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British National Formulary > Chapter 10- Musculoskeletal System > Flashcards

Chapter 10- Musculoskeletal System Flashcards

1
Q

DMARDs used in rheumatic disease take how long to work

A

2-6 months

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2
Q

If a DMARD does not lead to an objective benefit within 6 months what should happen?

A

Replace it with another one

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3
Q

Mode of action of the cytokine modulators (adalimumab, certolizumab, etanercept, golimumab, infliximab)

A

Inhibit the activity of tumour necrosis factor alpha

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4
Q

Cautions/further information with chloroquine/hydroxychlorquine

A

Screening for ocular toxicity

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5
Q

Patient and carer advice with hydroxychloroquine

A

Do not take antacids for at least 4 hours before or after hydroxychloroquine to reduce possible interference with absorption

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6
Q

Side effects of leflunomide

A

Potentially life threatening hepatotoxicity

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7
Q

Effective contraception is essential for how longneck in women and how long in men after taking leflunomide

A

Women - 2 years

Men - 3 months

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8
Q

Penicillamine aids the eliminations of what in Wilson’s disease

A

Copper

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9
Q

List some NSAIDs used in acute attacks of gout

A 
Diclofenac 
Etoricoxib
Indometacin
Ketoprofen
Naproxen 
Sulindec
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10
Q

What can be used in acute attacks of gout if NSAIDs are contraindicated

A

Colchicine

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11
Q

Name two xantine oxidase inhibitors used for long term control of gout

A

Allopurinol

Febuxostat

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12
Q

Name the uricosuric drug that increases the excretion of Uric acid in the urine used for long term control of gout

A

Sulfinpyrazone

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13
Q

MHRA safety information with febuxostat

A

Hypersensitivity reactions- Stevens Johnson syndrome

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14
Q

Muscarinic side effects of anticholinesterases

A

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

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15
Q

Which drug is preferred for neuromuscular disorders: neostigmine and pyridostigmine and why?

A

Pyridostigmine - less powerful, longer duration of action (smoother action)

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16
Q

It may take how long for quinine to work for nocturnal leg cramps

A

4 weeks

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17
Q

How do NSAIDs work?

A

Reduce the production of prostaglandins by inhibiting the enzyme cyclo-oxygenase

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18
Q

For NSAIDs selectivity for cyclo-oxygenase 2 is associated with less or more GI intolerance?

A

Less GI intolerance

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19
Q

Name the active enatiomer of ibuprofen

A

Dexibuprofen

20
Q

Mefanamic acid has been associated with what which requires discontinuation of treatment

A

Diarrhoea and haemolytic anaemia

21
Q

Nom selective NSAIDs are more associated with serious upper GI bleeds- name two

A

Diclofenac

Naproxen

22
Q

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?

A

Diclofenac

Ibuprofen

23
Q

Name three NSAID associated with the highest risk of GI events

A

Piroxicam
Ketoprofen
Ketorolac

24
Q

Name three NSAIDs associated with intermediate risk of GI events

A

Indometacin
Diclofenac
Naproxen

25
Q

Name the NSAID with the lowest risk of GI events (although has intermediate risk at high doses)

A

Ibuprofen

26
Q

Use of NSAIDs in the third trimester has been associated with what

A

Closure of fetal ductus arteriosus in utero and possibly pulmonary hypertension of the newborn

27
Q

Licensing for ibuprofen

A

Not licensed in children under 3 months or body weight under 5kg

28
Q

CHMP advice with piroxicam

A

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)

29
Q

CSM advice with tiaprofenac acid

A

Reports of severe cystitis

30
Q

Drugs that are likely to cause extravasation injury should be given through what type of line?

A

Central line

31
Q

General management of extravasation

A

Corticosteroids
Antihistamines
Analgesic

32
Q

What’s licensed for the extravasation of anthracycline induced extravasation

A

Dexrazoxane

33
Q

Antimalarials can be used in arthritis - what’s the counselling points for hydroxychloroquine

A

Do not take antacids 4 hrs before or after

Can cause retinopathy

34
Q

When is leflunomide given and what’s the side effect

A

In moderate to severe RA can cause life threatening hepatotoxicity

35
Q

Options for acute attack of gout

A

High dose NSAIDs (diclofenac/naproxen)
Colchicine
Oral/parenteral corticosteroid

36
Q

Long term gout prevention ?

A

Allopurinol

Uricosic drug e.g sulfinpyrazone

37
Q

Counselling points for allopurinol

A

Take after food

If rash develops needs to be withdrawn

38
Q

Counselling points with uricosic drugs and how do they work

A

Increase excretion of uric acid- ensure to keep hydrated to prevent crystallisation of urine

39
Q

Selective COX-2 NSAIDS such as celecoxib used for RA/osteoarthritis have what GI side effect profile?

A

Higher GI risk but lower risk of upper GI s/e

40
Q

Two NSAIDs with highest GI s/e

A

Ketoprofen

Piroxicam

41
Q

Intermediate GI s/e NSAIDs

A

Diclofenac
Indometacin
Naproxen

42
Q

Lowest GI S/E NSAID

A

Ibuprofen

43
Q

NSAIDs with highest risk of thrombotic effects

A

(DISc)
Diclofenac
Ibuprofen
Selective COX-2 inhibitors

44
Q

True or false - tiaprofenac is allowed in people with urinary tract disorders

A

FALSE do not give

45
Q

Ways to prevent extravasation

A

Central line
Change cannula
GTN patch locally

46
Q

Two methods of managing extravasation

A

Localise and neutralise

Spread and dilute

British National Formulary (18 decks)

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