Pharmacology of Arthritis Flashcards

1
Q

negative effects of NSAIDs

A
peptic ulcers 
oesophagitis
gastritis
dyspepsia
renal impairment
increased CV risk
asthma exacerbation
wheeze
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2
Q

when should DMARDs be commenced

A

as early as possible, before 3 months of having the disease

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3
Q

which arthritis drugs will alleviate symptoms

A

analgesics

NSAIDs

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4
Q

name DMARDs used in arthritis?

A

methotrexate
sulfasalazine
hydrocychloroquine
leflunomide

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5
Q

name biologic agents used in arthrtis?

A

anti-TNF
rituximab
tocilizumab

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6
Q

name some stronger analgesics than paracetamol used in arthritis?

A
co-codamol
dihydrocodeine
tramadol
amitryptiline
gabapentin
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7
Q

what are the steps of pain management?

A

1) non-opiod eg paracetamol
2) weak opiod eg codeine
3) strong opiod eg morphine

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8
Q

what kind of drug is naproxen

A

NSAID

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9
Q

what kind of drug is diclofenac

A

NSAID

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10
Q

main contraindication of giving a COX2 inhibitor

A

increases CV events

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11
Q

do DMARDs have an analgesic effect?

A

no

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12
Q

how long do DMARDs take to work?

A

weeks to months

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13
Q

methotrexate side effects?

A
low WCC -> infection
hepatitis
pneumonitis
rash/mouth ulcers
nausea/diarrhoea
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14
Q

how often are arthritis patients seen in GP?`

A

monthly

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15
Q

what should you do if DMARD isn’t proving effective?

A

add another eg sulfasalazine

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16
Q

what is methotrexate’s MoA

A

folate antagonist

17
Q

what rheumatological conditions is methotrexate commonly used in?

A

RA
psoriatic arthritis
CT disease
vasculitis

18
Q

when should methotrexate be stopped if someone is trying to get pregnant

A

3 months before attempting to conceive

19
Q

adverse effects of sulfasalazine

A

same as methotrexate with neutropenia and stephen johnson syndrome (low neutrophils)

20
Q

which rheumatological conditions is anti-TNF therapy used in?

A

RA
psoriatic arthritis
ankylosing spondylitis
NOT CT disease

21
Q

adverse effects of anti-TNF therapy?

A

risk of infection eg reactivation of latent TB
risk of melanoma
can exacerbate HF

22
Q

does anti-TNF therapy cause foetal abnormalities

A

no

23
Q

2 stages of gout treatment?

A

acute episode

prophylaxis

24
Q

drugs used to treat acute episode of gout?

A

colchicine
NSAIDs
steroids - oral/IM

25
Q

why is allopurinol not used in acute episode?

A

only works in long term once flare has settled

26
Q

main role of drugs used in prophylaxis

A

lowering urate levels

27
Q

name drugs used in prophylaxis of gout?

A

allopurinol
febuxostat
uricosurics

28
Q

MoA of allopurinol?

A

blocks synthesis of uric acid by inhibiting xanthine oxidase

29
Q

side effects of allopurinol

A

vasculitic rash

bone marrow aplasia if used with azathioprine

30
Q

what urate level should the patient be after treatment

A

<360

31
Q

what drug should be given if patient cannot tolrate allopurinol

A

febuxostat

32
Q

which patients should you monitor carefully if they are on allopurinol

A

IHD patients

monitor renal function

33
Q

rhumatological conditions that steroids are useful in

A

RA
CT disease
polymyalgia rheumatica/giant cell arteritis
vasculitis

34
Q

adverse effects of steroids

A
muscle wasting
skin atrophy
osteoporosis
diabetes
hypertension
weight gain
immunosuppression
cataract
glaucoma
fluid retension
avascular necrosis
35
Q

what medication can be used instead of methotrexate in pregnancy

A

sulfasalazine