Musculoskeletal Flashcards
First line pain relief medication for osteoarthritis and soft tissue injury
Paracetamol regular +/- oral NSAID
In knee or hand arthritis, topical preparations of what masy be used?
NSAID or 0.025% capsaicin
If a patient has arthritis and is on low dose aspirin, how would their pain managment differ from a regular artitis patient>
Paracetamol first, then consider opioid before starting an NSAID
first line management of patient with detected RA
DMARD monotherapy e.g. MTX, lefluonamide, sulfasalazine or hydroxychloroquine (weak DMARD)
How long can conventional DMARDS take to be effective?
2-3 months
What can DMARDS be brridge with give a more rapid effect of symptomatic control?
Corticosteroids
If there is inadequate responce using 2 DMARDS, what else can be offered?
TNF alpha inhibitor, biological DMARD,
Example of TNF alpha inhibitors
Adalimumab, Golimumab, etanercept, certolizumab pegol
Abatercept, Sarliumab and Tocilizumab are examples of what?
Biological DMARDS
If a patient is intolerant to DMARDS and a TNF alpha inhibitor, what else can be trialled?
RTX in combination with MTX
What needs to be monitored wiht patients on hydorxychloroquine / chloroquine?
Ocular function - risk of retinopathy
What organ needs to be monitored in patients using Toculizumab?
Hepatic function
First line treatment of an acute gout attack
NSAIDS
If NSAIDS are contraindicated, what is next in line to treat an acute gout attack?
Colchicine
Long term management of gout
Xanthine oxidase inhibitors e.g. Allopurinol or febuxostat or the uricosuric drug sulfinpyrazone
When should xanthine oxidase inhibitor never be started?
During an acute gout attack
When are xanthine oxidase inhibitors started in regards toa gout attack?
1 to 2 weeks adter the attack has settled
If an acute attack of gout starts during treatment of a xanthine oxfidase inhibitor, should they be stopped?
No - continue
max dose of colcichine per course
6mg
How many days should colchicine course not be repeated within?
3 days
At what eGFR should colchicine be avoided?
<10
Should allopurinol be taken with food?
Preferably after food
Common side effect of allopurinol
Rash
Febuxostat has 2 MHRA warnings regarding what?
- hypersensitivity reactions
2. Increase risk of CV death
Common side effect with colcichine
Diarrhorea, abdominal pain
Muscarinic side effects of anticholinesterase drugs
increase sweating, bradycardia, increase salivary and gastric seretions
Pyridostigmine nad neostigmine ar eexamples of what drug class
muscarinics / anticholinesterase
Signs of anticholinesterase drug overdose
Nystagmus, miosis, bronchoconstriction, bradycardia, lacrimation, heart block, excessive sweating
What drug is used to treat nocturnal leg cramps
Quinine
Acute low back pain should be treated with which analgesics?
NSAIDS
Is paracetamol alone effective for treating lower back pain?
No - if intolerate to NSAID add in opioid
What enzyme do NSAIDS inhibit?
COX enzyme thereby inhibiting prostagladin production
Which COX enzyme is associated with less GI intolerance
COX 2
If a patient is on Mercaptopurine or Azathioprine and is due to start Allopurinol what dose alteraction is required?
Reduce dose by 1/4 to 1/2 with allopurinol
What is a risk with quinine toxicity
QT prolongation
Celecoxib, etorocoxib and parecoxib are examples of what type of NSAID
COX 2 selective
Why should NSAIDS be used in caution in asthmatic patients
risk of bronchospasm
If a patient is in AKI what should be done to the NSAID
stop temporarily
Ketoprofen, piroxicam and ketolorac are the highest risk of what side effect
GI toxicity
Lowest risk NSAIDS of GI toxicity
COX 2 selective (COXIBS)
What NSAIDS are at high risk of CV events
Cox 2 selectives, High dose ibuprofen (>2.4g), Diclofenac
Can NSAIDS be given in severe heart failure?
No - always contraindicated
Are NSAIDS safe in pregancy?
No - they delay labour, cause pulmonary hypertension and premature closure of ductus arteriosus
If a patient is taking an ACEi / Ciclosporin / Tacrolimus / Diuretics with an NSAID - what is the risk
risk of AKI
NSAID taken alongiside SSRI, Warfarin, aspirin, venlafaxine increases the risk of what?
Bleeding
Potassium sparring diuretic + NSAID interaction
Hyperkalaemia
Quinolones + NSAID interaction
Risk of convulsions
Methotrexate / Lithium + NSAID interaction
Risk of toxicity
Naproxen can be sold OTC to women aged ….?
15 to 50 years for dysmenorrhea
How many days is naproxen OTC used for?
3 days - pack size 9 x 250mg tabs
