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Musculoskeletal > Pharmacology of Arthritis > Flashcards

Pharmacology of Arthritis Flashcards

Dr S Silburn

1
Q

name the medications used in arthritis

A

Analgesics e.g. paracetamol, opiates

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

Disease Modifying Anti-Rheumatic Drugs (DMARDs)

Biologics

Gout therapy

Corticosteroids

Special circumstances

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2
Q

what medication is under step 1 in pain control of arthritis?

A

non-opioid - aspirin, paracetamol or NSAID

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3
Q

what medication is under step 2 in pain control of arthritis?

A

weak opioid - codeine

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4
Q

what medication is under step 3 in pain control of arthritis?

A

strong opioid - morphine

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5
Q

give some examples of NSAIDs

A 
Ibuprofen
Naproxen
Diclofenac
Indometacin 
Etodolac
Celecoxib (Cox 2 inhibitor)
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6
Q

what are the indications you should prescribe a NSAID?

A

inflammatory arthritis
MSK pain
pleuritic/pericardial pain

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7
Q

what are the adverse effects in the use of NSAIDs?

A 
Dyspepsia
Oesophagitis
Gastritis
Peptic Ulcer
Small/large bowel ulceration
Renal impairment
Increased cardiovascular events (Cox 2 inhibitors + others)
Fluid retention
Wheeze
Rash
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8
Q

what is DMARDs short for?

A

Disease modifying anti-rheumatic drugs

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9
Q

DMARDs are ____ acting

A

slow acting - weeks to months

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10
Q

DMARDs are pure anti-inflammatories with no direct analgesic effect

true or false?

A

true

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11
Q

DMARDs require _______ _________ for adverse effects

A

regular monitoring

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12
Q

what are the 2 DMARDs of choice in RA?

A

MTX and sulfasalazine

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13
Q

what are the commonly used DMARDs? (4)

A

Methotrexate
Sulphasalazine
Leflunomide
Hydroxychloroquine

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14
Q

MTX is a ______ antagonist

A

folate

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15
Q

what 4 things do you use MTX for?

A

RA, psoriatic arthritis, connective tissue disease, vasculitis

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16
Q

what are the adverse effects of MTX?

A

Leucopenia / thrombocytopenia

Hepatitis / cirrhosis

Pneumonitis

Rash / mouth ulcers

Nausea / diarrhoea

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17
Q

what must be limited when taking MTX?

A

alcohol intake

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18
Q

what needs monitoring with MTX?

A

FBCs and LFTs

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19
Q

when must MTX be stopped?

A

Must be stopped in males and females at least 3 months before conception and throughout pregnancy

TERATOGENIC

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20
Q

Leflunomide is similar to MTX but has a very short half life

true or false?

A

false

leflunomide - very long half life, so requires wash out

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21
Q

when is sulfasalazine used in combination with MTX?

A

in early inflammatory arthritis

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22
Q

what are the adverse effects of sulfasalazine?

A 
Nausea
Rash / mouth ulcers
Neutropenia
Hepatitis
Reversible oligozoospermia
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23
Q

what requires monitoring when taking sulfasalazine?

A

FBC and LFTs

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24
Q

does Hydroxychloroquine have an effect on joint damage?

A

no

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25
Q

when is HCQ used?

A

connective tissue disease such as SLE (helps skin, joints and general malaise) Sjogren’s syndrome and RA

26
Q

what is the recognised but rare side effect of HCQ?

A

retinopathy

27
Q

what is the other name given to sodium aurothiomalate?

A

gold

28
Q

ow is the gold given?

A

IM

29
Q

what are the adverse effects of gold?

A

bone marrow suppression, glomerulonephritis, rash , mouth ulcers

30
Q

what must you monitor when prescribing gold? what are you looking for?

A

Monitor FBC plus urine for proteinuria.

31
Q

name some targets for biologics use?

A

Tumour Necrosis factor (TNF)
CD 20 B cells
Interleukin 6
Interleukin 17, 12 and 23

32
Q

Anti-TNF therapy is licensed for what 3 conditions?

A

RA

psoriatic arthritis ankylosing spondylitis

33
Q

Anti-TNF is more effective in combination with what?

A

DMARDs

34
Q

how is Anti-TNF given?

A

sub-cutaneously

35
Q

how much do DMARDs cost?

A

£10000 pa

36
Q

name some anti-TNF drugs (6)

A

Etanercept

Adalimumab

Certolizumab

Infliximab

Golimumab

Biosimilars: Benepali

37
Q

when must you only prescribe anti-TNF?

A

high disease activity score - DAS28

use of previous standard DMARDs

38
Q

what are the adverse effects of anti-TNF?

A

risk of infection - TB

malignancy - skin cancer

39
Q

when is Anti-TNF contraindicated?

A

pulmonary fibrosis

heart failure

40
Q

rituximab is a biologic against…

A

monoclonal antibody against B (CD20) lymphocytes

41
Q

Tocilizumab inhibits…

A

IL-6

42
Q

Abatacept blocks what?

A

CTLA-4 Ig -blocks full activation of T lymphocytes

43
Q

Ustekinumab inhibits…

A

inhibits IL12 and IL23

44
Q

Secukinimab inhibits…

A

IL17

45
Q

Tofacitinib/baricitinib inhibits…

A

Janus kinase

46
Q

name the 2 components to treatment of gout?

A

acute episode

prophylaxis

47
Q

what drugs are used in the treatment of an acute episode of gout? (3)

A

Colchicine
NSAIDs
Steroids, either oral or IM

48
Q

what is the common side effect of colchicine?

A

diarrhoea

49
Q

what drugs are used in the prophylaxis of gout? (3)

A

Allopurinol
Febuxostat
Uricosurics

50
Q

what do Allopurinol, Febuxostat and Uricosurics lower?

A

urate

51
Q

Allopurinol is a ________ _______ inhibitor

A

Xanthine oxidase

52
Q

what are the adverse effects of allopurinol?

A

rash - vasculitis (commoner in elderly and renal impairment)

marrow aplasia

53
Q

what other drug does allopurinol interact with?

A

azathioprine

54
Q

what is the other drug that is also a xanthine oxidase inhibitor that you use in those who cannot tolerate allopurinol?

A

febuxostat

55
Q

you must use febuxostat with caution in those with ________ _____ disease

A

ischaemic heart disease

56
Q

name the uricosuric drugs used in gout

A

Probenecid
Sulphinpyrazone
Azapropazone
Benzbromarone

57
Q

what conditions indicate the use of corticosteroids? (4)

A

Connective tissue disease

Polymyalgia rheumatica / giant cell arteritis

Vasculitis

Rheumatoid arthritis

58
Q

what are the modes of administration in corticosteroids?

A 
Oral
Intra-articular
Soft tissue injections
Intramuscular
Intravenous
59
Q

what are the adverse effects of corticosteroid use?

A 
Weight gain - centripetal obesity
Muscle wasting
Skin atrophy
Osteoporosis
Diabetes
Hypertension
Cataract
Glaucoma
Fluid retention
Adrenal Suppression
Immunosuppression
Avascular necrosis of the femoral head
60
Q

whats the difference between 3 penises and a joke?

A

your mum can’t take a joke

Musculoskeletal (37 decks)

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