October 27, 2021

Practical #05

Arthritis

Arthritis is a disease that affects your joints (areas where your bones meet and
move). Arthritis usually involves inflammation or degeneration (breakdown) of
your joints. Arthritis is most common in the following areas of the body:

 Feet, Hands, Hips, Knees, Lower back.

Types of arthritis

 Osteoarthritis, or “wear and tear” arthritis, which develops when joint

cartilage breaks down from repeated stress. It is the most common form of arthritis
 Gout: a disease that causes hard crystals of uric acid to form in your joints.
 Psoriatic arthritis: joint inflammation that develops in people
with psoriasis (autoimmune disorder that causes skin irritation).
 Rheumatoid arthritis: a disease that causes the immune system to attack
synovial membranes in your joints.

Pathophysiology:

Stage 1: (Pre-Clinical)

Before Arthritis becomes clinically apparent, immune pathology already beginning-

Raised ESR, C-reactive proteins and Rheumatoid Factor.

Stage 2: (Synovitis)

Synovial membrane inflamed and thickened. Joint and tendon are intact.

Stage 3: (Destruction)

Persistent inflammation causes joint and tendon destruction. Articular cartilage

eroded due to proteolytic enzymes. Bone eroded by granulation tissue

Stage 4: (Deformity)

Due to articular destruction, capsule stretching, tendon rupture.

 Practical #05
Patient profile
Patient Name: Jamila akhter.
Disease:
 Arthritis
Duration:
 5 years
History:
 Pain in joints
Medication history:
 Etbricoxibe
Medications:
Drugs Brands Dose Indication Duration
Etbricoxibe Arcox 60mg Osteoarthritis 1 daily
moderate pain,
gouty arthritis
Esomeprazole Esante 20mg Treatment and 1 in morning
prevention of
NSAID’s, peptic
ulcer
Cyclosporine Neural 25mg Immunosuppression A capsule
in organ and bone twice a day
marrow transplant
on severe active
rheumatoid
arthritis.
Methotrexate sodium Unitrexate 10mg Reduce effective Once a week
optimal response
sever and active
arthritis.
Folic acid Folic acid 5 mg Dietary supplement Once a week
for renal defect.
 Prednisolone predisolone 5mg Allergic condition, Once a day
requiring
corticosteroid
therapy.
Floxitine flux 20mg Observe 1 capsule
compulsive daily.
disorder.

Drugs Interaction:
Drugs With OTC With other With Food
drugs
Etoricoxib The risk and Oral Take it with or without food.
severity of anticoagulants, The absorption is unaffected
adverse effects ACE inhibitors, by food.
increase. diuretics.
Esomeprazole According to Phenytoin, Food may interact with
FDA it can give warfarin, esomeprazole so should be
with OTC. protease taken 1hour before meal.
inhibitors and
diazepam.
Methotrexate sodium Ibuprofen Protein bound Caffeine, alcohol and food
drug, NSAID’s, delay its absorption and
Levofloxacin
antibiotic decrease serum conc.
Prednisolone Aspirin, Vaccines, May or may not interact with
iburophen anticoagulants, food.
diuretics
Cyclosporine Aspirin, Barbiturates. Grape fruit and grape fruit
iburophen Macrolides, juice.
NSAID’s
Fluoxetine Iburophen, Amino acids, Take with or without meal.
levofloxacin, calcium channel
aspirin. blockers.
Adverse Reactions:
Drugs Adverse Reactions
Etoricoxib Edema, dizziness, Palpitation, headache, hypertension, GIT upset, raised
liver enzymes.
Esomeprazole Headaches, skin reaction, dry mouth.
Cyclosporine Hyperlipidemia, hypertension, thrombocytopenia.
Methotrexate Bone marrow depression, GIT upset, hepatotoxicity, CNS disturbances.
Prednisolone Electrolyte disturbance, adrenal suppression. Growth suppression.
Fluoxetine Nausea, anxiety, insomnia, dizziness.

Precautions and Instruction:

Drugs Contraindicated Precautions Advice to patient
Etoricoxib Active peptic ulcer, History of GI Take with or without
hepatic ulcer, renal disease, meal.
impairment. cardiovascular
risk factors.
Esomeprazole Decrease amount of GI infection, Take at least 1 hour
Mg, inadequate monitor renal or before meal.
vitamin B12 sever liver function, BP,
liver disease. serum lipids
Cyclosporine Lactation Hematological Not to take with grape
depression, fruit or its juice.
pulmonary hepatic
disease.
Methotrexate Renal or hepatic Hematological Report immediately
impairment, active depression, redness, swelling
infectious disease, pulmonary hepatic yellowing of eye or
immune deficiency disease breathing problems
syndrome.
Prednisolone Systemic fungal Caution in Take with meal.
infection, stroke. chichenpox
measles, hepatic
 failure.
Fluoxetine Sever renal failure, Hepatic Don’t stop abruptly.
unstable epilepsy. impairment,
diabetes, cardiac
disease

Clinical pharmacy-pharm-611 Signature………………….