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PHRM2101 > WEEK 2: Managing Pain > Flashcards

WEEK 2: Managing Pain Flashcards

1
Q

What is nociceptive pain?

A

Nociceptive pain is pain that arises from actual or threatened damage to tissue outside the somatosensory nervous system due to the activation of nociceptors

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2
Q

What is neuropathic pain caused by?

A

Neuropathic pain is caused by a lesion or disease of the somatosensory nervous system.

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3
Q

Nociplastic pain arises from altered … despite a lack of evidence of tissue damage.

A

nociception

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4
Q

What is rheumatoid arthritis

A

Rheumatoid arthritis is a chronic autoimmune inflammatory disease that causes symmetric
peripheral polyarthritis.

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5
Q

T or F
A common presentation of rheumatoid arthritis is the inflammation of the joints in the hands and feet.

A

T

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6
Q

Chronic inflammation of the …… leads to the pain of rheumatoid arthritis.

A

synovial tissue

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7
Q

Key mechanisms undermining the overreactive response of rheumatoid arthritis include…

A

T cells, B cells, tumour necrosis factor alpha, macrophages and a host of cytokines.

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8
Q

A patient with rheumatoid arthritis is in remission when…

A

A patient is in clinical remission when they have few symptoms, inflammatory markers are
normal, and their joints are not swollen.

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9
Q

RA affects the synovial tissue primarily of the … joints and underlying cartilage and bone.

A

diarthrodial

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10
Q

Self reactive T cells drive the chronic inflammatory response of rheumatoid arthritis, especially…

A

CD4 + T cells

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11
Q

T-cells stimulate … that promote pro-inflammatory mediators that destroy cartilage and bone. These mediators include … IL-1 and IL-6 (and others).

A

macrophages
TNF-alpha

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12
Q

In the treatment of rheumatoid arthritis DMARDS such as methotrexate work by …

A

having a general anti-inflammatory effect on a broad range of cytokines.

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13
Q

T or F
There is a very similar pattern of joint involvement in rheumatoid arthritis and osteoarthritis.

A

F
There is a different pattern of joint involvement in rheumatoid arthritis and osteoarthritis.

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14
Q

T or F
Rheumatoid arthritis affects 2% of the population and is more common in women

A

F
Rheumatoid arthritis affects 1% of the population and is more common in women

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15
Q

Common early signs of RA include …

A

inflammation of the joints, often small joints of the hands and feet and early morning joint stiffness

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16
Q

In rheumatoid arthritis the approach to treatment is …, aggressively aiming for remission, which often requires … treatment

A

“treat to target”
combination

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17
Q

T or F
A key diagnostic figure in rheumatoid arthritis is the asymmetry of the areas affected

A

F
symmetry

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18
Q

T or F
Early morning stiffness in the joints can be a sign of rheumatoid arthritis

A

T

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19
Q

To be diagnosed with rheumatoid arthritis a patient must have arthritis in … or more regions.

A

3

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20
Q

… and … are antibodies that are helpful in diagnosing RA. These antibodies are part of the pathogenesis of RA.

A

Rheumatoid factors (RF)
anti-cyclic citrullinated peptide (anti-CCP)

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21
Q

T or F
Both Rheumatoid factors (RF) and
anti-cyclic citrullinated peptide (anti-CCP) have similar sensitivity, anti-CCP has greater specificity

A

T

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22
Q

A test is sensitive when:
a) it correctly identifies the disease in people with the disease.
OR
b) it correctly identifies the absence of disease in people without the disease.

A

a

23
Q

A test is specific when:
a) it correctly identifies the disease in people with the disease.
OR
b) it correctly identifies the absence of disease in people without the disease.

A

b

24
Q

T or F
Erythrocyte sedimentation rate (ESR) is an acute-phase reactant that is a sensitive but non-specific marker of inflammation.

A

False!
That is C-reactive protein (CRP)

25
Q

T or F
Erythrocyte sedimentation rate (ESR) increases when there are acute-phase reactants in the plasma: infection and inflammation.

A

T

26
Q

T or F
Most patients with rheumatoid arthritis end up on multiple DMARDs.

A

T

27
Q

How might the drug treatment of rheumatoid arthritis be intensified?

A

by increasing the dose of the drugs the patient is taking, or adding in another agent.

28
Q

For most patients with rheumatoid arthritis which drug is the first-line treatment?

A

methotrexate
(if further treatments are needed, they are in addition to methotrexate.)

29
Q

T or F
The response to DMARDs is relatively fast

A

F
The response to DMARDs is relatively slow

30
Q

T or F
In patients with rheumatoid arthritis Corticosteroids might be used long-term for symptom control while waiting for DMARDs to work.

A

F
Long-term use of corticosteriods are avoided due to adverse effects.

31
Q

If a patient with rheumatoid arthritis doesn’t achieve clinical remission on a combination of conventional synthetic DMARDs what types of medications will be initiated?

A

Biologic and targeted synthetic DMARDS

32
Q

T or F
When treating patients with rheumatoid arthritis usually several bDMARDs and tsDMARDs are used at a time.

A

F
Usually, only one bDMARD and tsDMARD is used at a time.

33
Q

……. supplementation reduces the effects of methotrexate on the gastrointestinal tract (nausea and mouth ulcers) and elevated liver function tests.

A

Folic acid.

34
Q

What is the most common arthritis?

A

osteorthritis

35
Q

Osteoarthritic joints are characterised by …

A

a loss of cartilage,
variable levels of inflammation and by weakness in the muscles stabilising the joint.

36
Q

What are the common joints affected in osteoarthritis?

A

Common joints that are effected are the joints in the hand, back, knee and hip.

37
Q

What type of drug is the first-line management in patients with osteoarthritis?

A

Topical NSAIDs

38
Q

If topical NSAIDs don’t work in a patient with osteoarthritis, what is used next?

A

oral NSAIDs and paracetamol can be considered.

39
Q

Gout is an acute and chronic arthritis caused by …

A

the deposition of monosodium urate crystals in joints.

40
Q

What is Hyperuricaemia?

A

(high uric acid levels in the blood)

41
Q

T or F
Hyperuricaemia is an unnecessary precondition for the development of gout.

A

F
Hyperuricaemia (high uric acid levels in the blood) is a necessary but not sufficient
precondition for the development of gout.

42
Q

Urate saturates at … mmol/L

A

0.42 mmol/L,

43
Q

T or F
Uric acid level at or above 0.42 mmol/L increases the risk of gout.

A

T

44
Q

The first presentation of gout is typically …

A

acute arthritis in the big toe.
The arthritis has a quick onset and can be very painful.

45
Q

What are the precipitators of gout?

A

Precipitators include over-eating, trauma, surgery, excessive alcohol
intake, treatments that lower blood uric acid, myocardial infarction and stroke.

46
Q

The initial acute attack of gout usually resolves within … to … days.

A

8 to 10

47
Q

What type of drug is the first-line treatment for gout?

A

NSAIDs

48
Q

T or F
Given the pain frequently associated with gout,
it is common to give a relatively potent NSAID at a reasonable dose,

A

T

49
Q

What alternatives no NSAIDs are there for the treatment of GOUT?

A

Alternatives to oral NSAIDs, include intrarticular or oral corticosteroids or colchicine.

50
Q

T or F
A patient on thiazide diuretics who develops gout should discontinue their use of thiazide diuretics

A

F
Hypertension and a common treatment for hypertension, thiazide diuretics,
are independently associated with hyperuricaemia and gout.
Managing hypertension is important for both gout and cardiovascular risk.
Given the effects of thiazide diuretics on uric acid levels are usually small,
most people can continue to take them.

51
Q

When is urate-lowering treatment initiated for gout patients?

A

If they have a second attack

52
Q

Why is allopurinol usually started at least 2 weeks following a gout flare?

A

The most important adverse effect of allopurinol is that it can precipitate a gout attack on initiation.

53
Q

What is the most common urate-lowering treatment used?

A

Allopurinol

54
Q

What is a tophi?

A

Masses of uric acid crystals

PHRM2101 (12 decks)

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