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Musculoskeletal > Pharmacology of Arthritis > Flashcards

Pharmacology of Arthritis Flashcards

1
Q

3 steps of pain management?

A

Step 1: Non-opioid e.g. aspirin, paracetamol or NSAID
Step 2: Weak opioid for mild to moderate pain e.g. codeine
Step 3: Strong opioid for bad pain .e.g morphine

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2
Q

2 actions of NSAIDs? Some examples?

A 
Anti-inflammatory and analgesic 
Examples:
•	Ibuprofen
•	Naproxen
•	Diclofenac
•	Indometacin 
•	Etodolac
•	Celecoxib (Cox 2 inhibitor)
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3
Q

Indications for NSAIDs?

A

Inflammatory arthritis, mechanical MSK pain, pleuritic/ pericardial pain.

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4
Q

Adverse effects 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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5
Q

Describe two routes can take NSAIDs?

A

Orally

Can also apply topically, this is good for localised pain and reduces adverse affects.

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6
Q

DMARD therapy should be started within _____1______of symptoms starting. Isn’t vital to have antibodies or X-rays before start treatment as may be negative and may be too late.

A

1) 3 months

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7
Q

Actions of DMARDs? How long do they take to have an affect?

A

Slow acting - weeks to months
Pure anti-inflammatory with no direct analgesic effect
Reduce rate of disease progression

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8
Q

Why do DMARDs need regular monitoring?

A

They have lots of adverse side effects

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9
Q

Why is methotrexate given with folate?

A

As methotrexate is a folate antagonist may become deficient in folate. Folate is involved in new immune cells being produced.

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10
Q

Adverse effects of methotrexate?

A
  • Leucopenia / thrombocytopenia
  • Hepatitis / cirrhosis (alcohol intake must be limited)
  • Pneumonitis- either you get this or you don’t
  • Rash / mouth ulcers
  • Nausea / diarrhoea
  • Needs monitoring of FBC and LFTs
  • Teratogenic. Must be stopped in females at least 3 months before conception. Methotrexate can be replaced with another DMARD during this time.
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11
Q

Woman wants to have a baby on methotrexate what should you do?

A

Tell them they must stop methotrexate and wait three months before conception METHOTREXATE IS TERATOGENIC

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12
Q

What is often used in combination with methotrexate in early inflammatory arthritis?

A

Sulfasalazine

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13
Q

What drug is being described:

  • Similar efficacy to methotrexate
  • Similar side effects
  • Also teratogenic
  • Very long half life so requires wash out if patient wants to become pregnant
A

Leflunomide

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14
Q

Hydroxxyquinine uses and side effects?

A
  • No effect on joint damage
  • Used in connective tissue disease such as SLE (helps skin, joints and general malaise) Sjogren’s syndrome and RA

Side effects: Retinopathy - recognised but rare effect

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15
Q

What do you need to get a biologic for rheumatoid?

A

DAS28 of more than 5.1 and already tried two DMARDs at different doses

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16
Q

Examples of Anti TNF therapy? What are they used for?

A

Licensed for RA, psoriatic arthritis and ankylosing spondylitis. Etanercept, Adalimumab, Certolizumab, Infliximab, Golimumab

17
Q

Why may everyone not find biologics useful?

A

Some immune system components have not been discovered to target yet and that may be what is causing the disease.

18
Q

Adverse effects of biologics?

A
  • Risk of infection (esp TB) significantly higher than DMARDs and need screening for HIV etc even chicken pox and TB.
  • Question over risk of malignancy (esp skin cancer)
  • Contraindicated in certain situations e.g. pulmonary fibrosis, heart failure
19
Q

What do you need screened for if going on biologic, why?

A

TB, HIV, chicken pox etc

Risk of infection is high, if you have latent TB it could become active once you go on the biologic.

20
Q

Acute treatment of gout?

A
  • Colchicine (diarrhoea common)
  • NSAIDs
  • Steroids, either oral or IM
21
Q

When is allopurinol contraindicated?

A

Renal Impairment

22
Q

When is febuxostat given?

A

gout prophylaxis also a xanthine oxidase inhibitor- used when allopurinol can’t be tolerated

23
Q

4 points to reduce toxicity of corticosteroids?

A
  • Use lowest possible dose for as short a time as possible
  • Consider steroid sparing agents
  • Osteoporosis prophylaxis
  • Watch cardiovascular risk factors
24
Q

Indications for corticosteroids?

A
  • Connective tissue disease
  • Polymyalgia rheumatica / giant cell arteritis
  • Vasculitis
  • Rheumatoid arthritis
25
Q

Adverse 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 the femoral head

Musculoskeletal (18 decks)

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