Pharmacology of Arthritis Flashcards
what is step 1 of the analgesic ladder?
non opioid
+/- adjuvant
what is step 2 of the analgesic ladder?
weak opioid such as codeine
+/- non opioid
+/- adjuvant
what is step 3 of the analgesic ladder?
strong opioid
+/- step 1
what two effects do NSAIDs have?
anti inflammatory
analgesic
name three NSAIDs
ibuprofen
naproxen
diclofenac
what does DMARD stand for?
disease modifying anti rheumatic drugs
when should DMARDs be started for the best results?
within three months of symptoms starting
how long do DMARDs take to work?
weeks-months
what effects do DMARDs have?
purely anti-inflammatory
what are the first choice DMARDs?
methotrexate
sulfasalazine
is methotrexate safe in pregnancy?
no
females must be on appropriate contraception while taking it
when does methotrexate need to be stopped if pregnant?
at least three months before conception
what kind of medication is methotrexate?
a folate antagonist
what monitoring is required when a patient is on methotrexate and why?
FBC and LFT’s
risk of leukopenia and hepatitis
what can methotrexate be co-prescribed with to reduce risk of complications?
folic acid
if a patient needs to stop the DMARD leflunomide, what should be done?
a wash out with something like cholestyramine
as the half life is very long
what are biologics?
drugs designed to target specific aspects of the immune system
when are biologics started in inflammatory arthritis?
after failure of two DMARDs
or two NSAIDs in AS
what can anti-TNF therapy be used for?
RA
psoriatic arthritis
AS
which is more effective - anti TNF or DMARDs?
anti TNF
how is anti-TNF therapy administered?
combination therapy with DMARDs
subcutaneous injection
name two anti TNF drugs
infliximab
adalimumab
what criteria needs to be met before anti-TNF therapy is started?
high disease activity score after use of DMARDs
what are the adverse effects of anti-TNF therapy?
risk of infection
risk of malignancy
when is anti-TNF therapy contraindicated?
pulmonary fibrosis
heart failure
how is an acute episode of gout managed?
colchicine
NSAIDs
steroids
what is a common side effect of colchicine/
diarrhoea
what three drugs can be given as gout prophylaxis?
allopurinol
febuxostat
uricosurics
what type of drug is allopurinol?
xanthine oxidase inhibitor
why is allopurinol not given in acute gout?
rapidly reduces uric acid - can cause an acute exacerbation fo gout
what are two possible side effects of allopurinol?
rash
marrow aplasia
what drug does allopurinol interact with?
azathioprine
when is febuxostat given for gout prophylaxis?
when allopurinol can’t be tolerated
renal impairment
when should febuxostat be avoided for gout prophylaxis?
ischaemic heart disease
name two uricosurics
sulphinpyrazone
azapropazone
