Drugs in the Management of Musculoskeletal Disorders

Question 1

What is an Osteoblast and Osteoclast?

Answer 1

Osteoblast: Cells which make bone

Osteoclast: Cells which breakdown bone

Question 2

Describe the structure of Osteoblasts and Osteoclasts

Answer 2

Osteoclasts are multinucleated with up to 200 nuclei, and Osteoblasts have one nuclei

Question 3

How do Osteoclasts break down bone?

Answer 3

Bind to bone surface via integrins, forming a “ceiling zone”. They then breakdown bone and release calcium

Question 4

What are three treatments doctors can offer patients to alleviate Osteoporosis?

Answer 4

Appropriate diet & exercise
Medications
Replacement

Question 5

Describe the mechanism of action of Bisphosphonates

Answer 5

Bisphosphonates are enzyme resistant analogues of pyrophosphate, which normally inhibits mineralisation of bone

They inhibit osteoclast activity, inhibit osteoclast progenitor development and increase osteoclast apoptosis

Question 6

Give 2 examples of drugs which are Bisphosphonates

Answer 6

Alenodronate

Etidronate

Question 7

What are some side effects of Bisphosphonate therapy?

Answer 7

Osteonecrosis of the Jaw

Question 8

Give 2 examples of drugs which is a SERM (Selective Estrogen Receptor Modulator)

Answer 8

Raloxifene

Tamoxifen

Question 9

What is an adverse side effect of the SERM drug, Raloxifine?

Answer 9

Increased risk of blood clots

Question 10

What is the role of Calcitonin when Ca2+ levels are high in plasma?

Answer 10

The thyroid gland releases Calcitonin, which stimulates Osteoblast activity (bone deposition) and reduces plasma calcium

Question 11

What is the role of PTH when Ca2+ levels are low in plasma?

Answer 11

The parathyroid gland releases PTH, which stimulates Osteoclast activity (bone resorption) which releases Ca2+ from bone into the blood

Question 12

What 4 classes of drugs can be used to target Rheumatoid Arthritis?

Answer 12

NSAIDs
Steroids
DMARDs
Antibody therapy

Question 13

Give 4 examples of non-selective COX inhibitor NSAIDs

Answer 13

Aspirin
Diclofenac
Ibuprofen
Naproxen

Question 14

Give 1 example of a COX-2 selective inhibitor NSAID used to treat Rheumatoid Arthritis

Answer 14

Celecoxib

coxib suffix

Question 15

What is the mode of action of Steroid drugs?

Answer 15

Nuclear receptor, which reduce expression of inflammatory cytokines and increased expression of anti-inflammatory cytokines

Question 16

What are two adverse effects of Steroid use?

Answer 16

Adrenal insufficiency

Cushing’s disease

Question 17

Give 5 examples of DMARD drugs

Answer 17

Gold
MTX
Sulfasalazine (SSZ)
Azathioprine 
Ciclosporin

Question 18

What conditions can Sulfasalazine be used to treat?

Answer 18

Rheumatoid Arthritis
Crohn’s Disease
Ulcerative Colitis

Question 19

Give 1 example of an antibody used to treat Rheumatoid Arthritis.

Answer 19

Infliximab

Question 20

What does Infliximab target?

Answer 20

TNF-alpha

Question 21

What does Adalimumab (Humira) target?

Answer 21

TNF-alpha

Question 22

What are 2 agents of last resort when all Rheumatoid Arthritis drugs have failed?

Answer 22

Cyclophosphamide, Cyclosporin (global immunosupressants)

Question 23

Which drug used to treat Rheumatoid Arthritis CANNOT be consumed with Grapefruit juice?

Answer 23

Cyclosporin