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GPhC Exam > MSK > Flashcards

MSK Flashcards

1
Q

What is RA

A

Chronic systemic inflammatory disease affecting joint synovial membrane

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2
Q

RA symptoms

A

Pain and stiffness - worse with rest, inactivity, and heat in joints. Nodules, swelling, tenderness, malaise, fatigue, fever, weight loss

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3
Q

RA non-drug therapy

A

physio, exercise, relaxation, stress management

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4
Q

RA drug therapy

A

1: MTX, leflunomide or sulfasalazine (hydroxychloroquine in mild)
2: MoAbs (adalimumab, entanercept, infliximab, tocilizumab, baricitinib)
- bridge with corticosteroids when rapid suppression needed
- NSAIDs for pain relief

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5
Q

RA drug therapy interaction

A

MTX and NSAID not ok OTC - ok if rxed

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6
Q

MTX MHRA Warnings

A
  • Once a week
  • Prescription and label clearly shows dose and frequency
  • Commonly co-rxed with folic acid, not on MTX day
  • Report signs of blood dyscrasia, liver toxicity and respiratory effects
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7
Q

MTX side effects

A
  • Blood dyscrasias - sore throat, bruising, mouth ulcers
  • Liver toxicity - N&V, abdo discomfort, dark urine, jaundice, itchy skin
  • Pulmonary toxicity - SOB, coughing
  • GI toxicity - stomatitis, diarrhoea
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8
Q

MTX toxicity antidote

A

Folinic acid (calcium folinate)

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9
Q

MTX monitoring and screening

A
  • FBC, UEs, LFTs - every 1-2 wks until stable, then every 2-3 months
  • Rule out pregnancy - MTX is antifolate so harmful to foetus growth
  • Contraception during and after tx for men and women
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10
Q

MTX Interactions

A
  • Nephrotoxics - MTX reduces renal function
  • NSAIDs - not ok OTC
  • Other antifolates - trimethoprim, phenytoin, co-trimox
  • Hepatotoxics - rifampicin, antifungals
  • Omeprazole/Esomeprazole - reduces clearance so increases toxicity
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11
Q

What is Gout

A

Increase in uric acid = deposition of crystals in joints and other tissue from increased salt intake, chemo drugs and bendroflumethiazide

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12
Q

Gout Acute Tx

A
  1. High dose NSAID (not aspirin) + PPI
  2. Colchicine 500mcg 2-4 x day, max 3 days, no repeats within 3 days
    Alternative: short course corticosteroid or IM injection of corticosteroid or canakinumab
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13
Q

Gout Chronic Tx

A
  • 2 or more attacks a year
  • reduce uric acid with xanthine-oxidase inhibitors
    1. Allopurinol
    2. Febuxostat
    -If acute attack during tx, continue chronic tx and tx acute separately
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14
Q

Allopurinol side effects

A

When initiation, use colchicine/NSAID to prevent flare
- Rash - stop, if mild - restart carefully but stop if recurrence

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15
Q

Allopurinol interaction

A

Allopurinol increases dose of azathioprine/mercaptopurine - reduce dose of aza/merc

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16
Q

Nocturnal Leg Cramps Treatment

A
  • Quinine sulphate - trial of 4 wks, if benefit - continue
  • Potential toxicity so only use if cramps regularly disrupt sleep, are very painful, or other tx hasn’t worked
  • Stop tx every 3 months and assess need for further tx
17
Q

NSAIDs Indication

A

Pain related to inflammation e.g. RA, back pain, soft tissue disorder

18
Q

NSAIDs contra-indication

A

Asthmatics due to bronchospasms

19
Q

NSAIDs GI side effects most to least risk

A
  • Piroxicam, ketoprofen, ketorolac
  • Indometacin, diclofenac, naproxen
  • Ibuprofen
  • Cox-2 selective inhibitors (Celecoxib, Etoricoxib)
20
Q

NSAIDs CV side effects most to least risk

A
  • Cox-2 selective inhibitors (Celecoxib, Etoricoxib), Ibuprofen 2.4g, Diclofenac
  • medium - none
  • Naproxen, Ibuprofen 1.2g
  • Lowest - none
21
Q

NSAIDs considerations

A
  • NSAIDs + aspirin/alcohol = increase GI bleed risk
  • Use PPI - stomach protection
  • avoid in renal impairment - risk of fluid retention and further impairment
  • avoid in pregnancy - caution in breastfeeding
22
Q

NSAIDs Interactions

A
  • MTX/Lithium - reduces clearance
  • Ciprofloxacin - increase risk of seizures
  • Blood thinners - increase risk of bleeding
  • Hyperkalaemic drug - Hyperkalaemia
  • Nephrotoxics (DAMN) - AKI

GPhC Exam (22 decks)

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