Musculoskeletal Flashcards
what drugs should be given first line to patients with newly diagnosed rheumatoid arthritis?
DMARD (methotrexate/ leflunomide/ sulfasalazine)
which two antimalarials are used in rheumatic conditions?
chloroquine and hydroxychloroquine
what is the MHRA alert for hydroxychloroquine and chloroquine?
risk of cardiovascular events when used with macrolides
how should methotrexate be given?
once weekly, on the same day each week
what medication should be given alongside methotrexate?
folic acid
5mg once weekly, day after MTX dose
what are the side effects on methotrexate?
blood dyscrasias
hepatotoxicity
nephrotoxicity
pulmonary toxicity
GI toxicity
what is the reversal agent of methotrexate?
folinic acid (calcium folinate)
how do you treat an acute attack of gout?
1st NSAIDs (diclofenac, naproxen)
2nd colchicine
what is the counselling advice for colchicine?
do not repeat course in 3 days
max dose 500mcg 2-4 times a day
max 6mg per course
how do you manage gout prophylactically?
1st allopurinol
2nd febuxostat
started after inflammation of acute attack settled, start 1-2 weeks after acute
what is the side effect of allopurinol requiring discontinuation of treatment?
rash
what is the MHRA alert for febuxostat?
-hypersensitivity
-risk of cardiovascular death
what treatment is used for nocturnal leg cramps?
quinine sulfate
trial for 4 weeks
what is the MHRA alert for quinine?
QT prolongation
name the selective cox-2 inhibitors?
celecoxib, parecoxib, etorcoxib
what are NSAIDs cautioned in?
heart failure, renal and liver impairment, hypertension
which of the NSAIDS have the lowest risk of cardiovascular events?
naproxen and low dose (<1.2g) ibuprofen
which of the NSAIDs have the highest risk of cardiovascular events?
cox-2 inhibitors (coxib)
high dose ibuprofen (2.4g)
diclofenac
which of the NSAIDs have the lowest risk of GI effects?
Ibuprofen
cox-2 inhibitors have the lowest risk
which of the NSAIDS have the highest risk of GI effects?
piroxicam, ketoprofen
which of the NSAIDs have an intermediate risk of GI effects?
indometacin, diclofenac, naproxen
can NSAIDs be use during pregnancy?
should be avoided, especially in the third trimester
(delays labour, causes pulmonary hypertension in neonate, premature closure of foetal ductus arteriosus)
