Musculoskeletal Flashcards
How do NSAIDs work?
Reduce prostaglandin production by inhibiting cyclo-oxygenase.
Which drugs interact with NSAIDs?
Anticoagulants - NSAIDs may potentiate warfarin and NSAID induced GI bleeding is more severe in patients on warfarin
ACEis, ARBs and diruetics - risk of renal failure due to decreased renal blood flow
By reducing renal blood flow, NSAIDs may increase levels of renally excreted drugs: lithium is a particular hazard
What is the management of acute gout?
NSAIDs - especially naproxen
Colchicine - may be used in patients with HF, asthma and those on anticoagulants where NSAID is contraindicated
Corticosteroids - intra-articular or systemic
What are common side effects of colchicine?
Nausea, vomiting, diarrhoea and abdominal pain. Excessive doses may cause profuse diarrhoea, GI haemorrhage, rashes, renal and hepatic damage
What are rare side effects of colchicine?
Peripheral neuropathy, myositis
When should prophylactic therapy be started for gout according to NICE?
In uncomplicated gout, uric acid lowering drug therapy should be started if second attack, or further attacks occur within 1 year.
Uric acid lowering drug therapy should also be offered to patients with tophi, patients with renal insufficiency, patients with uric acid stones and gout and patients who need to continue treatment with diuretics.
How does allopurinol work?
Inhibits xanthine oxidase which catalyses the breakdown of xanthine and hypoxanthine derived from purines to uric acid.
What are the side effects of allopurinol?
Occasional - rashes (withdraw therapy as may progress to serious skin reaction)
Rare but serious: hypersensitivity reactions include exfoliation, fever, lymphadenopathy, arthralgia and eosinophilia resembling SJS or Lyell’s syndrome, vasculitis, hepatitis, renal impairment, seizures, GI disorders, blood disorders (leucopenia, thrombocytopenia, haemolytic anaemia and aplastic anaemia)
How should the dose of allopurinol be adjusted in renal disease?
Reduced, as renally excreted
What does allopurinol do to doses of azathioprine?
Increases levels, so should decrease dose to avoid toxicity.
What are the pharmacological treatments of osteoarthritis?
Paracetamol just as effective as NSAIDs and better for older people.
Offer paracetamol and/or topical NSAIDs before considering oral NSAIDs, COX-2 inhibitors or opioids.
Topical capsaicin can be used for knee or hand arthritis
Intra-articular corticosteroid injections when pain is moderate to severe.
What are non-pharmacological treatments of osteoarthritis?
Application of heat or cold to site of pain.
TENS
Manipulation and stretching
Assessment for bracing/joint supports/insoles for people with biomechanical joint pain or instability.
Assistive devices e.g. walking sticks or tap turners
What are the potential side effects of hydroxychloroquine?
Macular changes - check visual visual acuity and fundoscopy yearly
What the the potential side effects of sulfasalazine?
Neuropenia, myelosuppression
Evaluate baseline FBC and monitor
What are the side effects of methotrexate and how is it monitored?
SE - myelosuppression, hepatic fibrosis, pneumonitis
Evaluation and follow up: FBC, LFTs, creatinine, CXR