Chapter 10: Musculoskeletal system Flashcards
AzathrioprineCiclosporinCyclophosphamideLeflunomidePenicillamineMethotrexateGoldAre all seen in which condition?
These are the DMARDs used in Rhumatoid arthritis
Hydroxychloroquine is indicated for active rhumatoid arthritis. What is a big warning with this drug?
Screening for ocular toxicity is required- monitor visual symptoms during treatment
What drugs are used in the treatment of Gout?
Colchicine
Allopurinol
sulfinpyrazone
febuxostat
What severe hypersensitivity reaction has been associated with Febuxostat use?
Steven Johnsons syndromeStop immediately if steven johnsons ulcer like rash occurs
Why must we avoid abrupt withdrawal with Baclofen?
Risk of hyperactive state- hyperthermia, psychiatric reactions, convulsion.
Dose should be discontinued gradually over 1-2 weeks
What should patients on Baclofen be advised with regards to driving?
Baclofen may cause drowsiness
What are Aceclofenac, Acemetacin, Celecoxib, Etodolac,Felbinac, Indometacin
Mefenamic acid all examples of?
NSAIDs
Why have restrictions on the use of Piroxicam been put forward?
Increased risk of GI side effects + serious skin reactions.
~ NOT used first line
~ ONLY initiated by specialist
~ ONLY used for rheumatoid arthritis not for pain anymore (this guidance does not effect topical preps only oral)
What is the big safety warning with TIAPROFENIC ACID (an NSAID)?
can cause SEVERE CYSTITIS
DO NOT give to patients with UTI disorders!
Stop if symptoms develop- increased frequency, nocturia, urgency, pain on urination, blood in urine.
Etanercept
Adalimumab
Liximab
Certolizumab
Golimumab
Infliximab
used in?
Rhumatoid arthritis
Chrons Ulcerative colitis ‘Cytokine Modulators’
What should patients taking Cytokine Modulators be advised to look out for?EtanerceptadalimumabLiximabCertolizumabGolimumab Infliximab
TUBERCULOSIS:(as immunosuppressant so infection with TB more likely)
Signs: persistent cough, Hemoptysis (coughing blood), weight loss
BLOOD DISORDERS:agranulocytosis: fever, sore throat, bruising, bleeding
Which NSAID carries the lowest risk of CV effects?
Naproxen
Which NSAID carries the lowest risk of Gastro-intestinal side effects?
Ibuprofen
Acute attacks of gout are usually managed how?
1) high doses of NSAIDs (diclofenac, etoricoxib, indometacin, ketoprofen, naproxen or sulindac)
2) Colchicine = alternative in patients unable to take NSAIDs such as hx of CVD issues.
What is an alternative to high dose NSAIDs for the treatment of acute attacks of gout?
Colchicine is an alternative in patients in whom NSAIDs are contra-indicated. Aspirin is not indicated in gout.
What medication should not be used to treat acute attacks of gout due to a risk of prolonging the attack indefinitely? (3)
Allopurinol, febuxostat, & uricosurics = NOT effective in treating acute attack + may prolong it indefinitely if started during acute episode.
The use of colchicine to manage acute gout is limited by what?
by development of toxicity at higher doses, ~ is of value in patients with heart failure since, unlike NSAIDs, does not induce fluid retention
~ can be given to patients receiving anticoagulants.
The use of colchicine is limited by the development of toxicity at higher doses, but it is of value in patients with heart failure for what reason?
since, unlike NSAIDs, does not induce fluid retention; moreover, it can be given to patients receiving anticoagulants.
What treatment options for acute gout in those who cannot tolerate NSAIDs & in whom use of colchicine ineffective?
~ Oral / parenteral corticosteroids = effective alternative
~ Intra-articular injection corticosteroid used in acute monoarticular gout [unlicensed indication]
~ corticosteroid by IM injection effective in podagra
~ Canakinumab, recombinant monoclonal antibody, used for symptomatic TX of frequent gouty arthritis attacks (at least 3 in previous 12 months)
What is Canakinumab?
~ recombinant monoclonal antibody
~ in symptomatic TX of frequent gouty arthritis attacks (at least 3 in previous 12 months)
~ licensed for use in patients whose condition not responded adequately to NSAIDs or colchicine, or intolerant of them.
Canakinumab is a recombinant monoclonal antibody which can be used for the symptomatic treatment of frequent gouty arthritis attacks, which is defined as how many in the previous 3 months?
Canakinumab, a recombinant monoclonal antibody, can be used for the symptomatic treatment of frequent gouty arthritis attacks (at least 3 in the previous 12 months). It is licensed for use in patients whose condition has not responded adequately to treatment with NSAIDs or colchicine, or who are intolerant of them.
For long-term control of gout the drugs allopurinol, febuxostat and sulfinpyrazone may be used. How do they work?
Both allopurinol & febuxostat ➡ reduce formation of uric acid from purines as xanthine-oxidase inhibitors.
Sulfinpyrazone = uricosuric drug which may be used to increase excretion of uric acid in urine.
Allopurinol, febuxostat and sulfinpyrazone should never be started during an acute attack of gout, they are usually started how long after an attack has settled?
1-2 weeks.
The initiation of long-term treatment for gout may precipitate an acute attack. How is this managed?
The initiation of treatment may precipitate an acute attack, and therefore an anti-inflammatory analgesic or colchicine should be used as a prophylactic and continued for at least one month after the hyperuricaemia has been corrected. However, if an acute attack develops during treatment, then the treatment should continue at the same dosage and the acute attack treated in its own right.