Friday, August 19, 2011

(¬_¬) rheumatoid arthritis. cause i think this will help me pass my exam.

Rheumatoid Arthritis
40-60's woman are prone to have this. more RA pt get Osteoporosis. shorter life span. 
sometimes happen in children below 16 y.o.
called juvenile rheumatoid arthritis.
[symptom: inflammation of the joint for >6weeks. complication:eye inflammation. pauciarticular, affect 4 joint; polyarticular, affect 5 joint; systemic JRA, affect all body]
an autoimmune disease. unknown cause. happens when immune system consider your joint as foreign substance. so it will send WBC to to attack your joint [knee,ankle,hand and wrist] -synovium will become thicken called pannus as WBC release protein [prostaglandin,cytokines] to that site and cause this symptom:
joint inflammation
joint pain
joint tender to touch
morning stiffness 
fatigue
fever 
decrease in body weight
as the years by, this will destruct your bone, ligament and cartilage.
diagnosis:
RF [Rheumatoid Factor] 
ACPA's [Anti-Citrullinated Peptides]
*both AB
Excessice Erythrocyte Sedimentation Rate [ESR]
and
Radiological Changes [MRI]
Goals of theraphy:
Prevent/Slow Joint deformation
Increase pain/symptom
preserve quality of life
[Tx]:
1st Line - NSAID and Corticosteroid
2nd Line - DMARD [Disease Modifying Anti-Rhematoid Drugs]

NSAID
MOA: inhibit prostaglandin synthesis by blocking COX 1 and COX 2
COX 1 found everywhere in the body
COX 2 found in the site of inflammation
there is 2 types of NSAID which is
Non Selective COX 1 and COX 2 
[mefenamic acid, piroxicam, indomethacin, ibuprofen]
Selective COX 2 Inhibitor
[meloxicam, etoricoxib, diclofenac]
S/E
renal impairment 
bleeding problem
stomach irritation
increase HPT
[*as this link to prostaglandin inhibition]
*COX 2 have a safer GI profile than Non Selective
Pharmacokinetic DI
absorption: sucralfate - coated stomach acid, low A
antacid - low A of NSAID
*high stomach PH, more ionised drug, less absorbtion
protein binding: warfarin, digoxin and aspirin [WDA]
NSAID are more protein bound, concentration WDA will increase in blood plasma
metabolism: Fluconazole - enzyme inhibitor
increase NSAID in blood cause no metabolism
Rifampicin - Liver Enzyme Inducer
Warfarin - low metabolize of warfarin, warfarin increase in blood, increase bleeding
excretion: probenecid - increase reabsorbtion of NSAID
Pharmacodynamic DI
increase bleeding: salycylic acid, anticoagulant, antidepressant
nephrotoxicity: aminoglycoside, MTX, cyclosporin
Pro and [Cons]:
reduce pain+inflammation, reduce swelling, increase mobility and quality of life and low cost
[CVS Toxicity, Renal Impairment, GI Toxicity, Hepatic dis(fx) and doesn't affect RA progreesion]

Corticosteroid
oral, iv, im and intramuscular [methyprednisolone]
1st high dose and need to tapered slowly
*to avoid worsening of RA and SE
S/E: cushion syndrom [buffalo hump, moon face, redness, puffy]
supress immune system, prone to infection
decrease bone mass
muscle wasting 
increase BP
pro: fast onset, reduce inflammation and overactive body system immune, can be inject to IA
cons: lower bone mass, tapering discontinue not successful, S/E, does not affect RA progression.

DMARD [Disease Modifyying Anti-Rheumatoid Drug]
moa: supress body immune/inflammatory system
*pt often get infection cough, sakit tekak etc
MHSCLAPAIMG
*Mohd Hazwan Suka Cari LA PAI MaGgi*
Methotrexate - cause lung damage
Hydrochloroquine - retina damage
Sulfasalazine - sweat, urine, tears orange
Cyclosporin
Leflunomide
Azathioprine
Penicillamine
intramuscular gold
combination of drug
MTX+SFZ+HCQ
MTX+LEFLUNOMIDE
MTX+CYCLOSPORIN
why combine?
decrease toxicity level
long term use are more favorable
better than using one type of DMARD

ini yang aku hafal, keluar soalan lain. memang hancus la.
(>.<)


*update on the same day, 12:31pm
dem. aku salah 1 soalan. MTX ambik seminggu sekali OK?!
aku tak tahu and tak terbaca.

2 comments:

  1. Boleh buat e-reading kalau macam ni Lin. hehe... good info bytheway. Kak Ijan pernah ada kawan kena arthritis at age of 20s. pity her. :(

    ReplyDelete
  2. hahaha. ye la kak~mentang2 ada nook baru kan~happy belated bday :]

    kesiannya kawan akak tu. :(

    ReplyDelete

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