Musculo-Skeletal and Joint Diseases Flashcards
What NSAIDs can be used in rheumatic disease and gout?
Ibuprofen (first-line)
Naproxen (second-line)
NSAIDs in Rheumatic Disease
-For NSAIDs the cardiovascular (CV) and gastrointestinal (GI) risk of each patient should be
assessed individually and the balance between benefit and risk carefully considered before starting treatment with any NSAID. Treatment with NSAIDs should be continued for the shortest time and at the lowest dose necessary to control symptoms.
-Two oral NSAIDs (including low dose aspirin) increase GI risk and should not be routinely given
concurrently.
-Standard NSAID + PPI e.g. lansoprazole 15mg is preferred option in high-risk individuals where
gastro-protection is required. Where patients have swallowing difficulties /PEG tubes Lansoprazole
orodispersible is the preferred choice.
.
Which PPI is the preferred option for use alongside an NSAID when gastro-protection is required?
Lansoprazole 15mg
COX-2 inhibitors should rarely be used. If they have to be used, which drug is the preferred option?
Celecoxib
What are some examples of corticosteroids that are given as local corticosteroid injections?
Methylprednisolone acetate
Methylprednisolone with lidocaine
Triamcinolone acetonide
What are some drugs that suppress the rheumatic disease process?
Azathioprine
Ciclosporin
Leflunomide
Mercaptopurine
Methotrexate
Penicillamine
Sulfasalazine
Hydroxychloroquine
Methotrexate
-Normally given as a _ dose
-Good practice to state on the prescription the day of the week when it is taken, plus the dose as both the nuber of tablets and mgs, e.g. 4 tablets (10mg)
-_ _ is usually given to reduce the likelihood of methotrexate toxicity at a dose of 5mg once a week, but NOT on the same day as the methotrexate is taken.
Weekly
Folic acid
Hydroxychloroquine
Hydroxychloroquine, chloroquine: increased risk of cardiovascular events when
used with macrolide antibiotics; reminder of psychiatric reactions.
Advice for healthcare professionals:
* an observational study has shown that co-administration of azithromycin with hydroxychloroquine
in patients with rheumatoid arthritis is associated with an increased risk of cardiovascular events
(including angina or chest pain and heart failure) and cardiovascular mortality
* carefully consider the benefits and risks before prescribing systemic azithromycin or other
systemic macrolide antibiotics (erythromycin or clarithromycin) to patients being treated with
hydroxychloroquine or chloroquine
* if there is a clinical need to prescribe systemic macrolide antibiotics with hydroxychloroquine or
chloroquine, use caution in patients with risk factors for cardiac events and follow advice in the
product information for each medicine
* be vigilant for psychiatric reactions associated with hydroxychloroquine or chloroquine, especially
in the first month of treatment; events have been reported in patients with no prior history of
psychiatric disorders
.
What drugs can be used for gout and cytotoxic-induced hyperuricaemia?
Colchine
Allopurinol
Febuxostat (second-line for when allopurinol is not tolerated or is contraindicated)
When should treatment with febuxostat be avoided?
In patients with pre-existing major cardiovascular disease, e.g. MI, stroke or unstable angina, unless there is no other option.
What are some examples of skeletal muscle relaxants?
Baclofen
Diazepam
Tizanidine
Quinine sulfate
Quinine sulfate
- An antimalarial, that is also used to treat leg cramps and restless leg syndrome.
-Toxic in overdose
-Can take up to 4 weeks for improvements in nocturnal leg cramps to become apparent- stop treatment if no improvement after this time. Interrupt treatment every 3 months to assess the need for further treatment.
-Quinine can increase the levels of _ and carbamazepine
Phenobarbital
Topical Antirheumatics
Fenbid (Ibuprofen) gel
Ketoprofen gel
-Treatment of osteoarthritis should involve paracetamol as a first-line, and then a topical NSAID as a second-line.
-Recommend ibuprofen 5% gel as a first-line above the 10%- stronger strength does not appear to give more benefit.
Using NSAIDs- Options to Reduce Risk of Serious GI Event
If NSAID use is required, use cautiously:
-Use lesser toxic agents (ibuprofen first, then naproxen as second-line)
-Use at the lowest effective dose and for the shortest duration
-Avoid piroxicam
-Do not use alongside low-dose aspirin if at all possible
-Review treatment regularly
-Use gastroprotection in high-risk patients taking NSAIDs
-Counsel patients appropriately, e.g. take with food, potential GI, cardiovascular and renal effects etc
.
What is cerebral palsy?
A group of permanent, non-progressive abnormalities of the developing fetal or neonatal brain that lead to movement and posture disorders, causing activity limitation and functional impact.
What are some examples of clinical and developmental comorbidities that can accompany cerebral palsy?
These include disturbances of sensation, perception, cognition, communication and behaviour, epilepsy, and secondary musculoskeletal problems (such as muscle contracture and abnormal torsion). Cerebral palsy is not curable and the comorbidities can impact on many areas of participation and quality of life, particularly eating, drinking, comfort, and sleep.
What is gout?
A common form of inflammatory arthritis characterised by raised uric acid concentration in the blood, and the deposition of urate crystals in joints and other tissues.
