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Musculoskeletal > Pharmacology of Arthritis > Flashcards

Pharmacology of Arthritis Flashcards

1
Q

What is the first step of arthritis treatment?

A

Non-opioid (e.g aspirin, paracetamol, NSAID) +/- adjuvant

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2
Q

What is the second step of arthritis treatment?

A

Weak opioid for mild to moderate pain (e.g codeine) +/- non-opioid +/- adjuvant

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3
Q

What is the third step of arthritis treatment?

A

Strong opioid for moderate to severe pain (e.g morphine) +/- non-opioid +/- adjuvant

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4
Q

What does NSAID stand for?

A

Non-steroidal anti-inflammatory

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5
Q

What properties do NSAIDs have?

A

Anti-inflammatory and analgesic

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6
Q

What are some examples of NSAIDs?

A

Ibuprofen, naproxen, diclofenac, indometacin, etodolac, celecoxib

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7
Q

What are some indications for NSAID use?

A

Inflammatory arthritis, mechanical MSK pain, pleuritic/pericardial pain

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8
Q

What are some adverse effects of NSAIDs?

A

Dyspepsia, oesophagitis, gastritis, peptic ulcer, small/large bowel ulceration, renal impairment, increased CV events, fluid retention, wheeze, rash

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9
Q

What does DMARD stand for?

A

Disease-modifying anti-rheumatic drugs

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10
Q

How should DMARDs be used to treat inflammatory arthritis?

A

Early aggressive DMARD therapy, start treatment within 3 months of symptom onset

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11
Q

What are some features of DMARDs?

A

Slow acting (weeks-months), pure anti-inflammatory action with no analgesic effect, reduce rate of joint damage, most need regular monitoring for side effects

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12
Q

What are some examples of DMARDs?

A

Methotrexate, leflunomide, sulfasalazine, hydroxychloroquine, penicillamine, sodium aurothiomalate (gold)

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13
Q

What are some features of methotrexate?

A

Mode of action unknown, folate antagonist, 1st choice DMARD in many patients, given orally or subcutaneously, often used in combination

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14
Q

What are some indications for methotrexate use?

A

Rheumatoid arthritis, psoriatic arthritis, connective tissue disease, vasculitis

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15
Q

What needs to be monitored in patients on methotrexate and sulfasalazine?

A

FBC and LFTs

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16
Q

What are some adverse effects of methotrexate?

A

Leucopenia/thrombocytopenia, hepatitis/cirrhosis (must limit alcohol intake), pneumonitis, rash, mouth ulcers, nausea, diarrhoea

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17
Q

What are some teratogenic DMARDs?

A

Methotrexate and leflunomide = must be stopped at least three months before conception in male and females

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18
Q

What are some features of leflunomide?

A

Similar efficacy and side effects to methotrexate, very long half life so requires wash out

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19
Q

What is sulfasalazine used to treat?

A

Often used in combination with methotrexate to treat inflammatory arthritis

20
Q

What are some adverse effects of sulfasalazine?

A

Nausea, rash, mouth ulcers, neutropenia, hepatitis, reversible oligozoospermia

21
Q

What are some features of hydroxychloroquine?

A

No effect on joint damage, can cause retinopathy

22
Q

What is hydroxychloroquine used to treat?

A

Used in connective tissue diseases = SLE (helps skin, joints and with general malaise), Sjogren’s syndrome, rheumatoid arthritis

23
Q

What are some features of penicillamine?

A

Oral, has same adverse effects as IM sodium aurothiomalate (gold)

24
Q

How is sodium aurothiomalate (gold) given?

A

Intramuscularly (IM)

25
Q

What are some adverse effects of sodium aurothiomalate (gold)?

A

Bone marrow suppression, glomerulonephritis, rash, mouth ulcers (monitor FBC plus urine for proteinuria)

26
Q

What are biologics?

A

Drugs designed to target specific aspects of immune system found to be impacted in inflammatory arthritis (e.g anti-TNF drugs)

27
Q

What is anti-TNF therapy licenced to treat?

A

Rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis

28
Q

How effective is anti-TNF therapy?

A

About 1.5 times as effective as standard DMARDs, more effective in combination with DMARDs

29
Q

How are most anti-TNF agents delivered?

A

By subcutaneous injection

30
Q

What are some examples of anti-TNF agents?

A

Etanercept, adalimumab, certolizumab, infliximab, golimumab

31
Q

What is an example of a biosimilar to anti-TNF agents?

A

Benepali

32
Q

What are the criteria for prescribing anti-TNF therapy?

A

High disease activity score, use of previous standard DMARDs

33
Q

What are the adverse effects of anti-TNF agents?

A

Risk of infection (especially TB), possible risk of cancer (especially skin)

34
Q

When are anti-TNF agents contra-indicated?

A

In patients with pulmonary fibrosis or heart failure

35
Q

What are some other biologic agents?

A

Rituximab = monoclonal antibody against B (CD20) lymphocytes
Tocilizumab = inhibits IL-6
Abatacept = CTLA-4 Ig blocks full activation of T cells
Ustekimimab = inhibits IL-12 and IL-23
Secukinimab = inhibits IL-17
Tofacitinib and Baricitinib = janus kinase inhibitors

36
Q

What agents are used to treat acute gout?

A

Colchicine (causes diarrhoea), NSAIDs, steroids (oral, IM)

37
Q

What are some agents used in the prophylactic treatment of gout?

A

Allopurinol, febuxostat, uricosurics

38
Q

What is allopurinol and what are some of its adverse effects?

A

Xanthine oxidase inhibitor; rapid reduction in uric acid may exacerbate gout, rash (vasculitis) more common in elderly and renal impairment, azathioprine interaction, rarely marrow aplasia

39
Q

What is febuxostat and what are some of its side effects?

A

Xanthine oxidase inhibitor prescribed for patients who can’t tolerate allopurinol; renal impairment, use cautiously in patients with ischaemic heart disease

40
Q

What are some examples of uricosurics?

A

Probenecid, sulphinpyrazone, azapropazone, benzbromarone

41
Q

When are corticosteroids indicated?

A

Connective tissue diseases, polymyalgia rheumatica/giant cell arteritis, vasculitis, rheumatoid arthritis

42
Q

How can corticosteroids be administered?

A

Oral, intra-articular, soft tissue injection, IV, IM

43
Q

What are some side effects of corticosteroids?

A

Weight gain (centripetal obesity), muscle wasting, skin atrophy, osteoporosis, diabetes, hypertension, cataract, glaucoma, fluid retention, adrenal suppression, immunosuppression, avascular necrosis of femoral head

44
Q

How can corticosteroid toxicity be reduced?

A

Use lowest possible dose for as short a time as possible
Consider steroid-sparing agents
Osteoporosis prophylaxis
Watch CV risk factors

45
Q

What are the considerations that must be made for patients on drugs that may impact conception?

A

Some drugs may alter fertility and others can have an effect on foetal development (e.g methotrexate), important to discuss implications with patients before starting treatment and when planning a family

Musculoskeletal (57 decks)

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