Pharmacology of Arthritis

Question 1

what is step 1 of the analgesic ladder?

Answer 1

non opioid

+/- adjuvant

Question 2

what is step 2 of the analgesic ladder?

Answer 2

weak opioid such as codeine

+/- non opioid
+/- adjuvant

Question 3

what is step 3 of the analgesic ladder?

Answer 3

strong opioid

+/- step 1

Question 4

what two effects do NSAIDs have?

Answer 4

anti inflammatory

analgesic

Question 5

name three NSAIDs

Answer 5

ibuprofen
naproxen
diclofenac

Question 6

what does DMARD stand for?

Answer 6

disease modifying anti rheumatic drugs

Question 7

when should DMARDs be started for the best results?

Answer 7

within three months of symptoms starting

Question 8

how long do DMARDs take to work?

Answer 8

weeks-months

Question 9

what effects do DMARDs have?

Answer 9

purely anti-inflammatory

Question 10

what are the first choice DMARDs?

Answer 10

methotrexate

sulfasalazine

Question 11

is methotrexate safe in pregnancy?

Answer 11

no

females must be on appropriate contraception while taking it

Question 12

when does methotrexate need to be stopped if pregnant?

Answer 12

at least three months before conception

Question 13

what kind of medication is methotrexate?

Answer 13

a folate antagonist

Question 14

what monitoring is required when a patient is on methotrexate and why?

Answer 14

FBC and LFT’s

risk of leukopenia and hepatitis

Question 15

what can methotrexate be co-prescribed with to reduce risk of complications?

Answer 15

folic acid

Question 16

if a patient needs to stop the DMARD leflunomide, what should be done?

Answer 16

a wash out with something like cholestyramine

as the half life is very long

Question 17

what are biologics?

Answer 17

drugs designed to target specific aspects of the immune system

Question 18

when are biologics started in inflammatory arthritis?

Answer 18

after failure of two DMARDs

or two NSAIDs in AS

Question 19

what can anti-TNF therapy be used for?

Answer 19

RA
psoriatic arthritis
AS

Question 20

which is more effective - anti TNF or DMARDs?

Answer 20

anti TNF

Question 21

how is anti-TNF therapy administered?

Answer 21

combination therapy with DMARDs

subcutaneous injection

Question 22

name two anti TNF drugs

Answer 22

infliximab

adalimumab

Question 23

what criteria needs to be met before anti-TNF therapy is started?

Answer 23

high disease activity score after use of DMARDs

Question 24

what are the adverse effects of anti-TNF therapy?

Answer 24

risk of infection

risk of malignancy

Question 25

when is anti-TNF therapy contraindicated?

Answer 25

pulmonary fibrosis

heart failure

Question 26

how is an acute episode of gout managed?

Answer 26

colchicine
NSAIDs
steroids

Question 27

what is a common side effect of colchicine/

Answer 27

diarrhoea

Question 28

what three drugs can be given as gout prophylaxis?

Answer 28

allopurinol
febuxostat
uricosurics

Question 29

what type of drug is allopurinol?

Answer 29

xanthine oxidase inhibitor

Question 30

why is allopurinol not given in acute gout?

Answer 30

rapidly reduces uric acid - can cause an acute exacerbation fo gout

Question 31

what are two possible side effects of allopurinol?

Answer 31

rash

marrow aplasia

Question 32

what drug does allopurinol interact with?

Answer 32

azathioprine

Question 33

when is febuxostat given for gout prophylaxis?

Answer 33

when allopurinol can’t be tolerated

renal impairment

Question 34

when should febuxostat be avoided for gout prophylaxis?

Answer 34

ischaemic heart disease

Question 35

name two uricosurics

Answer 35

sulphinpyrazone

azapropazone