MSK DRUGS

Question 1

Non Steroidal Anti Inflammatory Drugs (NSAIDS)

Answer 1

I: Mild to moderate pain, pain related to inflammation
MOA: inhibits cyclo-oxygenate (COX)
SE: GI toxicity, renal impairment, increased risk of CVE (myocardial infarction and stroke), hypersensitivity e.g. bronchospasm, fluid retention
CI: severe renal impairment, heart failure, liver failure, hypersensitivity
C: PUD, GI bleeding, CVD, renal impairment
KI: Aspirin, steroids can increase risk of peptic ulceration.
Anticoagulants e.g. warfarin, DOACS and SSRIs (venlafaxine) can increase risk of GI bleeds.
ACEi and diuretics can lead to renal impairment.
PC: Common side effect is indigestion - advise to stop treatment and seek medical help.
Short term- beyond 10 days is not recommended due to risk of side effects
Long term- stop NSAIDS if they become acutely unwell or dehydrated to reduce risk of damage to the kidneys.

Question 2

Bisphosphonates

Alendronic acid, Zoledronic acid, Disodium pamidronate

Answer 2

I: Osteoporotic fragility fractures. Severe hypercalcaemia of malignancy, myeloma, breast cancer with bone metastases, Paget’s disease.
SE: Oesphagitis, Hypophosphataemia, osteonecrosis of the jaw, atypical femoral fracture (long term fracture)
CI: severe renal impairment, hypocalcaemia, upper GI disorders
C: Smokers, dental disease (osteonecrosis)
PC: Swallowed whole 30 mins before breakfast or other medication with plenty of water.
Remain upright for 30 minutes after taking it to reduce oesophageal irritation.
Advise patients to see their dentist before and during bisphosphonate treatment.
M: Osteoporosis: check + replace calcium and Vit D before treatment. Monitor with DEXA scan every 1-2 years whether bone density is stable or increasing
Hypercalcaemia: symptom enquiry and calcium levels
Myeloma, bone mets, Paget’s disease: symptom enquiry.

Question 3

Allopurinol

Answer 3

I: prevent recurrent attacks of gout, prevent renal stones, prevent hyperuricaemia and tumour lysis syndrome
MOA: Xanthine oxidase inhibitor - metabolises xanthines to Uric acid - reduces precipitation of uric acid in the joints or kidneys.
SE: Can trigger or worsen acute attack of gout. Skin rash. Severe cases: Steven Johnson syndrome.
CI: Acute attacks of gout, recurrent skin rash, severe hypersensitivity
C: Renal impairment, hepatic impairment
KI: ACEi + thiazides increase risk of hypersensitivity
Amoxicillin increases risk of skin rash
Aspirin inhibits renal secretion - trigger acute gout
PC: Reduce attacks of gout or formation of kidney stones. Seek medical advice if they develop a rash.
DO NOT STOP DRUG IF THEY GET ACUTE GOUT
M: Checked 4 weeks after initiating drug/ dose change. Aim for low uric acid concentrations <300 µmol/L.
Stop if they develop a rash

Question 4

Colchicine

Question 5

Methotrexate

Answer 5

I: Rheumatoid Arthritis, Chemo: leukaemia, lymphoma and solid tumours, psoriasis
MOA: inhibits dihydrofolate reductase and prevents cellular replication
SE: Mucosal damage (sore mouth, GI upset), bone marrow suppression,
Long term use: hepatic cirrhosis or pulmonary fibrosis
CI: Pregnancy (teratogenic), severe renal impairment, abnormal liver function
KI: NSAIDS, Penicillin can lead to toxicity. Trimethoprim and Phenytoin increase risk of haematological abnormalities
Risk of neutropenia if combined with clozapine
PC: Taken once a week,
- SAFETYNET
- sore throat, fever (infection)
- Bruising or bleeding (thrombocytopaenia)
- Dark urine (liver poisioning)
- Breathlessness (lung toxicity)
PURPLE METHOTREXATE TREATMENT BOOKLET AND WARNING CARD