Drugs for MSK Disorders

Question 1

What is an iatrogenic condition?

Answer 1

An illness caused by medical treatment or examination.

Question 2

What is the role of osteoblasts?

Answer 2

They build bone by producing and mineralizing bone matrix.

Question 3

What do osteoclasts do?

Answer 3

Break down bone during bone resorption.

Question 4

What is pharmacokinetics?

Answer 4

The study of how a drug is absorbed, distributed, metabolized, and eliminated.

Question 5

What is bioavailability?

Answer 5

The degree to which a drug becomes available to target tissues.

Question 6

What are the two main types of bone structure?

Answer 6

Cortical (outer shell) and trabecular (inner honeycomb-like).

Question 7

Which cells occupy Howship’s lacunae?

Answer 7

Osteoclasts.

Question 8

What type of cells do osteoclasts originate from?

Answer 8

Monocyte-derived cells.

Question 9

What is required for osteoblast differentiation?

Answer 9

Blood supply; without it, chondroblasts form instead.

Question 10

What is osteoporosis?

Answer 10

Thinning and weakening of bone, increasing fracture risk.

Question 11

Which bones are commonly affected in osteoporosis?

Answer 11

Spine, hip, wrist.

Question 12

Why are women more prone to osteoporosis?

Answer 12

Bone loss accelerates after menopause due to estrogen deficiency.

Question 13

What is osteopenia?

Answer 13

A precursor to osteoporosis, T-score between -1.0 and -2.5.

Question 14

How is osteoporosis diagnosed?

Answer 14

DEXA scan with T-score ≤ -2.5.

Question 15

List 3 broad approaches to managing MSK disorders.

Answer 15

1. Diet/exercise
2. Drug therapy
3. Hormonal/replacement therapy

Question 16

What are bisphosphonates?

Answer 16

Enzyme-resistant analogues of pyrophosphate that bind to calcium in bones.

Question 17

How do non-nitrogen-containing BPs work?

Answer 17

Inhibit ATP-dependent enzymes by forming non-hydrolysable ATP analogues.

Question 18

How do nitrogen-containing BPs work?

Answer 18

Inhibit farnesyl pyrophosphate synthase, disrupting osteoclast function.

Question 19

What is the overall effect of bisphosphonates?

Answer 19

↓ osteoclast activity, ↑ osteoclast apoptosis, ↓ bone resorption.

Question 20

What serious side effect is linked with BP therapy?

Answer 20

Osteonecrosis of the jaw (ONJ).

Question 21

What other rare complication can BPs cause?

Answer 21

Atypical thigh fractures.

Question 22

When is HRT useful in osteoporosis?

Answer 22

In early menopause or menopause-related bone loss.

Question 23

What are SERMs?

Answer 23

Selective Estrogen Receptor Modulators – act as estrogen agonists/antagonists in a tissue-specific way.

Question 24

What determines SERM tissue specificity?

Answer 24

ER subtype binding, receptor conformation, cofactor expression.

Question 25

What is calcitonin’s role in bone?

Answer 25

Inhibits osteoclasts, reducing bone resorption.

Question 26

What does PTH do in low/intermittent doses?

Answer 26

Stimulates osteoblasts to build bone (anabolic effect).

Question 27

What percent of the population is affected by RA?

Answer 27

About 1%.

Question 28

What are the main treatment categories for RA?

Answer 28

1. NSAIDs 2. Steroids 3. DMARDs 4. Biological agents

Question 29

What type of drugs are used in severe RA?

Answer 29

Immunosuppressants

Question 30

What is the MoA of NSAIDs?

Answer 30

Inhibit COX enzymes, reducing prostaglandin synthesis (anti-inflammatory).

Question 31

What are COX-2 selective inhibitors called?

Answer 31

Coxibs (e.g., celecoxib)

Question 32

Why were Coxibs developed?

Answer 32

To reduce GI side effects of traditional NSAIDs.

Question 33

What is a serious side effect of some Coxibs (e.g., rofecoxib)?

Answer 33

Increased cardiovascular risk.

Question 34

Name two commonly used glucocorticoids.

Answer 34

Prednisolone, dexamethasone.

Question 35

What are some chronic side effects of steroids?

Answer 35

Cushing’s syndrome, osteoporosis, cataracts, increased IOP, femoral head necrosis.

Question 36

What determines steroid toxicity?

Answer 36

Dose, potency, and duration of use.

Question 37

What is the main goal of DMARDs?

Answer 37

To slow or stop joint damage and disease progression.

Question 38

How long are DMARDs usually taken?

Answer 38

Lifelong (with monitoring).

Question 39

What monitoring is essential with DMARDs?

Answer 39

Blood tests for liver, kidney, and bone marrow function.

Question 40

What is methotrexate’s mechanism in RA?

Answer 40

Immunosuppressive, reduces immune cell activity.

Question 41

Why is methotrexate contraindicated in pregnancy?

Answer 41

It is teratogenic.

Question 42

What are key facts about sulfasalazine?

Answer 42

Prodrug, takes 6+ weeks, reduces sperm count, used in Crohn’s.

Question 43

What drug is also used for malaria and RA?

Answer 43

Chloroquine.

Question 44

How long does chloroquine take to work in RA?

Answer 44

2–4 months.

Question 45

What are biological agents used in RA?

Answer 45

Monoclonal antibodies or cytokine modulators.

Question 46

Name 3 anti-TNF biologicals.

Answer 46

Infliximab, etanercept, adalimumab.

Question 47

What is the MoA of infliximab?

Answer 47

Chimeric monoclonal antibody targeting TNF-alpha.

Question 48

What is etanercept?

Answer 48

A soluble TNF receptor.

Question 49

When are biologics used?

Answer 49

After failure of conventional DMARDs.

Question 50

What is cyclophosphamide’s role in RA?

Answer 50

Severe, systemic disease (unlicensed); very toxic.

Question 51

What must be monitored during cyclophosphamide use?

Answer 51

Complete blood counts, including platelets.

Question 52

What is an important warning with ciclosporin?

Answer 52

Do not take with grapefruit juice.

Question 53

What is ciclosporin used for in RA?

Answer 53

When other DMARDs fail or are inappropriate.