MSK

Question 1

Colchicine

Dose in Acute Gout Attack

Answer 1

NB! <36H

1,2mg PO stat

then 0,6mg PO in 1 hour

then 0,6mg PO BD

Question 2

Colchicine

Drug Class

Answer 2

Antimitotic

Question 3

Colchicine

Side Effects

Answer 3

Common:
GIT: Abdo pain | NVD
SKIN: Rash | Alopecia
MSK: Muscle pain

Rare:

• Neutropenia
• Myopathy
• Rhabdomyolysis

Question 4

Colchicine

Contraindications

Cautions

Answer 4

CI:

1. Solid organ transplant
2. Blood dyscrasia
3. Renal / Hepatic impairment

Caution: Decreased renal fnx = Decreased dose

Question 5

Colchicine

Drug Interactions

Answer 5

COLCHICINE TOXICITY (Fever | Leukopenia | GI sx)

• ARVs
• Azoles
• CCB (Verapamil)
• Cyclosporin
• MACROLIDES
• Statins

FATAL REACTION:
Erythromycin & Clarithromycin
- Leukopenia, Myopathy, multi-organ failure

MYOTOXIC
Statins

Question 6

Colchicine

Monitoring

Answer 6

CBC (Leukopenia | Neutropenia)
CK (Myopathy)
Renal functions (dose adjustments)

q6monthly

Question 7

Gout

Indications for Urate Lowering Medication

Answer 7

1. Tophi
2. > 2 attacks per year
3. eGFR <89
4. Past urolithiasis
5. Low dose ASA

Question 8

Gout

Target for serum urate

Answer 8

<360 umol/L

but if tophi = <300 umol/L

Question 9

Gout

First-line choices for urate lowering therapy

Answer 9

Allopurinol

Febuxostat (Renal friendly)

Class: Xanthine Oxidase Inhibitors

Question 10

Systemic corticosteroids

Common short term side effects

Common long term side effects

Answer 10

ST:

• Hypertension
• Hyperglycemia
• GIT upset
• Insomnia
• Mood changes

LT:

• PUD / GI bleeding
• Osteoporosis
• Increased risk of heart disease
• Increased risk of infections
• Skin thinning
• Cataracts

Question 11

Osteoporosis

Classes & medications used

Answer 11

BISPHOSPHONATES
Alendronate 70mg PO weekly
Zolendronate 5mg IVI annually

LIGAND INHIBITORS
Denosumab 60mg SC 6monthly

SELECTIVE ESTROGEN RECEPTOR MODULATORS
Raloxifene

HORMONAL THERAPY
Estrogen & Progesterone

CALCITONIN

PTH ANALOGUE
Teriparatide 20micro per day SC x 2 years

Question 12

NSAIDS

Cardiovascular Side effects

& Best NSAID to use in pt with CVD

Answer 12

Edema
Hypertension

Increased risk of

• MI
• AF
• Heart failure
• VTE
• Ischemic stroke

Least CV risks = low dose Naproxen (<750mg per day)

Naproxen 250mg PO TID

Question 13

NSAIDS

GIT Side effects

& best NSAID to use in GI pt

Answer 13

Dyspepsia
Nausea
Diarrhoea

GI ulcers

GI bleeding and perforation

use: Topical Diclofenac or Acetominophen
NSAID: Celecoxib 200mg PO dly with PPI

Question 14

NSAIDS

Side Effects

Answer 14

• GIT:
• Dyspepsia
• GI ulcers
• GI bleeding
• GI perforation
• Cardiovascular
• Hypertension
• Oedema
• Increased risk of: MI, AF, HF, Stroke
• Nephrotoxic
• Acute kidney injury
• Chronic kidney disease
• Oedema
• Renal insufficiency
• CNS:
• Tinnitus
• Stroke

Question 15

Osteo-arthritis

Step wise pharmacology

Answer 15

TOPICAL ANALGESICS
Diclofenac K

v

SIMPLE ANALGESICS
Acetominophen max: 4g per day

v

NSAIDS
CVD pt: Naproxen 250mg TID
GI pt: Celecoxib 200mg PO dly + PPI

v

SNRI
Duloxetine

v

OPIOIDS
Tramadol

v

GLUCOSAMINE
Glucosamine sulfate

v

CORTICOSTEROIDS
Prednisone

v

INJECTING TREATMENT

• Intra-articular corticosteroid injections
• Hyaluronic acid injections
• Platelet-rich Plasma injections

Question 16

NSAIDS & Pregnancy

Answer 16

Only indicated for short-term therapy in T1 & T2

NOT in T3

• Oligohydramnios
• Premature closure of the ductus arteriosus
• Neonatal Pulmonary Hypertension

Also avoid topical Diclofenac K

Question 17

Fibromyalgia

Drug classes and medications

Answer 17

SNRI
Duloxetine

TCA
Amitriptyline

SSRI
Fluoxetine

GABA derivatives
Pregabalin

NO PLACE FOR:
Opioids
Cannabis

Question 18

Allopurinol

Class

Dose

Answer 18

Xanthine Oxidase Inhibitor

start: Allopurinol 100mg PO dly
increase to: Allopurinol 300g PO dly
Max: 800mg PO dly

Question 19

Allopurinol

Side effects

Answer 19

HYPERSENSITIVITY 
RASH 
HEPATOTOXIC 
GIT UPSET 
BM SUPRESSION 

HYPERSENSITIVITY REACTION

• SJS
• TEN
• Eosinophilia
• Vasculitis
• Cytopenia
• Fever
• Organ damage

RASH

GI UPSET

• Nausea
• Diarrhoea
• Abdominal pain

BM SUPRESSION
- Fever

Question 20

Febuxostat

Class

Dose

Answer 20

Xanthine Oxidase Inhibitor

Febuxostat 40mg PO dly then 80mg PO dly in 2 weeks

Question 21

Febuxostat

Side effects

Answer 21

NVD

Arthralgia

Derange liver enzymes

Increased risk of MI or stroke

Question 22

Gout

Name all medications that can be used for Urate-Lowering-Therapy

Answer 22

1. Allopurinol
2. Febuxostat
3. Probenecid
4. Losartan
5. Fenofibrate

Question 23

Fibromyalgia

Non-pharmalogical advices

Answer 23

• Cognitive behavioural therapy
• Pain reduction techniques
  
  • Cold/heat pads
  • Massage
  • Electroacupuncture
• Graded aerobic exercises
• Sleep hygiene
• Stress management
• Relaxation techniques
• Empathy & acknowledgement of suffering
• Self management
• Comprehensive, multidisciplinary education

Question 24

Fibromyalgia

3 classes & example

Answer 24

SNRI - Duloxetine
TCA - Amitriptyline
Gaba derivatives - Gabapentin

Question 25

Patient with fibromyalgia on Ibuprofen 800mg BD PO 36 weeks pregnant Advices regarding painkillers and rationale

Answer 25

Stop ibuprofen in T3 because: - Oligohydramnios - Premature closure of ductus arteriosus - Persistent pulmonary hypertension of the newborn