Pharmacology of Arthritis Flashcards
NSAIDs should generally not be used long term and instead be reserved for _______
Flares
NSAIDs have some negative side effects.
List as many as possible
- Peptic ulceration
- Renal impairment
- Increased CV risk
- Exacerbation of asthma
- Fluid retention
- Wheeze
- Rash
COX2 inhibitors are a newer form of NSAID which are more effective. However, what is their major downside?
They drastically increase CV risk
What is the first line DMARD and when should it ideally be started?
Methotrexate
Within 3 months of symptoms starting
How long does it take methotrexate to start working and what can be used for symptoms management in the interim period?
Around 6 weeks
Steroids and anti-inflammatory medication
What is the second line treatment for arthritis?
Methotrexate + sulfasalazine
(leflunomide and hydroxychloroquine can also be added if required)
How soon must methotrexate be stopped before someone becomes pregnant?
3 months
People on methotrexate require frequent blood tests.
What are the main reasons for this?
- Leucopenia
- Thrombocytopenia
- Hepatitis
- Cirrhosis
What are some of the negative effects of methotrexate?
- Leucopenia/Thrombocytopenia
- Low sperm count
- Hepatitis
- Cirrhosis
- Nausea/diarrhoea
- Rash
- Mouth ulcers
- Temporary hair loss
Leflunomide is a similar drug to methotrexate, but why is it potentially less desirable?
It has a very long half life
Sulfasalazine famously can induce which condition?
Stevens-Johnson syndrome
What are some of the negative side effects of sulfasalazine?
- Nausea
- Rash
- Mouth ulcers
- Hepatitis
- Reversible low sperm count
- Can induce Stevens-Johnson syndrome
Why do patients taking hydroxychloroquine require an annual review?
Hydroxychloroquine can cause irreversible retinopathy
Anti-TNF treatment has certain side effects and contraindications. What are these?
Risk of infection - especially reactivation of latent TB
Can increase risk of skin cancer
Contraindicated in heart failure and pulmonary fibrosis
Give 2 examples of Anti-TNF drugs
- Etanercept
- Adalimumab
- Certolizumab
- Infliximab
- Golimumab
Acutely, how is gout treated?
- NSAID e.g. naproxen, ibuprofen
- Colchicine (usually 2nd line anti-inflammatory)
- IM steroid
Name two urate lowering drugs used for gout prophylaxis
- Allopurinol
- Febuxostat
- Uricosurics
What is a common side effect of allopurinol?
Vasculitic rash
(febuxostat may be better tolerated in such patients)
When should urate lowering therapy be administered and why?
2 weeks subsequent to a gout attack
The medication can provoke another gout attack
How does allopurinol work?
Inhibits xanthine oxidase
(prevents formation of uric acid)
Allopurinol should never be co-prescribed with which other drug and why?
Azathioprine
(It can cause irreversible bone marrow depletion and suppression)
When taking urate lowering medication, what is the level to which urate must be lowered to?
< 360mg/l
Corticosteroids have many negative side effects.
List as many as possible
- Loss in bone density
- Contribute to diabetes
- Weight gain
- Cattaracts
- Fluid retention
- Avascular necrosis
- Can affect fertility
If a young woman is on methotrexate and comes to you for advice about becoming pregnant, what would you tell her?
- Must stop methotrexate for 3 months before attempting to become pregnant
- Must use contraception in these 3 months
- Must switch to sulfasalazine or hydroxychloroquine
- Use steroids in the interim drug change over period
- Once pregnant, inflammatory arthritis commonly improves
