methotrexate administered?

A

Methotrexate can be administers orally or subcutaneously

38
Q

What is methotrexate used in?

A

RA, psoriatic arthritis, connective tissue disease and vasculitis

39
Q

Methotrexate side effects

A 
Myelotoxicity, fibrosing alveolitis
TERATOGENIC
Leucopenia / thrombocytopenia 
Hepatitis / cirrhosis (alcohol intake must be limited)
Pneumonitis
Rash / mouth ulcers
Nausea / diarrhoea
Needs monitoring of FBC 
    and LFTs
40
Q

Side effects of sulfasalazine?

A 
Nausea
Rash, mouth ulcers
Hepatitis
Neutropenia
Oligozoospermia
41
Q

Side effect of anti-malarial drugs?

A

Retinopathy

42
Q

Side effect of ciclosporin?

A

Nephrotoxicity, hypertension

43
Q

Can NSAIDS cause renal impairment?

44
Q

NSAID adverse effects

A
  • gastric ulcers
  • oesophagitis
  • bowel ulceration
  • dysphagia
  • gastritis
  • Renal impairment
  • Increased cardiovascular events (Cox 2 inhibitors + others)
  • Fluid retention
  • Wheeze
  • Rash
45
Q

How do you make anti-TNF therapy more effective?

A

Give in combination with DMARDS

46
Q

When is anti-TNF contraindicated?

A

Pulmonary fibrosis, heart failure

47
Q

Ustekinumab?

A

IL12 and IL13 inhibitor

48
Q

CTLA-4 Ig (blocks full activation of T cells)

49
Q

What does abatacept do?

A

Blocks full activation of T cells

CTLA-4

50
Q

Inhibits interleukin 6?

A

Tocilizumab

51
Q

Monoclonal antibody against CD20?

52
Q

Side effects of colchicine?

A

Diarrhoea and vomitting

53
Q

Urate lowering drugs

A

Allopurinol
Febuxostat
Uricosurics

54
Q

What do allopurinol and febuxostat do?

A

Stop the conversion of xanthine to uric acid

allopurinol is a xanthine oxidase inhibitor

55
Q

Name a xanthine oxidase inhibitor?

A

Allopurinol

56
Q

Why do you not prescribe allopurinol initially for acute attacks?

A

Rapid reductio in uric acid could result in exacerbation of gout. Always co-prescribe anti-inflammatory for the first couple of weeks

57
Q

Which drug may inhibit warfarin metabolism?

A

Allopurinol

58
Q

Which drug could cause marrow aplasia?

A

Allopurinol

59
Q

Side effects of allopurinol?

A

Rash (commoner in elderly)
AZATHIOPRINE INTERACTION
May inhibit warfarin metabolism
Rarely, marrow aplasia

60
Q

Which drug can allopurinol react with?

A

Azathioprine

61
Q

When would you give febuxostat?

A

For someone who can’t tolerate allopurinol

62
Q

Which drug can you give if someone can’t tolerate allopurinol?

A

Febuxostat

63
Q

When is the rash from allopurinol more common?

A

In old people and people with renal impairment

64
Q

Uricosurics

A

Probenecid
Sulphinpyrazone
Azapropazone
Benzbromarone

65
Q

Metabolic effects of corticosteroids?

A

Salt and water retention
Increased gluconeogenesis
Increased hepatic glycogen deposition
Increased protein breakdown

66
Q

Effects of corticosteroids on the eyes?

A

Glaucoma, cataratcs

67
Q

Side effects of leflunomide

A

Leflunomide (DMARD)

-nausea, diarrhoea and mouth ulcers

68
Q

Corticosteroids and adrenal suppression?

A

Corticosteroids can cause adrenal suppression

69
Q

PTH

A

Squamous cell carcinoma

70
Q

ACTH

A

Small cell

71
Q

P63

A

Squamous cell

72
Q

TTF-1

A

Small cell and adeoncarcinoma

73
Q

Cavitates, central necrosis

Keratin

A

Squmaous cell carcinoma

74
Q

Biologics for ankylosing spondylitis

A

IA
Infliximab
Adalimumab

75
Q

Biologics for SLE

A

Rituximab

Belimumab

76
Q

Biologics for psoriatic arthritis

A

Etanercept

Ustekinab

77
Q

When is anti-TNF contraindicated?

A

Pulmonary fibrosis

Heart failure

Musculoskeletal (44 decks)

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