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Pre-reg > Musculoskeletal > Flashcards

Musculoskeletal Flashcards

1
Q

what is rhermatoid arthritis?

A

pain and stiffness, worsens with rest, inactivity and heat in the joints

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2
Q

what are the drug options for rheumatoid arthritis?

A

1st line = methotrexate, leflunomide or sulfasalazine
2nd - MAbs

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3
Q

what does DMARDs stand for?

A

disease modifying anti rheumatic drugs

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4
Q

what DMARD is used in mild RA?

A

hydroxychloroquine

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5
Q

what MAbs can be used for RA?

A

adalimumab, infliximad, etanercept, tozlizumab

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6
Q

what can you give is someone with RA is in severe pain and need of treatment whilst waiting for methotrexate to work?

A

can bridge with corticosteroids
NSAIDs can also be used by need to withdraw when methorexate given

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7
Q

what red flags symptoms need an urgent referral with methotrexate?

A

signs of blood disorders
liver toxicity
respiratory effects
gastro toxicity

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8
Q

how many times a week in folic acid taken when rxd methotrexate?

A

6 days a week - not on same day

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9
Q

whats the antidote for methotrexate?

A

folininc acid

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10
Q

what tests need to be done for methotrexate monitoring?

A

FBC, renal profile, LFTS
every 1 - 2 weeks until stable

then every 2 - 3 weeks after

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11
Q

if a male is taking methotrexate, does their partner need to be on contraception?
does contraception need to be continued post treatment?

A

yes need effective contraception during treatment and at least 6 months after for both men and women

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12
Q

what are the 4 types on interactions to look out for with methotrexate?

A
  1. nephtotoxic drugs as MTX reduced renal function hence why need to avoid NSAIDs
  2. anti-folates (trimethprim, phenytoin)
  3. hepatotoxic (rifampicin, antifungals)
  4. PPIs - reduce clearance = increased toxicity
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13
Q

what are some of the cuases of gout?

A

diet (high salt, fat, alcohol)

bendroflumethiazide

chemotherapy drugs

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14
Q

whats the acute management of gout?

A
  • colchicine or high dose NSAID + PPI

dose of colchicine = 500mcg 2 -4 times a day max TDS

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15
Q

how long do you need to leave before repeating course of colchicine?

A

do not repeat courses within 3 days

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16
Q

when would you avoid using NSAIDs to treat gout?

A

in people on diuretics due to fluid retention

17
Q

what are less common options for acute gout management?

A

short course or oral corticosteroid

IM injection of corticosteroid or canakinumab

18
Q

when do you offer chronic treatment for gout?
what is the 1st and 2nd line?

A

2 or more attacks in a year

1st line = allopurinol
2nd = febuxostat

19
Q

what do you do if someone has an acute gout attack whilst on chronic gout treatment?

A

continue chronic treatment whilst taking colchicine

20
Q

whats the most common SE with allopurinol?

A

rash, hypersensitvity
discontinue, if mild cna restart with caution, may need to stop

21
Q

what do you need to do with the dose of azathioprine/mercaptopurie if given with allopurinol?

A

reduce the dose of azathioprine/mercaptopurine due to interaction

22
Q

what is used for nocturnal leg cramps?
how long do you trial before assessing benefit?

is this a recommended option?

A

quinne sulfate

trial for 4 weeks, only continue if benefit - need to stop and review treatment every 3 months

not routinely recommended, only if disrupts sleep or are very painful

23
Q

what patients do you need to avoid NSAIDs?

A

asthmatics - increased risk of bronchospasams

24
Q

what are the 2 main side effects of NSAIDs?

A

GI and cardiac

25
Q

which NSAIDs have the highest risk of GI SE?

A

piroxicam, ketoprofen, ketorolac

26
Q

what NSAIDs have the lowest risk of GI effects?

A

celeoxib, etoricoxib (COX-2 selective inhibitors)

27
Q

what NASIDs have a higher risk of GI SE out of naproxen, diclofenac, indometacin and ibuprofen?

A

ibuprofen has the lowest risk out of those listed but not as low of celeoxib and etoricoxib

28
Q

what NSAIDs have the highest and lowest risk of CV effects?

A

Highest = COX-2selective (celecoxib, etoricoxib), diclofenac, high dose ibuprofen (2.4g)

Lowest = naproxen, ibuporfen 1.2g

29
Q

can NSAIDs be used in pregnancy and breastfeeding?

A

avoid in pregnancy
caution in breastfeeding

30
Q

what things can increase the risk fo GI bleeds if given with NSAIDs?

A

low dose aspirin and alcohol - need PPI cover especially in elderly

31
Q

what should you do if someone has a known sensitivity to aspirin?

A

caution due to hypersenstivity reactions and cross senstivity with aspirin

32
Q

can NSAIDs be used in renal impairment?

A

no due to fluid retention and further impairment

33
Q

whats the risk of giving NSAID with MTX/lithium?

A

reduces the clearance of these drugs = increases toxicity

34
Q

whats the risk if NSAIDs given ith ciprofloxacin?

A

increases risk of seizures

35
Q

whats the risk if NSAIDs gven with other drugs which raise K+?

A

hyperkalaemia ‘tequila always makes nurses smile’

Pre-reg (47 decks)

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