Pharmacology of Arthritis

Question 1

negative effects of NSAIDs

Answer 1

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

Question 2

when should DMARDs be commenced

Answer 2

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

Question 3

which arthritis drugs will alleviate symptoms

Answer 3

analgesics

NSAIDs

Question 4

name DMARDs used in arthritis?

Answer 4

methotrexate
sulfasalazine
hydrocychloroquine
leflunomide

Question 5

name biologic agents used in arthrtis?

Answer 5

anti-TNF
rituximab
tocilizumab

Question 6

name some stronger analgesics than paracetamol used in arthritis?

Answer 6

co-codamol
dihydrocodeine
tramadol
amitryptiline
gabapentin

Question 7

what are the steps of pain management?

Answer 7

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

Question 8

what kind of drug is naproxen

Answer 8

NSAID

Question 9

what kind of drug is diclofenac

Answer 9

NSAID

Question 10

main contraindication of giving a COX2 inhibitor

Answer 10

increases CV events

Question 11

do DMARDs have an analgesic effect?

Answer 11

no

Question 12

how long do DMARDs take to work?

Answer 12

weeks to months

Question 13

methotrexate side effects?

Answer 13

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

Question 14

how often are arthritis patients seen in GP?`

Answer 14

monthly

Question 15

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

Answer 15

add another eg sulfasalazine

Question 16

what is methotrexate’s MoA

Answer 16

folate antagonist

Question 17

what rheumatological conditions is methotrexate commonly used in?

Answer 17

RA
psoriatic arthritis
CT disease
vasculitis

Question 18

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

Answer 18

3 months before attempting to conceive

Question 19

adverse effects of sulfasalazine

Answer 19

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

Question 20

which rheumatological conditions is anti-TNF therapy used in?

Answer 20

RA
psoriatic arthritis
ankylosing spondylitis
NOT CT disease

Question 21

adverse effects of anti-TNF therapy?

Answer 21

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

Question 22

does anti-TNF therapy cause foetal abnormalities

Answer 22

no

Question 23

2 stages of gout treatment?

Answer 23

acute episode

prophylaxis

Question 24

drugs used to treat acute episode of gout?

Answer 24

colchicine
NSAIDs
steroids - oral/IM

Question 25

why is allopurinol not used in acute episode?

Answer 25

only works in long term once flare has settled

Question 26

main role of drugs used in prophylaxis

Answer 26

lowering urate levels

Question 27

name drugs used in prophylaxis of gout?

Answer 27

allopurinol febuxostat uricosurics

Question 28

MoA of allopurinol?

Answer 28

blocks synthesis of uric acid by inhibiting xanthine oxidase

Question 29

side effects of allopurinol

Answer 29

vasculitic rash | bone marrow aplasia if used with azathioprine

Question 30

what urate level should the patient be after treatment

Answer 30

<360

Question 31

what drug should be given if patient cannot tolrate allopurinol

Answer 31

febuxostat

Question 32

which patients should you monitor carefully if they are on allopurinol

Answer 32

IHD patients | monitor renal function

Question 33

rhumatological conditions that steroids are useful in

Answer 33

RA CT disease polymyalgia rheumatica/giant cell arteritis vasculitis

Question 34

adverse effects of steroids

Answer 34

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

Question 35

what medication can be used instead of methotrexate in pregnancy

Answer 35

sulfasalazine