MSK Flashcards
A patient has come in diagnosed with arthritis. What is one otc treatment that could help her symptoms?
NSAIDs
DISCUSS NSAIDs CLINICAL PHARM
Drug names:
- naproxen, ibuprofen, etoricoxib
MOA:
- NSAIDs inhibit prostaglandin synthesis from arachidonic acid by inhibiting cyclo-oxygenase (COX). inhibiting this reduces inflammation and pain.
Indications:
- ‘As needed’ treatment of mild-to-moderate pain (
- Regular treatment for pain related to inflammation,
Adverse effects:
- gastrointestinal (GI) toxicity
- renal impairment
- increased risk of cardiovascular events (MI & stroke)
- hypersensitivity reactions
- fluid retention, which can worsen hypertension and heart failure.
Warnings/cautions:
- ▴GI bleeding
- ▴cardiovascular disease
- ▴renal impairment
Contraindications:
- ✗severe renal impairment
- ✗heart failure
- ✗liver failure
- ✗NSAID hypersensitivity
Interactions:
- increase risk of ulcers low-dose ▴aspirin, corticosteroids
- ▴anticoagulants (e.g. warfarin
- ▴anticoagulants (e.g. warfarin, doacs, increased risk of gi bleeds
- antihypertensives
Monitoring:
- Oral NSAIDs should be taken with food to minimise GI upset
- Control of pain and inflammation can be assessed by enquiry about symptoms, examination
- identify if there are any side effects
I present as the following:
- First presentation is usually low trauma fragility fracture
Back pain, Usually occurs in the thoracic or lumbar region, due to wedging or compression of one or more vertebral bodies. Usually an early sign. What am i?
osteoporosis
DISCUSS BISPHOSPHONATES CLINICAL PHARM
Drug names: alendronic acid, disodium pamidronate, zoledronic acid
Indications:
- Alendronic acid is used as the first-line drug treatment option for patients at risk of osteoporotic fragility fractures.
- treatment of severe hypercalcaemia of malignancy
- myeloma and breast cancer with bone metastases
- Bisphosphonates are used as first-line treatment of metabolically active Paget’s disease
Adverse effects:
- oesophagitis
- hypophosphataemia
- osteonecrosis of the jaw
- atypical femoral fracture
Warnings/Caution:
- ▴smokers
- ▴dental disease
Contraindications:
- ✗severe renal impairment.
- ✗hypocalcaemia
- ✗upper gastrointestinal disorders
Interactions:
- Absorption reduced with calcium salts (including milk)
- Antacids and iron salts
Monitoring:
- medicine to help strengthen the bones to prevent fractures
- In osteoporosis, check and replace calcium and vitamin D before treatment.
- Monitor efficacy using dual-energy X-ray absorptiometry (DEXA) scans every 1–2 years to check whether bone density is stable or increasing
- monitor symptoms when it comes to hypercalcaemia, myeloma, bone metastases, pagets disease
I cause the following:
- Great difficulty with walking or inability to use the affected joint, Can’t bear to touch or pressure to the affected joint
Erythema overlying affected joint, Development of acute pain in a joint which becomes swollen, tender and erythematous and which reaches its crescendo over a 6- to 12-hour period. What am i?
Gout
DISCUSS ALLOPURINOL CLINICAL PHARM
Indications:
- Prevent recurrent attacks of gout
- Prevent uric acid and calcium oxalate renal stones
- Prevent hyperuricaemia and tumour lysis syndrome
Adverse effects:
- Trigger or worsen an acute attack of gout
- Skin rash
- Stevens–Johnson syndrome or toxic epidermal necrolysis
- Allopurinol hypersensitivity syndrome
- Fever, eosinophilia, lymphadenopathy
Warnings/cautions:
- ▴renal impairment
- ▴hepatic impairment
Contraindications:
- ✗acute attacks of gout
- ✗Recurrent skin rash
- ✗severe hypersensitivity
Interactions:
- ▴azathioprine
- ▴ACE inhibitors or thiazides
- Risk of hypersensitivity reactions
- Amoxicillin increases the risk of skin rash.
Monitoring:
- Advise patients that the purpose of treatment is to reduce attacks of gout
- Warn patients to seek medical advice if they develop a rash, usually mild and goes away
- Serum uric acid concentrations should be checked 4 weeks after initiating allopurinol or after a change in dose.
DISCUSS COLCHICINE CLINICAL PHARM
Indication: aid in the treatment of gout
Adverse effects:
- Gastrointestinal — nausea and vomiting, abdominal pain
- Alopecia
- Blood disorders
- Inhibition of spermatogenesis
Warnings/caution:
- receiving a statin
Contraindications:
- With blood disorders.
- eGFR less than 10
- Who are pregnant or breastfeeding
- severe hepatic impairment
- The elderly
