Pharmacology of Arthritis Flashcards
Pure analgesics such as paracetamol, have what properties?
Analgesic
Little anti-inflam activity
Anti-pyretic
What is co-codamol made with?
Codeine and paracetamol
What type of drug is amitryptiline?
Anti-depressant
What type of drug is Gabapentin?
Anti-convulsant
Give some side effects of opiod drugs?
dizzy Nausea vomiting sleepy confused
Give some side effects of long term opiod drug use?
constipation itching weight gain lack of sex drive reduced fertility erectile dysfunction irregular periods decreased ability to fight infection
What is the effect of NSAID on inflammation?
Symptomatic relief of inflammation but does not decrease inflammation to where the disease actually stops
Give some examples of NSAIDs?
Naproxen
Ibruprofen
Diclofenac
List some side effects of NSAIDs.
dyspepsia and peptic ulcers oesophagitis gastritis small/ large bowel ulceration rash wheeze (avoid in asthmatics) fluid retention
What is DMARDs onset of action like?
Slow acting - weeks to months
What should be given over the lag phase of DMARDs?
Steroids
Do DMARDs show any analgesic effect?
No
How quickly should patients who present with RA be started on DMARDs?
Aim for within 3 months of symptom onset - patients do not present at the onset of symptoms
What should be given prior to starting DMARDs?
Vaccinations - flu & pneumococcal
Are DMARDs normally started individually?
No, normally methotrexate an sulphasalazine are started together
What does Methotrexate work as in the body?
folate antagonist
How is MTX given?
Oral
Subcutaneously if GI SE of oral MTX
What conditions is MTX used in?
RA
Psoriatic arthritis
CTD
Vasculitis
Give some side effects of MTX.
Leucopenia/ thrombocytopenia
Hepatitis/ cirrhosis
rash and mouth ulcers
pneumonitis
Is MTX teratogenic?
Yes, should be stopped in males and females at least 3 months before conception
Are there any contraindications to giving MTX?
Pre-existing pulmonary fibrosis
What is sulphasalazine made of?
Azo-ester of sulphapyridine and 5-aminosalicylic acid
What is the main worrying SE of sulphasalazine?
Neutropenia
When is hydroxychloroquin used?
CTD
SLE
Sjogren’s syndrome
RA
What should HCQ be avoided in?
psoriatic arthritis
Why should azathioprine never be used with allopurinol?
Irreversible agranulocytosis occurs
In the UK, currently what is Anti-TNF licensed for?
RA
Psoriatic arthritis
ankylosing spondylitis
Are Anti-TNF drugs, more effective when used in combination with DMARDs or alone?
In combination with DMARDs
