Chapter 10- Musculoskeletal System Flashcards
DMARDs used in rheumatic disease take how long to work
2-6 months
If a DMARD does not lead to an objective benefit within 6 months what should happen?
Replace it with another one
Mode of action of the cytokine modulators (adalimumab, certolizumab, etanercept, golimumab, infliximab)
Inhibit the activity of tumour necrosis factor alpha
Cautions/further information with chloroquine/hydroxychlorquine
Screening for ocular toxicity
Patient and carer advice with hydroxychloroquine
Do not take antacids for at least 4 hours before or after hydroxychloroquine to reduce possible interference with absorption
Side effects of leflunomide
Potentially life threatening hepatotoxicity
Effective contraception is essential for how longneck in women and how long in men after taking leflunomide
Women - 2 years
Men - 3 months
Penicillamine aids the eliminations of what in Wilson’s disease
Copper
List some NSAIDs used in acute attacks of gout
Diclofenac Etoricoxib Indometacin Ketoprofen Naproxen Sulindec
What can be used in acute attacks of gout if NSAIDs are contraindicated
Colchicine
Name two xantine oxidase inhibitors used for long term control of gout
Allopurinol
Febuxostat
Name the uricosuric drug that increases the excretion of Uric acid in the urine used for long term control of gout
Sulfinpyrazone
MHRA safety information with febuxostat
Hypersensitivity reactions- Stevens Johnson syndrome
Muscarinic side effects of anticholinesterases
Increased sweating
Increased salivary and gastric secretions
Increased GI and uterine motility
Bradycardia
Which drug is preferred for neuromuscular disorders: neostigmine and pyridostigmine and why?
Pyridostigmine - less powerful, longer duration of action (smoother action)
It may take how long for quinine to work for nocturnal leg cramps
4 weeks
How do NSAIDs work?
Reduce the production of prostaglandins by inhibiting the enzyme cyclo-oxygenase
For NSAIDs selectivity for cyclo-oxygenase 2 is associated with less or more GI intolerance?
Less GI intolerance
Name the active enatiomer of ibuprofen
Dexibuprofen
Mefanamic acid has been associated with what which requires discontinuation of treatment
Diarrhoea and haemolytic anaemia
Nom selective NSAIDs are more associated with serious upper GI bleeds- name two
Diclofenac
Naproxen
All NSAIDs use can be associated with a small increased risk of thrombotic events (MI/stroke) independent of baseline risk or duration of use, name two NSAID with a higher risk?
Diclofenac
Ibuprofen
Name three NSAID associated with the highest risk of GI events
Piroxicam
Ketoprofen
Ketorolac
Name three NSAIDs associated with intermediate risk of GI events
Indometacin
Diclofenac
Naproxen
Name the NSAID with the lowest risk of GI events (although has intermediate risk at high doses)
Ibuprofen
Use of NSAIDs in the third trimester has been associated with what
Closure of fetal ductus arteriosus in utero and possibly pulmonary hypertension of the newborn
Licensing for ibuprofen
Not licensed in children under 3 months or body weight under 5kg
CHMP advice with piroxicam
Increased risk of GI side effects and skin reaction therefore restrictions are in place on the use e.g max 20mg daily (these restrictions do not apply to topical piroxicam)
CSM advice with tiaprofenac acid
Reports of severe cystitis
Drugs that are likely to cause extravasation injury should be given through what type of line?
Central line
General management of extravasation
Corticosteroids
Antihistamines
Analgesic
What’s licensed for the extravasation of anthracycline induced extravasation
Dexrazoxane
Antimalarials can be used in arthritis - what’s the counselling points for hydroxychloroquine
Do not take antacids 4 hrs before or after
Can cause retinopathy
When is leflunomide given and what’s the side effect
In moderate to severe RA can cause life threatening hepatotoxicity
Options for acute attack of gout
High dose NSAIDs (diclofenac/naproxen)
Colchicine
Oral/parenteral corticosteroid
Long term gout prevention ?
Allopurinol
Uricosic drug e.g sulfinpyrazone
Counselling points for allopurinol
Take after food
If rash develops needs to be withdrawn
Counselling points with uricosic drugs and how do they work
Increase excretion of uric acid- ensure to keep hydrated to prevent crystallisation of urine
Selective COX-2 NSAIDS such as celecoxib used for RA/osteoarthritis have what GI side effect profile?
Higher GI risk but lower risk of upper GI s/e
Two NSAIDs with highest GI s/e
Ketoprofen
Piroxicam
Intermediate GI s/e NSAIDs
Diclofenac
Indometacin
Naproxen
Lowest GI S/E NSAID
Ibuprofen
NSAIDs with highest risk of thrombotic effects
(DISc)
Diclofenac
Ibuprofen
Selective COX-2 inhibitors
True or false - tiaprofenac is allowed in people with urinary tract disorders
FALSE do not give
Ways to prevent extravasation
Central line
Change cannula
GTN patch locally
Two methods of managing extravasation
Localise and neutralise
Spread and dilute
