Drugs in the Management of Musculoskeletal Disorders Flashcards
What is an Osteoblast and Osteoclast?
Osteoblast: Cells which make bone
Osteoclast: Cells which breakdown bone
Describe the structure of Osteoblasts and Osteoclasts
Osteoclasts are multinucleated with up to 200 nuclei, and Osteoblasts have one nuclei
How do Osteoclasts break down bone?
Bind to bone surface via integrins, forming a “ceiling zone”. They then breakdown bone and release calcium
What are three treatments doctors can offer patients to alleviate Osteoporosis?
Appropriate diet & exercise
Medications
Replacement
Describe the mechanism of action of Bisphosphonates
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
Give 2 examples of drugs which are Bisphosphonates
Alenodronate
Etidronate
What are some side effects of Bisphosphonate therapy?
Osteonecrosis of the Jaw
Give 2 examples of drugs which is a SERM (Selective Estrogen Receptor Modulator)
Raloxifene
Tamoxifen
What is an adverse side effect of the SERM drug, Raloxifine?
Increased risk of blood clots
What is the role of Calcitonin when Ca2+ levels are high in plasma?
The thyroid gland releases Calcitonin, which stimulates Osteoblast activity (bone deposition) and reduces plasma calcium
What is the role of PTH when Ca2+ levels are low in plasma?
The parathyroid gland releases PTH, which stimulates Osteoclast activity (bone resorption) which releases Ca2+ from bone into the blood
What 4 classes of drugs can be used to target Rheumatoid Arthritis?
NSAIDs
Steroids
DMARDs
Antibody therapy
Give 4 examples of non-selective COX inhibitor NSAIDs
Aspirin
Diclofenac
Ibuprofen
Naproxen
Give 1 example of a COX-2 selective inhibitor NSAID used to treat Rheumatoid Arthritis
Celecoxib
coxib suffix
What is the mode of action of Steroid drugs?
Nuclear receptor, which reduce expression of inflammatory cytokines and increased expression of anti-inflammatory cytokines
What are two adverse effects of Steroid use?
Adrenal insufficiency
Cushing’s disease
Give 5 examples of DMARD drugs
Gold MTX Sulfasalazine (SSZ) Azathioprine Ciclosporin
What conditions can Sulfasalazine be used to treat?
Rheumatoid Arthritis
Crohn’s Disease
Ulcerative Colitis
Give 1 example of an antibody used to treat Rheumatoid Arthritis.
Infliximab
What does Infliximab target?
TNF-alpha
What does Adalimumab (Humira) target?
TNF-alpha
What are 2 agents of last resort when all Rheumatoid Arthritis drugs have failed?
Cyclophosphamide, Cyclosporin (global immunosupressants)
Which drug used to treat Rheumatoid Arthritis CANNOT be consumed with Grapefruit juice?
Cyclosporin
