Pharmacology of arthritis 12/10/18 Flashcards
WHO Pain ladder?
Non-opiod - aspirin/paracetomal \+/- adjuvant Wek opiod - codiene \+/- aduvant and non opiod Strong opiod - morphine \+/- aduvant and non opiod
What are some functions of NSAIDs?
Inflammatory arthritis
Mechanical MSK pain
Pleuritic pain
What are side effects of NSAIDs?
Peptic ulceration
Renal impairment
Increased cardiovascular risk
Exacerbation of asthma
What is the 1st line treatment for RA?
Methotrexate!!
When should methotrexate be started?
Within 3 months of symptom onset
How long does it take for a DMARD to work?
6 weeks
Do DMARDs improve pain?
No
What are some Common DMARDS?
Methotrexate
sulfasalazine
Leflunomide
Hydroxychloroquine
Is methotrexate safe in pregnancy?
NO
What are side effects of methotrexate?
leucopaenia
hepatitis
pneuomonitis
Commonest side effect of leflunomide?
Diarrhoea
Sulfasalazine side effects?
Nausea
Mouth ulcers
reash
reduced sperm count
What are some biological drug targets?
TNF
B cells
Interleukins
What is more effective DMARDs or biologics?
Biologics
Anti-TNFs?
Etanercept
Adallimunab
Infliximab
Golimumab
Criteria for anti TNF?
DAS28
Side effects of anti-TNF?
Increased risk of infection
Increases risk of skin cancer
Exacerbation of heart failure
Reactivation of latent TB
Is anti-TNF safe in pregnancy?
yes
What happens to RA during pregnancy?
Gets better
Two components of gout treatment/
?/
Do you start allopurinol during a flare of gout?
no
Treatment of gout flare?
Colchicine
NSAIDs
Steroids
Gout prophylaxis?
Allopurinol
Febuxostat
Uricosurics
Side effects of allopurinol
Allergic rash
Azathioprine interaction
-can cause irreversable Marrow aplasia
What is the gout urate level threshold?
360micromoles/l
What can steroids cause?
Loss of bone density
Contribute to diabetes
Increase weight
Cushinoid
