Pharmacology Week 4-6 Flashcards
1 in how many Australians reported having….
-osteoarthritis?
-osteoporosis or osteopenia?
- osteoarthritis 1 in 11 more so in F
- osteoporosis 1 in 5
People with back pain and problems were how many more times likely to experience…..
- poor health?
- very high psychological distress?
- very severe pain?
- PH: 3.2X
- PD: 1.8x
- SP: 2.4X
People with arthritis were how many more times likely to experience…..
- poor health?
- very high psychological distress?
- very severe pain?
- PH: 2.7x
- PD: 1.8X
- SP: 2.3X
People with osteoporosis were how many more times likely to experience…..
- poor health?
- very high psychological distress?
- very severe pain?
- PH: 2.0X
- PD: 1.9X
- 3.0X
Ankylosing spondylitis, psoriatic arthritis, reactive arthritis, enteropathic arthritis are all examples of what type of musculoskeletal disorder?
spondyloarthropathies
autoimmune disease that features painful swelling and stiffness in joints that is a systemic condition
rheumatoid arthritis (RA)
What happens at the cellular level in rheumatoid arthritis (RA)?
T cells invade the _____________ and produce _________ and _________
synovial membrane
interleukin-2
interferon
interleukin-2 and interferon signal a cascade reaction leading to an overproduction of ______________ which constitute the pivotal event leading to chronic inflammation
pro-inflammatory cytokines, mainly TNF-, IL-1 and IL-6
What are the stages of Rheumatoid arthritis?
1) synovitis
2) pannus formation
3) fibrous ankylosis
4) bony ankylosis
What is the general pharmaceutical management of Rheumatoid arthritis?
Disease Modifying Anti-Rheumatic Drugs (DMARDs)
What are the 3 main areas of pharmacological management of rheumatoid arthritis?
- pain management w/ analgesics
- disease modification with DMARDS w/ corticosteroids
- aggressive management of co-morbidities such as cardiovascular risk factors
reduce or eradicate synovial inflammation and thus prevent joint damage
disease modifying anti-rheumatic drugs (DMARDs)
When should a response with DMARDs therapy be expected?
apparent within 12 weeks
What is the most common DMARDs choice?
Methotrexate (MTX) in active cases which also is a common cancer drug
(combination therapy results in superior outcomes)
Methotrexate….
-what is it
- onset of action:
- often prescribes with:
- anti inflammatory, immunomodulatory and cytotoxic action
- w/in 3-6 weeks
- folic acid to reduce adverse effects
What are common adverse effects with methotrexate?
- nausea
- increase in rheumatoid arthritis
- mouth ulcers
- rash
- reversible hair loss
conventional synthetic DMARD that is an antimalarial that possesses anti-inflammatory and possibly immunosuppressive activity
hydroxychloroquine
What is the benefit to taking hydroxychloroquine too MTX?
better tolerated but less effective
What is the response onset of hydroxychloroquine?
2-6 months
Common adverse effects with hydroxychloroquine:
- nausea/ anorexia/ diarrhoea
- rash/ alopecia
- abdominal cramps
infrequent adverse effects if hydroxychloroquine:
- absent deep tendon reflexes
- muscle weakness
- neuromyopathy
What are the indications to use sulfasalazine?
- rheumatoid arthritis
- ulcerative colitis & chrons disease
Biological DMARDs (bDMARDs) are also known as…….
cytokine modulators
bDMARDs can act in different ways including….
- directly against pro-inflammatoy cytokines (TNF, IL-1 and IL6)
- act through B or T lymphocytes to decrease cytokine production
When are bDMARDs indicated?
- severe active RA
- psoriatic arthritis
- juvenile RA
- ankylosing spondylitis
What drugs are used to help with pain but does not modify the disease?
analgesics
if there is no inflammation what drug can be used in place of analgesics?
paracetamol
What are types of analgesics?
- paracetamol
- NSAID (ibuprofen)
- opiods
- fatty acid supplements (fish oil)
What is the dosage of DHA and EPA (fatty acid supplement) from fish oil are recommended a day to have an anti-inflammatory effect?
> 2.7g/day
Why are corticosteroids not always used to treat RA?
limited by adverse effects
What are the 3 main ways corticosteroids are used in RA?
- as an initial bridging therapy
- in the management of acute flares
- in combination with DMARDs when DMARds therapy is suboptimal
What are the effects corticosteroids have?
- anti-inflammatory
- immunosuppressant
- metabolic effects
glucocorticoids are diabetogenics meaning…..
- they can aggravate diabetes
- unmask latent diabetes
- cause insulin resistance
cortisol is important for…. (corticosteroids)
- carbohydrate metabolism
- protein metabolism
- fat metabolism
- calcium balance
- blood pressure and stress response
synthesis of corticosteroids…
-cholestrol –>
hydrocortisone (cortisol)
what controls the corticosteroid release?
-hypothalamic and pituitary control in adrenals
circadian rhythm and ultradian rhythm
steroids can block protein production (transrepression) which inhibit COX2 which causes an….
inflammatory effect
pregnancy and rheumatoid arthritis…give the class of drug
- NSAID
- corticosteroids
- fish oil and paracetamol
- category C
- Category A
can be used during pregnancy
Osteoarthritis is NOT an autoimmune disorder but a disorder of “______________”
wear and tear
What happens during osteoarthritis?
there is an imbalance between the synthesis and degradation of articular cartilage