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BNF > Chaper 10 Musculoskeletal > Flashcards

Chaper 10 Musculoskeletal Flashcards

1
Q

Pain and Stiffness resulting for inflammatory rheumatic disease

A

NSAID

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2
Q

Other analgesics in RA

A

Paracetamol or Codeine can also be used

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3
Q

DMARDs

A

Drugs used to influence the rheumatic disease process its self

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4
Q

DMARDs include:

A 
Methotrexate 
Cytokine Modulators 
Azathioprine
Cyclosporin 
Cyclophosphamide 
Leflunomide
Penicillamine 
Gold 
Antimalarials ( chloroquine and hudroxychloroquine) 
Sulfasalazine
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5
Q

Which two antimalarials can be used as DMARDs?

A

Chloroquine and Hydroxychloroquine sulfate

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6
Q

Corticosteroids have a significant role in?

A

Rheumatoid Arthritis

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7
Q

Drugs which may affect the disease process in psoriatic arthritis include:

A 
Sulfasalazine,
Gold,
Azathioprine,
Methotrexate,
Leflunomide,
Cytokine modulators
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8
Q

For pain relief in osteoarthritis and soft tissue disorders what should be used first?

A

Paracetamol and may need to be taken regularly

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9
Q

Topical NSAID or topical capsaicin 0.025%

A

Should be considered particularly in knee or hand osteoarthritis

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10
Q

Can be substituted for or used in addition to paracetamol in OA

A

Oral NSAID

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11
Q

Further pain relief in OA

A

The addition of an opioid analgesic may be considered, but with a substantial risk of adverse effects

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12
Q

Patient on low dose aspirin

A

Opioid analgesic considered before a NSAID in patients taking low dose aspirin

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13
Q

Intra-articular corticosteroid injections

A

May produce temporary benefit in osteoarthritis, especially if associated with soft tissue inflammation

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14
Q

Non drug measures:

A

Weight reduction and exercise should be encouraged

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15
Q

Not recommended for treatment of OA

A

Glucosamine and Rubefacients

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16
Q

Hyaluronic and its derivative available for OA of the knee

A

But are not recommended

May reduce pain over 1-6 months

Associated with short term increase in knee inflammation

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17
Q

NSAIDs are only used for

A

Symptom control

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18
Q

DMARDs can affect the progression of disease

A

But may require 2-6 months of treatment for a full therapeutic response

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19
Q

Respond to DMARDs may allow

A

NSAID dose to be withdrawn or reduced

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20
Q

All patients with suspected inflammatory joint disease

A

Should be referred to a specialist as soon as possible to confirm diagnosis and evaluate disease activity; early initiation of DMARDs is recommended to control the signs and symptoms, and to limit joint damage

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21
Q

DMARDs similar in efficacy

A

Methotrexate
Sulfasalazine
Intramuscular gold
Penicillamine

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22
Q

DMARDs better tolerated

A

Methotrexate

Sulfasalazine

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23
Q

Patient with newly diagnosed active RA

A

A combination of DMARDS (including methotrexate and at least one other DMARD) and a short term corticosteroid

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24
Q

Treatment initiation to patients with newly diagnosed active RA

A

Within 3 months of the onset of persistent symptoms

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25
Q

If use of a particular DMARD is contraindicated and combination therapy is not possible

A

Mono therapy with a suitable DMARD should be given and the dose rapidly increased until clinically effective

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26
Q

Patients with established and stable RA

A

Cautiously reduce drug doses to the lowest that are clinically effective

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27
Q

When should DMARD be replaced by another

A

Drug does not lead to objective benefit within 6 months

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28
Q

Sodium aurothiomolate

A

Gold for active progressive RA

Given by deep IM and the area gently massaged

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29
Q

Test dose followed by doses at weekly intervals

A

Until there is definite evidence of remission

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30
Q

In patients who do respond

A

The interval between injections is then gradually increased to 4 weeks and treatment is continued for up to 5 years after complete remission

31
Q

Relapse occurs

A

Dosage frequency immediately increased and once control obtained again should dosage frequency be decreased

32
Q

When to seek alternative treatment

A

If no response within 2 months

33
Q

Why avoid complete relapse

A

Since second courses of gold usually ineffective

34
Q

Penicillamine

A

Similar action to gold

More able to continue treatment than with gold but side effects are common

35
Q

Patients should be warned with penicillamine

A

Not to expect improvement for 6-12 weeks after treatment is initiated

36
Q

When should penicillamine be discontinued

A

No improvement within 1 year

37
Q

Beneficial effect in suppressing the inflammatory activity of RA

A

Sulfasalazine

38
Q

Used by specialist in the management of psoriatic arthritis affecting peripheral joints

A

Sulfasalazine

39
Q

Haematological abnormalities

A

Occur usually in the first 3 to 6 months of treatment with sulfasalazine and are reversible on cessation of treatment

40
Q

Which antimalarial is reserved if other drugs fail

A

Chloroquine

41
Q

Effective for mild systemic lupus erythematosus

A

Chloroquine and hydroxychloroquine

42
Q

Not to be used for psoriatic arthritis

Better tolerated than gold and penicillamine

Retinopathy rarely occurs provided doses are not exceeded

A

Chloroquine and hydroxychloroquine

43
Q

Drugs affecting the immune response:

A

Methotrexate
Leflunomide
Ciclosporin
Cyclophosphamide

44
Q

By mouth once a week

A

Methotrexate

45
Q

Mucosal and Gastrointestinal side effects with methotrexate

A

Folic acid given every week

46
Q

Therapeutic effect starts after 4-6 weeks and improvement may continue for a further 4-6 months

A

Leflunomide

47
Q

Leflunomide

A

Similar efficacy to sulfasalazine and methotrexate, may be chosen when these drugs cannot be used

48
Q

Licensed for severe active rheumatoid arthritis when conventional second line therapy is inappropriate or ineffective

A

Ciclosporin

49
Q

Some evidence that

A

Ciclosporin may retard the rate of erosive progression and improve symptom control in those who respond only partially to methotrexate

50
Q

Cyclophosphamide

A

RA with severe systemic manifestation

Toxic and regular blood counts ( including platelet counts) should be carried out

51
Q

Should be used under specialist supervision

A

Cytokine modulators

52
Q

Inhibit activity of TNF-alpha

A

Adalimumab, certolizumab, etanercept, golimumab and infliximab

53
Q

Important to distinguish drugs used

A

For the treatment of acute attacks of gout from those used in the long term control of the disease

The latter exacerbates and prolongs the acute manifestation of started during an attach

54
Q

The management of four in adolescents requires

A

Specialist supervision

55
Q

Acute attack of gouts

A

Usually treated with high doses of NSAIDs such as diclofenac and naproxen

56
Q

Alternative treatment in acute attack of gout in those in which NSAIDs contraindicated

A

Colchicine

57
Q

Aspirin

A

Not indicated in gout

58
Q

Allopurinol, febuxostat and uricosuric

A

Not affective in treating an acute attack and may prolong it indefinitely if started during an acute episode

59
Q

Restricted by development of toxicity in higher dose

A

Colchicine

60
Q

Benefits of colchicine

A

Unlike NSAIDs can be used in HF, does not induce fluid retention

It can be given in patients receiving anticoagulant

61
Q

Effective alternative in those who cannot tolerate NSAIDS or who are resistant to other treatments

A

Oral or parenteral corticosteroids

62
Q

Long term treatment of gout

A

Started 1-2 weeks after the attack has settled

63
Q

Allopurinol

A

Especially useful in renal impairment or urate stones when uricosuric drugs cannot be used

64
Q

Can cause rashes

A

Allopurinol

65
Q

Adequate urine output

A

With uricosuric drugs as crystallisation can occur in urine

66
Q

Antagonise uricosuric drugs

A

Aspirin and other salicylate

67
Q

Drugs that enhance neuromuscular transmission

A

Anticholinesterase are used as first line treatment in ocular myasthenia gravis

68
Q

when anticholinesterases do not control symptoms completely

A

Corticosteroids are used

69
Q

Frequently used to reduce dose of corticosteroids

A

Second line immunosuppressant such as azathioprine is used

70
Q

Excessive dosage of anticholinesterases

A

Can impair neuromuscular transmission and precipitate cholinergic crisis by causing depolarisation block

71
Q

Muscarinic side effects of anticholinesterases

A

Increased sweating
Increased salivary and gastric secretions
Increased gastrointestinal and uterine motility
Bradycardia

72
Q

Parasympathetic effects antagonised by

A

Atropine sulfate

73
Q

Neostigmine

A

Produces a therapeutic effect for up to 4 hours

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