Chapter 10 Muscoskeletal system Flashcards
what is the max dose of methotrexate
25mg once a week
what are the characteristics of rheumatoid arthritis?
joint pain morning stiffness over 30 mins weight loss fatigue symmetrical pain- pain on both sides- right and left
how long is treatment of rheumatoid arthritis taken for
2-6 months to stop it getting worse
what are the characteristics of osteoarthritis
less than 30 mins
one sided
joint pain when you put weight
what is treatment for osteoarthritis
1st line paracetamol
knee or hand- topical nsaid or capsacin 0.025%
if taking aspirin then opioid instead
Recommend weight reduction and exercise
what are the treatment options for rheumatoid arthritis
Methotrexate ciclosporin sulfasalasin azathiopurine gold hydroxycholoroquine
what are contra-indications of glucosamine
CI in shellfish allergy
avoid in pregnancy
not recommended
what is gout and characteristics
high amount of uric acid in blood leading to urate crystals which builds up in joints worsened by diuretics sudden severe episodes of pain tenderness redness warmth swelling most common in big toe
what are the treatment for gout
1st line NSAID- Naproxen 750mg then 250mg bd
or
Colchicine max 12 tablets in a course
500mcg 1 tab 2-4 times a day until symptoms relieve. max 6mg per course
once 12 tabs finish can’t repeat for another 3 days
what is the main side effect of colchicine
diarrhoea- refer to GP and stop because it could be sign of toxicity
why should statins be stopped whilst taking colchicine and for how long after
stop statins whilst taking and 2 days after colchicine due to increased risk of muscle death
what drugs are used for long term treatment of gout
have to let acute attack get better before starting treatment wait 1-2 weeks 1st line allopurinol 2nd line febuxostat continue treatment indefinitely to prevent further gout
what is a rare side effect that can happen with allopurinol or febuxostat
stevens johnson syndrome:
causes flu like symptoms
get rash red/ purply that spreads and can get blisters
need to stop and refer to gp
what is myasthenia gravis
rare long term condition
muscle weakness
tratments include anticholisterases e.g neostigmine and pyridostigmine
how should baclofen be withdrawn and why
what is an alternative
avoid stopping abruptly- withdrawal may worsen spasicity- spasms, hyperthermia and psychiatric reactions
reduce over 1-2 weeks
Methocarbamol is the alternative
