MSK Flashcards
What medications are likely to cause a rash when taken with allopurinol?
Ampicillin/amoxicillin, antacids, thiazides, ACE inhibitors
What supplement should be given along with methotrexate and why?
Folic acid d/t MTX being an anti-folate
What is initial first line therapy for rheumatoid arthritis?
Methotrexate (DMARD of choice)
For rheumatoid arthritis, what pharmacologic options can be considered while waiting for the prescribed DMARD to take effect?
Short-term NSAIDs or steroids
Why should a biologic be combined with a DMARD in rheumatoid arthritis?
To prevent formation of anti-drug antibodies
What is recommended as initial therapy for sports injuries? (First 24-48 hours)
RICE method
48 hours after a sports injury and use of RICE, what non-pharm options can be considered?
Heat therapy, early mobilization, physiotherapy, and/or massage therapy
What should be done for those on OAT when requiring acute pain management?
Continue baseline OAT tx/chronic opioid to avoid opioid deficit and add on NSAID/acetaminophen, another opioid or consider non-pharmacological approaches
What are the goals of therapy for fibromyalgia?
Reduce pain/fatigue/psychological distress and sleep problems, improve physical and emotional well-being/QOL/functioning, address associated conditions on an individual basis, promote self-management via individual and group education
What is recommended first line therapy for fibromyalgia?
Non-pharmacological therapy due to lack of evidence around pharmacological therapy
What pharmacological option is not recommended for fibromyalgia?
NSAIDs
What is considered first line therapy for back pain?
Active self-management techniques. Best evidence for short-term benefit and prevention of recurrence
What pharmacologic therapy is considered first-line for low back pain?
Small benefit for NSAIDs
What are some adverse effects of NSAIDs?
GI bleeds, dyspepsia, N/V, edema, phototoxic reaction, small bowel ulceration, anaphylaxis/hypersensitivity
What are cautions when prescribing NSAIDs?
Those with asthma (ASA-induced asthma common), HTN, CVD
What are the CI for NSAIDs?
CrCl <40 ml/min, cirrhosis, active GI ulcer, HF, MI, thrombocytopenia,
What are the goals of therapy for chronic fatigue syndrome?
Relieve symptoms where possible and according to patient preference, educate and promote self-management
What are some recommended non-pharmacological options for chronic fatigue syndrome?
Healthy/well-balanced diet, multivitamins, addressing sleep problems early, active pacing, CBT, graded exercise therapy
What are pharmacologic tx options for chronic fatigue syndrome?
No definite tx, some supplements shown benefit and TCAs/antidepressants have shown minimal efficacy
What is first line therapy for osteoarthritis?
Non-pharmacologic strategies such as weight loss, aerobic exercise/strength training, supports/braces. Surgery as last resort
What is the recommended tx for sports injuries?
RICE initially, then transition to heat/massage/physiotherapy after with short-term use of oral/topical NSAIDs
What is recommended therapy for the acute phase of neck pain/whiplash (1-30 days)?
Stretching, education, returning to work, NSAIDs (more effective than acetaminophen), muscle relaxants, consider tramadol or codeine (opioids) for severe pain
What should be considered before opioid therapy for chronic pain?
Adequate trial of non-opioid pain management (4-8 weeks)
What is the recommended therapy for rheumatoid arthritis?
Aggressive early DMARD therapy +/- biological therapy to slow and prevent progression
