Musculoskeletal

Question 1

rheumatoid arthritis

Answer 1

auto-immune where attacks on synovium (lining of joints)

Question 2

RA symptoms

Answer 2

~ joint pain
~ swelling
~ hands, feet, wrists affected

Question 3

TX for RA

Answer 3

DMARDs

new diagnosis
Methotrexate + other DMARD + short-term corticosteroid

Question 4

DMARDs examples

Answer 4

~ sulfasalazine (blood dyscrasias, colours bodily secretions orange)
~ Penicillamine (blood dyscrasias)
~ Gold (blood dyscrasias)

Question 5

Anti-malarial DMARDs

Answer 5

hydroxychloroquine
chloroquine (screen for occular toxicity)

Question 6

Drugs affecting immune response DMARDs

Answer 6

~ Methotrexate
~ Azathioprine
~ Ciclosporin (nephrotoxic)
~ Leflunamide
~ cyclophosphamide

Question 7

Cytokine modulators DMARDs

Answer 7

infliximab, etanercept (blood dyscrasias, report TB symptoms)

Question 8

Methotrexate MOA

Answer 8

Anti-folate, inhibits conversion of dihydrofolate (folic acid) to tetrahydrofolate used to make purines/pyrimidines so DNA…prevents cellular replication

ANTI=FOLTAE = TERATOGENIC + CAUSE BLOOD DYSCRASIAS

Question 9

Methotrexate USE

Answer 9

RA
Cancer
Psoriasis
Crohns

Question 10

Methotrexate DOSE

Answer 10

ONCE weekly (on same day each week)
prescription must state; dose & frequency

Question 11

Methotrexate and concomitant folic acid

Answer 11

help reduce MTX side effects
~ NOT TAKEN ON SAME DAY !!!

Question 12

Methotrexate counselling

Answer 12

~ weekly dose & avoid OTC NSAIDS (risk of toxicity)
~ annual flu vaccinations (as MTX causes immunosuppression)
~ MTX treatment booklet

Question 13

Methotrexate SIDE EFFECTS

Answer 13

1. Blood dyscrasias
   ~ low WBC
   ~ anaemia
   ~ thrombocytopenia
2. Hepatotoxic
3. Nephrotoxic
4. Pulmonary toxicity
5. GI toxic

Question 14

MTX induced side effects/toxicity

Answer 14

folinic acid rescue

Question 15

Methotrexate CONTRACEPTION/PREGNANCY

Answer 15

Teratogenic
effective contraception during & 3 months after both men + women

Question 16

Methotrexate HANDLING

Answer 16

avoid skin contact
pregnant women not handling !

Question 17

Methotrexate INTERACTIONS

Answer 17

1. increased risk of blood disorders
   ~ phenytoin, Co-trimoxazole, Clozapine
2. Reduced renal excretion = MTX toxicity
   ~ NSAIDs
3. Increased risk of hepatotoxicity
   ~ Isotretinoin, ketoconazole, Rifampicin, Antipsychotics

Question 18

Gout

Answer 18

sudden severe pain, swelling and redness in joints caused by build up of uric acid crystals in joints

Question 19

Gout drug causes (hyperuracemia)

Answer 19

Diuretics (Loop, thiazides)
Ciclosporins, Tacrolimus
Cytotoxic
Cancer

Question 20

Gout tx acute attack

Answer 20

1st line = NSAIDs (diclofenac, Naproxen)
Alternative = Colchicine
~ do not repeat course in 3 days
~ MAX = 500mcg 2-4x a day
~ 6mg per course

Question 21

Gout tx prevention

Answer 21

1st line = Xanthine oxidase inhibitors (Allopurinol)

2nd line = Febuxostat (causes hypersensitivity reaction, SJS, anaphylaxis)

Uricosucric drugs = Sulfinpyrazone
SEs = urine alkaline, urea crystals, RFTs, urine output

Question 22

Allopurinol use

Answer 22

1st line in prophylaxis of gout

Question 23

Allopurinol side effects

Answer 23

rashes

Question 24

Allopurinol how to take

Answer 24

with food or after

Question 25

Allopurinol interactions

Answer 25

reduce dose of mercaptopurine/Azathioprine by 1/4 or 1/2 WITH ALLOPURINOL (INCREASED RISK OF TOXICITY)