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MSK Week 2 2017/18 > 11: Pharmacology of arthritis > Flashcards

11: Pharmacology of arthritis Flashcards

1
Q

Which drugs are used to treat arthritis?

A

Simple analgesics

NSAIDs

DMARDs

Steroids

Biologics

Specific treatments for gout

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2
Q

What are adjuvant painkillers which can be added on to help control pain?

A

Opioids

Anti-depressants

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3
Q

What are some NSAIDs used to treat arthritis?

A

Diclofenac

Ibuprofen

Naproxen

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4
Q

What are some NSAID side effects which must be considered before putting an arthritis patient on them?

A

Peptic ulcers (loads of GI side effects)

Renal dysfunction

Increased CVD risk

Exacerbation of asthma

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5
Q

Which kind of NSAID disproportionately increases CVD risk?

A

Cox-2 inhibitors

(-coxibs)

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6
Q

What are DMARDs?

A

Disease modifying anti-rheumatic drugs

i.e drugs used alongside symptom controllers to alter the progression of the disease

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7
Q

What DMARD should be started immediately in RA patients to stop the progression of their disease?

How long have you got (ideally) after symptoms start?

A

Methotrexate usually

3 months

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8
Q

Apart from NSAIDs and DMARDs, which other drugs are used to treat inflammatory arthritis?

A

Steroids

Biologics

(+ stuff for gout)

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9
Q

How long do DMARDs need to take effect?

What is used in the interim?

A

Weeks to months (e.g methotrexate - 6 weeks)

Steroids likely

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10
Q

Do DMARDs have an analgesic effect?

A

No, purely anti-inflammatory to reduce rate of joint damage

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11
Q

DMARDs tend to have systemic __ __.

A

side effects

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12
Q

DMARDs are only used when the ___ outweighs the ___.

A

benefit > risk

This translates to almost all RA patients, to spare steroid side effects

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13
Q

Apart from methotrexate, what are some other DMARDs used to reduce disease progression?

A

Sulfasalazine

Leflunomide

Hydroxychloroquine

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14
Q

Patients on DMARDs like methotrexate must have their ___ tested regularly.

Why?

A

blood

Check for side effects

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15
Q

Hydroxychloroquine is the first line treatment in what kind of MSK disease?

A

Connective tissue disease

e.g SLE

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16
Q

What are some side effects of methotrexate?

A

GI - n/d, mouth ulcers, hepatitis

Haemo - leucopenia, thrombocytopenia

Resp - pneumonitis

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17
Q

What is methotrexate usually changed to if a patient has side effects?

A

Leflunomide

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18
Q

What is a major side effect of leflunomide, similar to methotrexate?

A

Teratogenicity

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19
Q

Which skin condition can sulfasalazine cause?

A

Steven Johnsons syndrome

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20
Q

Hydroxychloroquine is an add-on agent in ___ and a first line therapy in __ __ __.

A

RA

connective tissue disease

21
Q

What is a known permanent side effect of hydroxychloroquine?

A

Retinopathy - visual impairment

22
Q

What are some old fashioned DMARDs?

A

Gold

Penicillamine

23
Q

What is a common target of mechanism-based biologic agents?

A

TNF

B cells (bc they produce autoantibodies)

Interleukins

24
Q

Are biologic agents available to all patients?

A

No

Patient has to fulfill loads of criteria and they’re very expensive

25
Q

How do biologic agents tend to be given to patients?

A

Injections once every week / fortnight

26
Q

What is TNF?

A

Tumour necrosis factor

Pro-inflammatory cytokine

27
Q

Which scoring system for RA is used to measure the severity of the disease?

A

DAS28

28
Q

How high must a patient’s DAS28 score be to qualify for biologics?

What is the other criterion?

A

> 5.1

Have been on at least 2 different DMARDs already

29
Q

What are some side effects of anti-TNF agents?

A

Increased risk of infection

Increased risk of skin cancer

May reactivate latent TB

30
Q

Do anti-TNF therapies cause fetal abnormalities?

A

No

31
Q

What does rituximab target?

A

B cells

so can be used to treat any disease involving autoantibodies

32
Q

Ustekinumab and secukinimab are biologics used exclusively for which type of arthritis?

A

Psoriatic arthritis

(+ Psoriasis)

33
Q

What are the two aspects of gout treatment?

A

Acutely

Prophylactically (to prevent it happening again)

34
Q

Is allopurinol any good in an acute flare of gout?

A

No, may actually exacerbate symptoms

35
Q

What is used to treat acute episodes of gout?

A

NSAIDs

Steroids

Colchicine

36
Q

When should allopurinol be prescribed to a patient with a history of gout?

A

2-3 weeks after acute episode

To prevent recurrence

37
Q

When is gout prophylaxis indicated?

A

2 episodes of gout in 6 months

38
Q

What type of drug is allopurinol / febuxostat?

A

Xanthine oxidase inhibitor

39
Q

Which drug must be given in addition to allopurinol/febuxostat for gout prophylaxis?

A

Whatever drug you used to treat the acute flare

40
Q

What is a known side effect of allopurinol?

A

Vasculitis presenting as a big rash

41
Q

Which immunosuppressant drug, commonly used in SLE, interacts with allopurinol?

A

Azathioprine

42
Q

What happens if allopurinol and azathioprine interact?

A

Irreversible bone marrow suppression

43
Q

Why may allopurinol be contraindicated in a patient with gout?

What would be given instead?

A

Renal dysfunction

Febuxostat

44
Q

What are some steroid side effects?

A

Loss of bone density (osteoporosis)

Contribute to development of diabetes

Weight gain

Muscle atrophy

Moon face (Cushings appearance)

loads of others

45
Q

If a lupus patient complains of hip pain and they are on steroids, what should be suspected?

A

Avascular necrosis of femoral head

46
Q

If possible, steroids should be used for as (brief / long) a period as possible.

A

brief period

47
Q

How long should women come off methotrexate for before trying to conceive?

A

3 months

48
Q

Which alternatives to methotrexates are safe in pregnancy?

A

Sulfasalazine

Hydroxychloroquine

49
Q

RA often ___ during pregnancy.

A

improves

MSK Week 2 2017/18 (11 decks)

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