MSK Flashcards
What are some indications of methotrexate?
RA, cancers, psoriasis
What is the mechanism of action of methotrexate?
stops cell replication
What are some adverse reactions of methotrexate?
mucosal damage bone marrow suppression hypersensitivity reaction hepatic cirrhosis, pulmonary fibrosis risk of overdose
What are some warnings with methotrexate?
teratogenic
severe renal or liver impairment
What are contraindications of methotrexate?
drugs that inhibit renal excretion (NSAIDs etc)
folate antagnonists (e.g. trimethoprim)
clozapine
What are the common indications for allopurinol?
prevent gout, kidney stones, hyperuraemia and tumour lysis syndrome
What is the mechanism of action of allopurinol?
reduce plasma concentration of uric acid
What are adverse reactions of allopurinol?
worsen/trigger acute attacks of gout
rash
hypersensitivity reaction
What are interactions with allopurinol?
azathoprine
ACE-I
amoxicillin
What are warnings with allopurinol?
acute attack of gout
recurrent skin rash or hypersensitivity
renal or hepatic impairment
Which corticosteroids are glucocorticoids and how do they work?
prednisilone, hydrocortisone, dexamethasone
they exert glucocorticoid effects (modify immune response, downregulate pro-inflammation)
What are indications of glucocorticoid steroids?
allergic or inflammatory disorders, suppression of autoimmune, cancers, adrenal insufficiency
What are some adverse reactions of glucocorticoids?
immunosuppression, behavioural and mood change, DM, osteoporosis, hypertension, hypokalaemia, oedema
What are some warnings for glucocortoid steroids?
infection, children
What are important interactions of glucocorticoids?
with drugs that increase risk of peptic ulcers e.g. NSAIDs
drugs that increase hypokalaemia - e.g. diuretics
CPY inducers reduce efficacy
What are some indications of bisophosphonates?
to prevent patients at risk of osteoporotic fractures
malignant hypercalcaemia
bone metastases
active Paget’s disease
What are some examples of bisphosphonates and how do they work?
alendronic acid
disodium pamidronate
zolendronic acid
They reduce bone turnover and therefore inhibit bone resorption
What are some adverse effects of bisphosphonates?
oesophagitis
hypophosphataemia
osteonecrosis of jaw
atypical femoral fracture
What are some warnings of bisphosphonates?
severe renal impairment
hypocalcaemia
upper GI disorders
dental disorders and smokers (risk of jaw necrosis)
What are some important interactions of bisphosphonates?
absorption is reduced when taking calcium salts, antacids or iron salts
