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Inori Pre Reg > Musculoskeletal > Flashcards

Musculoskeletal Flashcards

1
Q

What is rheumatoid arthritis?

A

Autoimmune disease where the immune system mistakenly attacks the lining of joints
Chronic systemic inflammatory disease that causes persistent symmetrical joint inflammation.
Typically of the small joints of the hands and feet

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2
Q

Symptoms of RA?

A

Pain and prolonged stiffness that tends to be worse at rest or following peroods of inactivity, swelling, tenderness and heat in the affected joints.
Non specific symptoms include malaise, fatigue, fever and weight loss
Can progress to joint deformity, and affect different organs of the body like the heart, lungs and eyes

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3
Q

Non drug treatment for RA?

A

Physiotherapy to encourage exercise, enhance flexibility of joints and strengthen muscles

Psychological interventions such as relaxation, stress management and cognitive coping

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4
Q

First line for RA?

A

Monotheraoy with conventional disease modifying antirhematic drugs (DMARDs)

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5
Q

Choice of DMARDs for first line RA?

A

Methotrexate
Leflunomide
Sulfasalazine

Hydroxychloroquine is a weak DMARD so for only mild RA

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6
Q

Downside of DMARDs regarding its action time and how to overcome it?

A

Has a slow onset of action and can take 2-3 months to take effect
Consider short bridging treatment with corticosteroid PO, IM, Intra articular

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7
Q

Second line for RA?

A

Add another DMARDs

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8
Q

Treatment for flare up of RA?

A

Short term corticosteroid

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9
Q

Third line for RA?

A

Cytokine modulators DMARDs

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10
Q

Examples of cytokibe modulators DMARDs?

A

Tumour necrosis factor TNF alpha inhibitors like adalimumab, etanercept, infliximab, certolizumab, golimumab,

Other biological DMARDs like baricitinib, tofacitinib,

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11
Q

MoA of methotrexate?

A

Antifolate by inhibiting the conversion of dihydrofolate to tetrahydrofolate which are needed to make purines and pyrimdines, and therefore DNA prevents cellular replication

Anti folate drrrugs are teratogenic and cause blood dyscrasias

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12
Q

Missed dose of methotrexate?

A

If more than 3 days

Take next scheduled dose on normal day

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13
Q

Methotrexate ‘s blood dyscrasia symptoms and pt counselling points?

A

Low WBCs which makes pt susceptibile to infection
= report mouth ulcers, fever, malaise and sore throat

Low RBCs = anaemia
= report extreme Tiredness, pallor, dizziness

Low platelets = thrombocytopenia
= report N&V, dark urine, jaundice, abdominal pain (upper right), Pruritus, malaise, pale coloured stool

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14
Q

Side effects of methotrexate?

A 
Blood dyscrasia
Hepatotoxicity
Neohrotoxicity
Pulmonary toxicity
GI toxicity
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15
Q

Is methotrexate renally or hepatically excreted?

A

Renally

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16
Q

GI toxicity signs?

A

Stomatitis

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17
Q

What is stomatitis?

A

Inflammation of the mouth and lips

Sometimes oral ulceration

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18
Q

How to handle methotrexate?

A

Avoid skin contact with cytotoxic drugs

Pregnant women should avoid handling at all

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19
Q

What other DMARDs have similar efficacy to methotrexate and sulfasalazine but are less tolerated?

A

IM gold and penicillamine

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20
Q

How is Golf administered?

A

Given as IM sodium aurothiomalate
After administration, massage the area gently

A test dose must be given weekly until there is definite evidence of remission
Then given every 4eks and treatment continued for up to 5yrs after complete remission
Stop if no response seen within 2 months

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21
Q

Side effects of all DMARDs?

A

Blood dyscrasia

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22
Q

Therapeutic effect start after how long with Leflunomide?

A

4-6wks

Snd improvement may continue for a further 4-6months

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23
Q

Antimalarial DMARDs?

A

Hydroxychloroquine

Chloroquine (screening for ocular toxicity required)

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24
Q

Drugs of drugs affecting immune response DMARDs?

A 
Methotrexate
Axarhioprine
Ciclosporin
Leflunomide
Cyclophosphamide
25
Q

Side effect and pt advise on Leflunomide?

A

Hepatotoxic

Effective contraception for 2yrs after treatment for women and 3 month after treatment for men

26
Q

What drugs cause Hyperuricaemia and hence gout?

A

Diuretics loop and thiazidr
Ciclosporin and tacrolimus
Cytotoxics
Cancer

27
Q

Management of acute attacks of gout?

A

First line is NSAIDS like Diclofenac, naproxen, indomethacin
(aspirin not indicated)

Alternative is colchicine if NSAIDs not tolerated

Oral or parenteral corticosteroids is available

Canakinumab esp if frequent arthritis attack (at least 3 in the previous 12 months)

28
Q

Dose of colchicine?

A

500mcg BD to QDS

Max 6mg per course
And do not repeat course in 3 days

29
Q

Prevention treatment of gout?

A

First line is allopurinol

Second line is feboxustat

Uricosuric acid can also be used = sulfinapyrazone

30
Q

Rules on long term management of gout drugs?

A

Never start during an acute attack = start 1 to 2wks after an attack

Initiation may precipitate an acute attack so NASAI & colchicine for 1 month after Hyperuricaemia is corrected
If attack occurs during prophylaxis, continue as normal and treat attack separately

31
Q

Side effect of feboxustat?

A

Serious hypersensitivity recations like anaphylaxis and SJS

32
Q

Side effect of sulfibapyrazone?

A

Makes urine alkaline so allows urea crystals to form

Ensure adequate renal function and urine output

33
Q

Side effect of allopurinol?

A

Rashes

If mild, can re introduce but stop if it occurs again

34
Q

How to take allopurinol?

A

Take with or after food

35
Q

Management of myathena gravis?

A

It’s a muscle weakness
First lines is acetylcholinesterase like neostigmine and pyridostigmine

Second line is corticosteroid
Then Alternatively Immunosuporessants like azathioprine

Last resort is infusion of IV immunoglobulin

36
Q

What’s used to treat Nocturnal leg cramps?

A

Qunine

37
Q

Quinine has restricted use so when are you allowed to use it for Nocturnal cramps?

A

Sleep is regularly disturbed
Cramps are very painful or frequent
Treatable causes of cramps are excluded
Non pharmacological treatments have not worked like passive stretch exercise

38
Q

Side effects of quinine?

A

QT prolongation
Convulsions
Arrhythmia

Toxic in overdose

39
Q

MHRA warning on quinine?

A

Has dose dependent qt prolongation effect so caution in pts with risk factors for QT prolongation or in those with a trio ventricular block

40
Q

Monitoring for quinine?

A

Interrupt treatment every 3 months to assess further need

May take up to 4wks to improvement

41
Q

Treatment for spasticity?

A

Baclofen for chronic severe spasticity

42
Q

MoA of baclofen?

A

GABA analogue, works at spinal level and depresses CNS

43
Q

Side effects of baclofen?

A

Drowsiness

Muscular hypotonia

44
Q

Caution with baclofen?

A

Drowsiness so may affect driving
Can cause withdrawal reactions
Can be used intrathecally but need test dose and close monitoring. Initiate within 3 months of test dose

45
Q

Withdrawal reactions of baclofen?

A

Hyperactive state, exacerbates muscle spasticity, precipitates autonomic dysfunction, hyperthermia, Psychiatric reactions
Convulsiins

Avoid abrupt withdrawal. Gradually reduce dose over at least 1-2wks

46
Q

Alternative drugs that can be used in spasticity?

A 
Cannabis
Tizanidind
Dantrolene
Diazepam
Methocarbamol
47
Q

How long does it take for NSAIDs to work on mild to moderate pain relief?

A

With first dose

48
Q

How long does it take for NSAIDs to have analgesic full effect?

A

Takes 1wk

49
Q

How long does it take for NSAIDs to exert its anti inflammatory effect?

A

Takes 3wks

50
Q

Side effects of NSAIDs?

A

Bronchospasm so avoid in asthma
Hypersensitivity reaction (bronchospasm, rash, angiodema hives and rhinitis)
Nephrotoxicity as NSAIDs reduce glomerular filtration and are renally cleared
Sodium and fluid retention

51
Q

What NSAIDs have the highest risk of GI toxicity?

A

Ketoprofen
Ketolorac
Piroxicam

52
Q

Which NSAID has the intermediate risk of GI toxicity?

A

Naprixen
Diclofenac
Indomethacin

53
Q

Which NSAID has a low risk for GI toxicity?

A

Ibuprofen.

54
Q

Which NSAIDs have the lowest risk for GI toxicity?

A

COX2 selective COXIBs

55
Q

Which NSAIDs are classes as selective COX2 inhibitors?

A

Celecoxib
Etorocoxib
Parecoxib

56
Q

Why do NSAIDs have CV event risk?

A

Has small increased risk of thrombotic events like MI or stroke
Can cause severe HF so all NSAIDs are contra indicated in HF

57
Q

Which NSAIDs have the highest risk of CV events?

A 
High dose ibuprofen of over 2.4g daily
Dexibuprofen
COX2 selective inhibitors
Diclofenac
Acelcofenac
58
Q

Which NSAIDs have a low risk of CV events?

A

Naproxen 1g daily

Low dose of ibuprofen 1.2g or less have not been associated with any events

59
Q

NSAIDs and preg?

A

Avoid!
Esp jn the third trimester as
Delays Labour
Causes pulmonary hypertention jn new born baby
Premature closure of foetal ductus arterosus

Inori Pre Reg (22 decks)

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