Pharmacology of arthritis

Question 1

What analgesics can be used in arthritis?

Answer 1

Co-codamol
Dihydrocodeine 
Tramadol 
Amitryptiline 
Gabapentin

Question 2

Give me examples of NSAIDs

Answer 2

Ibuprofen
Naproxen – first anti inflammatory to be prescribed 
Diclofenac
Indometacin 
Etodolac
Celecoxib (Cox 2 inhibitor)

Question 3

What is the first drug used in lupus?

Answer 3

Hydroxychloroquine

Question 4

What are the commonly used DMARDs

Answer 4

Methotrexate, sulphasalazine, Leuflunomide, hydroxychloroquine

Question 5

What kind of antagonist is methotrexate?

Answer 5

Folate, have to be on folic acid

Question 6

What are the adverse effects of methotrexate?

Answer 6

Leucopenia/thrombocytopenia
Hepatitis – alcohol intake must be limited 
Pneumonitis 
Rash/ Mouth ulcer
Nausea/Diarrhoea
Needs monitoring – FBCs and LFTs

Question 7

How long after stopping methotrexate do you have to wait before trying for a baby?

Answer 7

3 months

Question 8

How long after stopping leflunomide do you have to wait before trying for a baby?

Answer 8

2 years, due to its very long half life

Question 9

What can hydroxychloroquine cause?

Answer 9

Retinopathy

Question 10

What are the adverse effects of sulfasalazine?

Answer 10

Nausea, Rash, mouth ulcers, neutropenia, hep, reversible oligozoospermia
Requires monitoring

Question 11

What are the targets for biologics?

Answer 11

TNF, CD20 B cells, IL6, IL17, 12 and 23

Question 12

What are the adverse effects of anti TNF

Answer 12

Infection risk (reactivate latent TB), Skin cancer

Question 13

What are the adverse effects of steroids?

Answer 13

• Weight gain
• Muscle wasting
• Skin atrophy
• Osteoparosis
• Diabetes
• Hypertension