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2 MSK > Pharmacology of Arthritis > Flashcards

Pharmacology of Arthritis Flashcards

1
Q

what is the ladder of pain management

A
  1. non-opioid (aspirin, paracetamol) +/- adjuvant

2. weak opiod for mild-moderate pain (+/- non opioid +/– adjuvant)

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2
Q

Indications for NSAID use

A

inflammatory arthritis
mechanical msk pain
pleuritic/pericardial pain

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3
Q

Do NSAIDS help cure inflammatory arthritis

A

No

just dampen down inflammation

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4
Q

side effects of NSAIDS

A

peptic ulceration
renal impairment
increased cardiovascular risk (if taken regularly over long period of time)
exacerbation of asthma

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5
Q

What is the best treatment choice for newly diagnosed rheumatoid arthritis

A

Methotrexate!!!!!! (first line DMARD)

Start on steroids at the same time to target inflammation

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6
Q

when should methotrexate be started

A

within 3 months of symptoms starting

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7
Q

what are biologic drugs

A

next step on for patients who dont respond to standard DMARD therapy

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8
Q

Limitations with DMARDS

A

slow acting - weeks to months

no pain relief- purely anti-inflammatory

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9
Q

when is the window of opportunity of intervention for inflammatory arthritis

A

EARLY to prevent loss of function, if u wait to long normal joint function can never be regained

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10
Q

some common DMARDS

A

methotrexate
sulfazalazine
leflunomide
hydroxychloroquine

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11
Q

when cant u use methotrexate

A

IN PREGNANCY

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12
Q

how is methotrexate given

A

oral or injection

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13
Q

methotrexate side effects

A 
nausea 
pneumonitis 
leucopenia/thrombocytopenia 
hepatitis 
most ulcers/rasah

therefore needs to be monitored regularly

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14
Q

what is leflunomide

A

similar to methotrexate
main difference is long held life so required wash out
also tetragenic and needs washed out so avoided in women of child baring age

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15
Q

what are sulfasalazine adverts effects

A 
nausea 
RASH 
neuropenia 
hepatitis 
reduced sperm count (reversible)
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16
Q

what does hydroxychoroquine do

A

no effect on joint damage

used more in connective tissue disease

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17
Q

what are biologic drugs

A

drugs designed to target specific aspects of the immune system found to be implicated in inflammatory arthritis

often first tine

18
Q

targets for biologics

A

TNF
IL6
IL 17, 12 and 23
CD 20 B cells

19
Q

what are more effective, DMARDS or biologics

A

biologics

only given to those who qualify, v expensive

20
Q

What is Anti- TNF

A

biologic
v expensive
for RA, psoriatic arthritis and ankylosing spondylitis

21
Q

how is anti-TNF given

A

subcutaneous injection

22
Q

what does anti-TNF do

A

targets TNF which is a key cytokine in inflammation

23
Q

who qualifies for anti-TNF

A

those with high disease activity
a high DAS28 score
use of 2 DMARDS which they’ve not responded to

24
Q

what are some side effects of anti-TNF

A

increased infection risk
increased skin cancer risk
reactivation of latent TB
exacerbation of heart failure

25
Q

what naturally happens to inflammatory arthritis in pregnancy

A

it gets better

26
Q

what is the treatment for gout

A

1.

2.

27
Q

what do u give AFTER gout flare has settled

A

1st line: allopurinol - needs to be increased gradually
febuxostat - works the same way as allopurinol but safe in patients with renal failure
uricosurics

28
Q

what do u use to treat an acute flare of gout

A

NSAIDS
steroids - doesn’t matter how given
Colchicine

29
Q

complications of allopurinol

A

allergic type rash (commoner in elderly and in renal impairment)
azathioprine interaction - causes irreversible bone marrow suppression

30
Q

can u co-prescribe azathioprine and allopurinol

A

NO causes irreversible bone marrow suppression

31
Q

what is the level of ureate in the blood aimed for after gout treatment

A

360micomoles/litre

means they will have no more symptoms

32
Q

indication for steroid use

A

suppress inflammation quickly in:
connective tissue disease
RA
others..

33
Q

side effects of steroids

A

loss of bone density
contribute to development of diabetes
make u fat (oral steroids over prolonged period)
should be used for as short a time as possible

34
Q

what kind of weight game do steroids give

A

puffy face
abdominal weight gain
muscle wasting

35
Q

how do u reduce the risk of steroids

A

use for as short a time as possible when there is no other option
consider other therapy
monitor cardiac risk factors

36
Q

possible cause of acute cough and breathlessness in a patient on methotrexate for RA

A

methotrexate pneumonitis

37
Q

what should you give a patient who isn’t responding to DMARDS and is in a high disease activity category for RA

A

start on anti-TNF

if they have latent TB, treat the TB then continue anti-TNF

38
Q

how long should you wait after stoping methotrexate to finish contraception and get pregnant

A

3 months

39
Q

what drug should you give instead of methotrexate when a woman wants to get pregnant

A

sulphasalazine

40
Q

how often is methotrexate given

A

weekly

41
Q

what DAS28 is ‘high activity’

A

> 5.1 on DAS28

2 MSK (35 decks)

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