pharmacology of arthritis

Question 1

what is the first line pain management

Answer 1

non-opioid +/- adjuvant eg aspirin, paracetemol, NSAIDs

Question 2

what is second line pain management

Answer 2

weak opioid eg codeine +/-non-opioid +/- adjuvant

Question 3

what is 3rd line pain management

Answer 3

strong opioid eg morphine +/- non-opioid +/- adjuvant

Question 4

what is the purpose of NSAIDs

Answer 4

anti-inflam and analgesic

Question 5

give 2 examples of MSK NSAIDs

Answer 5

ibuprofen and naproxen

Question 6

when are NSAIDs used in MSK

Answer 6

inflammatory arthritis/ diseases, mechanical pain, pleuritic pain

Question 7

what are some side effects of NSAIDs (7)

Answer 7

dyspepsia, oesophagitis, gastritis, peptic ulcers, renal + CVD risk, fluid retention

Question 8

what are the purpose of DMARDs

Answer 8

for inflam arthritis, reduce the rate of disease advancement, more effective started earlier and no analgesic affects

Question 9

name 4 DMARDs

Answer 9

Methotrexate, sulphasalazine, leflunomide, hydroxychloroquine

Question 10

what is usually first line DMARD in inflam MSK diseases

Answer 10

methotrexate

Question 11

what type of drug is methotrexate

Answer 11

folate antagonist

Question 12

what diseases is methotrexate used in

Answer 12

RA, psoriatic arthritis, connective tissue disease, vasculitis

Question 13

what are the side effects of methotrexate

Answer 13

leucopoenia, thromboctyopenia, hepatitis. cirrhosis, pneumonitis, mouth ulcers, GI upset

Question 14

what is monitored regularly with DMARDs

Answer 14

FBC and LFTs

Question 15

when is methotrexate contraindicated

Answer 15

lung disease, renal disease, immunosuppressed, women getting pregnant

Question 16

what DMARD is leflunomide similar to

Answer 16

methotrexate - same efficacy and side effects

Question 17

what is a downside to leflunomide

Answer 17

long half life so requires wash out

Question 18

what is 2nd line DMARD

Answer 18

sulfasalazine

Question 19

what are side effects of sulfasalazine

Answer 19

nausea, mouth ulcers, neutropenia, hepatitis, oligozoospermia (low sperm count)

Question 20

when is hydroxycholoroquine used

Answer 20

connective tissue disease eg SLE, sjorgen (not joints)

Question 21

what is a rare side effect of hydroxychloroquine

Answer 21

retinopathy

Question 22

what DMARD is used in combination with methotrexate in early disease

Answer 22

sulphasalzine

Question 23

what DMARDs are teratogenic

Answer 23

methotrexate and luflunomide

Question 24

what are some biologic targets in inflam arthritis

Answer 24

TNFa, B cells, interleukins

Question 25

what diseases are anti-TNFa used in

Answer 25

RA, psoriatic arthritis, AnkSpondy

Question 26

how are biologics given

Answer 26

injections

Question 27

give 2 examples of anti-TNFa drugs

Answer 27

etanercept, infliximab, -mab

Question 28

what are side effects/ contraindications of anti-TNF

Answer 28

TB, contraindicated in pulm fibrosis and HF

Question 29

what is more effective DMARDs or biologics

Answer 29

biologics more effective but strict criteria, best on combination

Question 30

what 3 drugs are given in acute gout

Answer 30

NSAIDs, steroids, colchicine

Question 31

what is a common side effect of colchicine

Answer 31

diarrhoea

Question 32

name 2 xanthine oxidase inhibitors used in gout prophylaxis

Answer 32

allopurinol, febuxostat

Question 33

when do prophylactic gout drugs need to be stared and with what drugs

Answer 33

2-4 weeks after acute gout, with NSAIDs

Question 34

what can allopurinol trigger and why

Answer 34

rapid reduction of uric acid to cause gout

Question 35

what is a side effect and drug reaction of allopurinol

Answer 35

vasculitis - azathioprine

Question 36

what are contraindications to febuxostat

Answer 36

renal impairment, ischaemic heart disease

Question 37

what are steroids side effects

Answer 37

weight gain, muscle wasting/ skin atrophy, osteoporosis, diabetes, hypertension, immunosuppression