pharmacology of arthritis Flashcards
what are the three steps for pain control?
1) non-opioid
2) weak opioid for mild to moderate pain
3) strong opioid for severe pain
indications for NSAIDs
- inflammatory arthritis
- mechanical msk pain
- pleuritic/pericardial pain
adverse effects of NSAIDs
- dyspepsia
- oesophagitis
- gastritis
- peptic ulcer
- bowel ulceration
- renal impairment
- fluid retention
- wheeze
- rash
when should methotrexate be started in a patient with newly diagnosed rheumatoid arthritis
within 3 months of symptoms
are DMARDs slow or fast acting
slow
what are the commonly used DMARDs
- methotrexate
- sulphasalazine
- leflunomide
- hydroxychloroquine
what is methotrexate
a folate antagonist
-first choice DMARD
what diseases are methotrexate used for
RA
psoriatic arthritis
connective tissue disease
vasculitis
adverse effects of methotrexate
- leucopenia/thrombocytopenia
- hepatitis/cirrhosis
- pneumonitis
- rash/mouth ulcers
- nausea/diarrhoea]
what needs to be monitored while on methotrexate
FBC and LFTs
what is methotrexate co-prescribed with
folic acid
which has a longer half life: methotrexate or leflunomide?
leflunomide
so requires a wash out
side effects of sulfasalazine
- nausea
- rash/mouth ulcers
- neutropenia
- hepatitis
- reversible oligozoospermia
what is hydroxychloroquine used by itself in?
connective tissue diseases like SLE, Sjogren’s syndrome and RA
what are biologics
drugs designed to target specific aspects of immune system found to be implicated in inflammatory arthritis
what are biologics targets
- TNF
- CD 20 B cells
- interleukin 6
- interleukin 17, 12 and 23
whats more effective: biologics or DMARDs
biologics
whats anti-tnf therapy used for
RA
psoriatic arthritis
ankylosing spondylitis
examples of Anti-TNF agents
- etanercept
- adalimumab
- certolizumab
what is the criteria for Anti-TNF
- high disease activity score
- use of previous standard DMARDs
adverse effects of Anti-TNF
-risk of infection
how do you treat an acute episode of gout
- colchicine
- NSAIDs
- steroids
how do you prevent gout
urate lowering
- allopurinol
- febuxostat
- uricosurics
indications for corticosteroids
- inflammatory arthritis
- polymyalgia rheumatica / giant cell arteritis
- vasculitis
side effects of corticosteroids
- weight gain
- muscle wasting
- skin atrophy
- osteoporosis
- diabetes
- hypertension
- cataract
- glaucoma
- fluid retention
- adrenal suppression
- immunosuppression
- avascular necrosis of the femoral head
