MSK drugs

Question 1

What drug is used to TREAT (not prevent) gout?

Answer 1

colchicine

Question 2

what type of drug is colchicine?

Answer 2

it is a mitotic inhibitor by preventing microtubule formation. This prevents proliferation of high turnover cells such as neutrophils in gout- which are the primary cause of inflammation

Question 3

what are the side effects of colchicine?

Answer 3

gastrointestinal upset and neutropenia, as well as anaemia

Question 4

how long would you use bisphosphonates? what is a risk of using bisphosphonates for longer than normal?

Answer 4

up to 5 years. Overuse of bisphosphonates leads to atypical fractures, particularly in the femur

Question 5

what is a SE of bisphosphonate use?

Answer 5

gastric reflux and osteonecrosis of the jaw

Question 6

what is risedronate and what is it used for?

Answer 6

bisphosphonate, used for osteoporosis and page’s disease

Question 7

name some DMARDS used for RA

Answer 7

hydroxychloraquine, sulfasalazine, methotrexate, leflunomide

Question 8

name some biological DMARDs for RA?

Answer 8

TNF inhibitor- inflixmab, B cell inhibitor- rituximab etc

Question 9

how does methotrexate work?

Answer 9

Folic acid antagonist. Inhibits DNA synthesis and cell replication by competitively inhibiting the conversion of folic acid to folinic acid, with cytotoxic, immunosuppressive and anti-inflammatory action

Question 10

SE of methotrexate?

Answer 10

bone marrow suppression (neutropenia, anaemia, thrombocytopenia), pulmonary toxicity (pneumonitis, pulmonary fibrosis), hepatic toxicity, vomiting nausea

Question 11

what are the 4 drugs you would consider in the medical management of gout?

Answer 11

1. allopurinol (prophylactic treatment)
2. cochicine (acute treatment)
3. NSAIDs or Glucocorticoid
4. Uric acid excreting agent like probenecid (prophylactic)

Question 12

how does allopurinol work?

Answer 12

Allopurinol competitively inhibits xanthine oxidase which is an enzyme that mediates uric acid production. (XO converts hypoxanthine to xanthine, as well as xanthine to uric acid).

Question 13

SE of allopurinol?

Answer 13

GIT upset, skin rashes, hypersensitivity, bone marrow suppression

Question 14

why won’t we use allopurinol and azathioprine together?

Answer 14

allopurinol inhibits xanthine oxidase, which is the enzyme that metabolises azathioprine. So azathioprine builds up to toxic levels

Question 15

medical 1st and 2nd line treatment for osteoporosis?

Answer 15

bisphosphonates with calcium and vitamin d supplementation= first line

2nd line= denosumab