pharmacology of arthritis Flashcards
what is the first line pain management
non-opioid +/- adjuvant eg aspirin, paracetemol, NSAIDs
what is second line pain management
weak opioid eg codeine +/-non-opioid +/- adjuvant
what is 3rd line pain management
strong opioid eg morphine +/- non-opioid +/- adjuvant
what is the purpose of NSAIDs
anti-inflam and analgesic
give 2 examples of MSK NSAIDs
ibuprofen and naproxen
when are NSAIDs used in MSK
inflammatory arthritis/ diseases, mechanical pain, pleuritic pain
what are some side effects of NSAIDs (7)
dyspepsia, oesophagitis, gastritis, peptic ulcers, renal + CVD risk, fluid retention
what are the purpose of DMARDs
for inflam arthritis, reduce the rate of disease advancement, more effective started earlier and no analgesic affects
name 4 DMARDs
Methotrexate, sulphasalazine, leflunomide, hydroxychloroquine
what is usually first line DMARD in inflam MSK diseases
methotrexate
what type of drug is methotrexate
folate antagonist
what diseases is methotrexate used in
RA, psoriatic arthritis, connective tissue disease, vasculitis
what are the side effects of methotrexate
leucopoenia, thromboctyopenia, hepatitis. cirrhosis, pneumonitis, mouth ulcers, GI upset
what is monitored regularly with DMARDs
FBC and LFTs
when is methotrexate contraindicated
lung disease, renal disease, immunosuppressed, women getting pregnant
what DMARD is leflunomide similar to
methotrexate - same efficacy and side effects
what is a downside to leflunomide
long half life so requires wash out
what is 2nd line DMARD
sulfasalazine
what are side effects of sulfasalazine
nausea, mouth ulcers, neutropenia, hepatitis, oligozoospermia (low sperm count)
when is hydroxycholoroquine used
connective tissue disease eg SLE, sjorgen (not joints)
what is a rare side effect of hydroxychloroquine
retinopathy
what DMARD is used in combination with methotrexate in early disease
sulphasalzine
what DMARDs are teratogenic
methotrexate and luflunomide
what are some biologic targets in inflam arthritis
TNFa, B cells, interleukins
what diseases are anti-TNFa used in
RA, psoriatic arthritis, AnkSpondy
how are biologics given
injections
give 2 examples of anti-TNFa drugs
etanercept, infliximab, -mab
what are side effects/ contraindications of anti-TNF
TB, contraindicated in pulm fibrosis and HF
what is more effective DMARDs or biologics
biologics more effective but strict criteria, best on combination
what 3 drugs are given in acute gout
NSAIDs, steroids, colchicine
what is a common side effect of colchicine
diarrhoea
name 2 xanthine oxidase inhibitors used in gout prophylaxis
allopurinol, febuxostat
when do prophylactic gout drugs need to be stared and with what drugs
2-4 weeks after acute gout, with NSAIDs
what can allopurinol trigger and why
rapid reduction of uric acid to cause gout
what is a side effect and drug reaction of allopurinol
vasculitis - azathioprine
what are contraindications to febuxostat
renal impairment, ischaemic heart disease
what are steroids side effects
weight gain, muscle wasting/ skin atrophy, osteoporosis, diabetes, hypertension, immunosuppression
