Pharmacology of arthritis 12/10/18

Question 1

WHO Pain ladder?

Answer 1

Non-opiod - aspirin/paracetomal
\+/- adjuvant
Wek opiod - codiene
\+/- aduvant and non opiod
Strong opiod - morphine
\+/- aduvant and non opiod

Question 2

What are some functions of NSAIDs?

Answer 2

Inflammatory arthritis
Mechanical MSK pain
Pleuritic pain

Question 3

What are side effects of NSAIDs?

Answer 3

Peptic ulceration
Renal impairment
Increased cardiovascular risk
Exacerbation of asthma

Question 4

What is the 1st line treatment for RA?

Answer 4

Methotrexate!!

Question 5

When should methotrexate be started?

Answer 5

Within 3 months of symptom onset

Question 6

How long does it take for a DMARD to work?

Answer 6

6 weeks

Question 7

Do DMARDs improve pain?

Answer 7

No

Question 8

What are some Common DMARDS?

Answer 8

Methotrexate
sulfasalazine
Leflunomide
Hydroxychloroquine

Question 9

Is methotrexate safe in pregnancy?

Answer 9

NO

Question 10

What are side effects of methotrexate?

Answer 10

leucopaenia
hepatitis
pneuomonitis

Question 11

Commonest side effect of leflunomide?

Answer 11

Diarrhoea

Question 12

Sulfasalazine side effects?

Answer 12

Nausea
Mouth ulcers
reash
reduced sperm count

Question 13

What are some biological drug targets?

Answer 13

TNF
B cells
Interleukins

Question 14

What is more effective DMARDs or biologics?

Answer 14

Biologics

Question 15

Anti-TNFs?

Answer 15

Etanercept
Adallimunab
Infliximab
Golimumab

Question 16

Criteria for anti TNF?

Answer 16

DAS28

Question 17

Side effects of anti-TNF?

Answer 17

Increased risk of infection
Increases risk of skin cancer
Exacerbation of heart failure
Reactivation of latent TB

Question 18

Is anti-TNF safe in pregnancy?

Answer 18

yes

Question 19

What happens to RA during pregnancy?

Answer 19

Gets better

Question 20

Two components of gout treatment/

Answer 20

?/

Question 21

Do you start allopurinol during a flare of gout?

Answer 21

no

Question 22

Treatment of gout flare?

Answer 22

Colchicine
NSAIDs
Steroids

Question 23

Gout prophylaxis?

Answer 23

Allopurinol
Febuxostat
Uricosurics

Question 24

Side effects of allopurinol

Answer 24

Allergic rash
Azathioprine interaction
-can cause irreversable Marrow aplasia

Question 25

What is the gout urate level threshold?

Answer 25

360micromoles/l

Question 26

What can steroids cause?

Answer 26

Loss of bone density
Contribute to diabetes
Increase weight
Cushinoid