Pharmacology of Arthritis Flashcards

1
Q

NSAIDs should generally not be used long term and instead be reserved for _______

A

Flares

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2
Q

NSAIDs have some negative side effects.

List as many as possible

A
  • Peptic ulceration
  • Renal impairment
  • Increased CV risk
  • Exacerbation of asthma
  • Fluid retention
  • Wheeze
  • Rash
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3
Q

COX2 inhibitors are a newer form of NSAID which are more effective. However, what is their major downside?

A

They drastically increase CV risk

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4
Q

What is the first line DMARD and when should it ideally be started?

A

Methotrexate

Within 3 months of symptoms starting

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5
Q

How long does it take methotrexate to start working and what can be used for symptoms management in the interim period?

A

Around 6 weeks

Steroids and anti-inflammatory medication

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6
Q

What is the second line treatment for arthritis?

A

Methotrexate + sulfasalazine

(leflunomide and hydroxychloroquine can also be added if required)

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7
Q

How soon must methotrexate be stopped before someone becomes pregnant?

A

3 months

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8
Q

People on methotrexate require frequent blood tests.

What are the main reasons for this?

A
  • Leucopenia
  • Thrombocytopenia
  • Hepatitis
  • Cirrhosis
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9
Q

What are some of the negative effects of methotrexate?

A
  • Leucopenia/Thrombocytopenia
  • Low sperm count
  • Hepatitis
  • Cirrhosis
  • Nausea/diarrhoea
  • Rash
  • Mouth ulcers
  • Temporary hair loss
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10
Q

Leflunomide is a similar drug to methotrexate, but why is it potentially less desirable?

A

It has a very long half life

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11
Q

Sulfasalazine famously can induce which condition?

A

Stevens-Johnson syndrome

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12
Q

What are some of the negative side effects of sulfasalazine?

A
  • Nausea
  • Rash
  • Mouth ulcers
  • Hepatitis
  • Reversible low sperm count
  • Can induce Stevens-Johnson syndrome
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13
Q

Why do patients taking hydroxychloroquine require an annual review?

A

Hydroxychloroquine can cause irreversible retinopathy

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14
Q

Anti-TNF treatment has certain side effects and contraindications. What are these?

A

Risk of infection - especially reactivation of latent TB

Can increase risk of skin cancer

Contraindicated in heart failure and pulmonary fibrosis

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15
Q

Give 2 examples of Anti-TNF drugs

A
  1. Etanercept
  2. Adalimumab
  3. Certolizumab
  4. Infliximab
  5. Golimumab
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16
Q

Acutely, how is gout treated?

A
  • NSAID e.g. naproxen, ibuprofen
  • Colchicine (usually 2nd line anti-inflammatory)
  • IM steroid
17
Q

Name two urate lowering drugs used for gout prophylaxis

A
  • Allopurinol
  • Febuxostat
  • Uricosurics
18
Q

What is a common side effect of allopurinol?

A

Vasculitic rash

(febuxostat may be better tolerated in such patients)

19
Q

When should urate lowering therapy be administered and why?

A

2 weeks subsequent to a gout attack

The medication can provoke another gout attack

20
Q

How does allopurinol work?

A

Inhibits xanthine oxidase

(prevents formation of uric acid)

21
Q

Allopurinol should never be co-prescribed with which other drug and why?

A

Azathioprine

(It can cause irreversible bone marrow depletion and suppression)

22
Q

Corticosteroids have many negative side effects.

List as many as possible

A
  • Loss in bone density
  • Contribute to diabetes
  • Weight gain
  • Cattaracts
  • Fluid retention
  • Avascular necrosis
  • Can affect fertility
23
Q

If a young woman is on methotrexate and comes to you for advice about becoming pregnant, what would you tell her?

A
  • Must stop methotrexate for 3 months before attempting to become pregnant
  • Must use contraception in these 3 months
  • Must switch to sulfasalazine or hydroxychloroquine
  • Use steroids in the interim drug change over period
  • Once pregnant, inflammatory arthritis commonly improves