Pharmacology of Arthritis Flashcards
negative effects of NSAIDs
peptic ulcers oesophagitis gastritis dyspepsia renal impairment increased CV risk asthma exacerbation wheeze
when should DMARDs be commenced
as early as possible, before 3 months of having the disease
which arthritis drugs will alleviate symptoms
analgesics
NSAIDs
name DMARDs used in arthritis?
methotrexate
sulfasalazine
hydrocychloroquine
leflunomide
name biologic agents used in arthrtis?
anti-TNF
rituximab
tocilizumab
name some stronger analgesics than paracetamol used in arthritis?
co-codamol dihydrocodeine tramadol amitryptiline gabapentin
what are the steps of pain management?
1) non-opiod eg paracetamol
2) weak opiod eg codeine
3) strong opiod eg morphine
what kind of drug is naproxen
NSAID
what kind of drug is diclofenac
NSAID
main contraindication of giving a COX2 inhibitor
increases CV events
do DMARDs have an analgesic effect?
no
how long do DMARDs take to work?
weeks to months
methotrexate side effects?
low WCC -> infection hepatitis pneumonitis rash/mouth ulcers nausea/diarrhoea
how often are arthritis patients seen in GP?`
monthly
what should you do if DMARD isn’t proving effective?
add another eg sulfasalazine
what is methotrexate’s MoA
folate antagonist
what rheumatological conditions is methotrexate commonly used in?
RA
psoriatic arthritis
CT disease
vasculitis
when should methotrexate be stopped if someone is trying to get pregnant
3 months before attempting to conceive
adverse effects of sulfasalazine
same as methotrexate with neutropenia and stephen johnson syndrome (low neutrophils)
which rheumatological conditions is anti-TNF therapy used in?
RA
psoriatic arthritis
ankylosing spondylitis
NOT CT disease
adverse effects of anti-TNF therapy?
risk of infection eg reactivation of latent TB
risk of melanoma
can exacerbate HF
does anti-TNF therapy cause foetal abnormalities
no
2 stages of gout treatment?
acute episode
prophylaxis
drugs used to treat acute episode of gout?
colchicine
NSAIDs
steroids - oral/IM
why is allopurinol not used in acute episode?
only works in long term once flare has settled
main role of drugs used in prophylaxis
lowering urate levels
name drugs used in prophylaxis of gout?
allopurinol
febuxostat
uricosurics
MoA of allopurinol?
blocks synthesis of uric acid by inhibiting xanthine oxidase
side effects of allopurinol
vasculitic rash
bone marrow aplasia if used with azathioprine
what urate level should the patient be after treatment
<360
what drug should be given if patient cannot tolrate allopurinol
febuxostat
which patients should you monitor carefully if they are on allopurinol
IHD patients
monitor renal function
rhumatological conditions that steroids are useful in
RA
CT disease
polymyalgia rheumatica/giant cell arteritis
vasculitis
adverse effects of steroids
muscle wasting skin atrophy osteoporosis diabetes hypertension weight gain immunosuppression cataract glaucoma fluid retension avascular necrosis
what medication can be used instead of methotrexate in pregnancy
sulfasalazine
