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Rheumatology > Pharmacology of arthritis > Flashcards

Pharmacology of arthritis Flashcards

1
Q

What are some analgesics used in the treatment of arthritis?

A 
Co-codamol
Dihydrocodeine
Tramadol
Amitryptiline
Gabapentin
Paracetamol
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2
Q

What are features of NSAIDs?

A

Anti-inflammatory
Analgesic
Antipyretic
Antiplatelet (aspirin v others)

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3
Q

What are some examples of NSAIDs?

A 
Aspirin
Ibuprofen
Naproxen
Diclofenac
Indometacin 
Etodolac
Celecoxib
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4
Q

What are some of the adverse affects of NSAIDs?

A 
Dyspepsia
Oesophagitis
Gastritis
Peptic Ulcer
Rash
Wheeze
Fluid retention
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5
Q

What are DMARDs?

A

Disease modifying anti-rheumatic drugs which are pure anti-inflammatorys with no direct analgesic effect
Most are slow acting (weeks) and need to be monitored carefully for side effects

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6
Q

What is the ideal time to get someone started on DMARDs in RA from onset of symptoms?

A

3 months

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7
Q

What precaution is undertaken to counter the immunosuppressant effect of DMARDs?

A

Vaccinations are given before starting the drugs

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8
Q

What are some examples of DMARDs?

A

Methotrexate
Sulphasalazine
Hydroxychloroquine

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9
Q

What is the first choice DMARD in most patients?

A

Methotrexate

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10
Q

What is methotrexate?

A

Folate antagonist

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11
Q

What conditions is methotrexate used in?

A

RA
Connective tissue disease
Psoriatic arthritis
Vasculitis

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12
Q

What are the adverse effects of methotrexate?

A 
Leucopenia / thrombocytopenia 
Hepatitis / cirrhosis (alcohol intake must be limited)
Pneumonitis
Rash / mouth ulcers
Nausea / diarrhoea
Needs monitoring of FBCand LFTs
Teratogenic
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13
Q

How long should patient on methotrexate wait after stopping the drug before conceiving?

A

3 months for both men and women

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14
Q

What is sulfasalazine?

A

An azo ester of sulfapyridine and 5-aminosalicylic acid

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15
Q

When is sulfasalazine used?

A

In combination with methotrexate in early inflammatory arthritis
As an alternative when a patient is trying to concieve

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16
Q

What are the adverse effects of sulfasalazine?

A 
Nausea
Rash / mouth ulcers
Neutropenia
Hepatitis
Reversible oligozoospermia
Monitoring of FBC and LFTs
17
Q

When is hydroxychloroquine used?

A

Connective tissue disease

RA

18
Q

What are some Anti-TNF drugs?

A

Infliximab (IV)
Etanercept
Adalimumab
Certolizumab

19
Q

When are anti-TNF drugs used?

A

RA, psoriatic arthritis and ankylosing spondylitis if DMARDs have failed or cannot be tolerated

20
Q

What is the most effective use of anti-TNF drugs?

A

In combination with DMARDs

21
Q

When is the use of anti-TNF drugs contraindicated?

A

Pulmonary fibrosis

Heart failure

22
Q

What are patients on anti-TNF drugs particularly at risk of?

A

Infection, especially TB

23
Q

What are the criteria for use of anti-TNF?

A

High disease activity score

Use of previous standard DMARDs

24
Q

Other than anti-TNF, give some other examples of biologic drugs.

A

Rituximab - monoclonal antibody against B (CD20) lymphocytes
Tocilizumab – inhibits Interleukin 6
Abatacept - CTLA-4 Ig -blocks full activation of T lymphocytes
Ustekinumab – Inhibits IL12 and IL23

25
Q

What drugs are used in the acute treatment of gout?

A

Colchicine
NSAIDs
Steroids

26
Q

What is a common adverse effect of colchicine?

A

Diarrhoea and vomiting

27
Q

What drugs are used in the prophylactic treatment of gout?

A

Allopurinol
Febuxostat
Uricosurics

All are urate lowering

Rheumatology (5 decks)

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