MUSCULOSKELETAL Flashcards
What is rheumatoid arthritis?
Immune system attack synovium= causes inflammation
What are 3 symptoms of rheumatoid arthritis?
Joint pain - swollen, heat, stiff, motion loss
Rheumatic nodules
affect hands + feet
What are 4 specific symptoms of rheumatoid arthritis?
malaise, fatigue, fever, and weight loss
What is Palindromic rheumatism?
Rare form of inflammatory arthritis.
Causes attacks of joint pain & swelling similar to rheumatoid arthritis, but joints return to normal in between attacks.
What is 1st line drug treatment for rheumatoid arthritis?
Conventional DMARD
What is 2nd line drug treatment for rheumatoid arthritis?
Combination therapy
What is 3rd line drug treatment for rheumatoid arthritis?
Cytokine modulators e.g. (TNF) alpha inhibitor
What 2 drugs are given for severe active RA?
Mtx + rituximab
What drug is used to manage short-term bridging treatment or flare up of RA?
Steroids
What 5 drugs effect immune response which are DMARDS?
MTX
azathioprine
ciclosporin
cyclophosphamide
leflunomide
What DMARD requires contraceptive after treatment + is hepatotoxic?
leflunomide
What 2 antimalarial drugs are DMARDS?
hydroxychloroquine
Chloroquine
What 3 cytokine modulators are are DMARDS?
TNF a inhibitor
targeted synthetic
Other biological
What DMARD colours urine + produces orange tears?
Sulfasalazine
What is MOA of methotrexate?
Blocks dihydrofolate reductase = prevents purine/ pyrimidine production
What are 4 conditions MTX is used in?
RA
Crohn’s disease
Psoriasis
Cancer
What should MTX be prescribed by?
Brand
What counts as a missed dose of MTX?
More than 2 days of not taking
What is dosing for mtx?
Once weekly
What is a MHRA warning for mtx?
Once weekly for autoimmune diseases - specific day each week.
Do not take daily, report overdose, provide pt with alert card + treatment booklet.
What is given with mtx to reduce SE?
Folic acid
What are the possible folic acid regimens?
5mg weekly- diff day to mtx day
1 or 5mg OD- except mtx day
What are 5 main SEs of MTX?
Blood disorders
nephrotoxicity
hepatotoxicity
Pulmonary toxicity
GI toxicity
What is antidote for mtx overdose?
folinic acid rescue
Can mtx be taken in pregnancy?
NO- teratogenic - contraceptive
How long is contraceptive needed for men + women for MTX
During + 6 M after
How to handle mtx?
Avoid contact with skin + avoid in pregnant women
What is monitored for mtx?
LFTs, FBC, renal - every 1 to 2 weeks until stable.
Then 2-3 monthly
What symptoms should be reported if patient on mtx?
Infection, sore throat
What 2 GI issues to stop MTX in?
Stomatitis or diarrhoea
What is the issue if there are symptoms of persistant vomiting, abdo pain, dark urine + jaundice?
Hepatotoxicity
What are 3 main contra-indications of MTX?
Ascites, active infection, significant plural effusion (lung)
What should be done to mtx in renal impairment?
Reduce dose
What 5 drugs can interact with mtx to increase blood disorders?
Trimethoprim**
Clozapine
Phenytoin
Cytotoxic drug
immunosuppressant
What 3 drug classes interacts with MTX to increase toxicity due to reduced renal clearance?
NSAIDS
Penicillin
PPI
What 5 drugs/classes interact with MTX to increase nephrotoxicity?
Aminoglycosides, cephalosporin, glycopeptide, ciclosporin/tac, NSAID
What 6 drugs interact with MTX to increase hepatotoxicity?
Statin, co-amoxiclav, flucloxicillin + tetracyclines, carbamazepine, sodium valproate, fluconazole, isoniazid
What is osteoarthritis?
cartilage wears down + prevents smooth movement.
What is 1st line treatment for arthritis?
Topical NSAID