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BNF musculoskeletal > Musculoskeletal > Flashcards

Musculoskeletal Flashcards

1
Q

First line pain relief medication for osteoarthritis and soft tissue injury

A

Paracetamol regular +/- oral NSAID

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2
Q

In knee or hand arthritis, topical preparations of what masy be used?

A

NSAID or 0.025% capsaicin

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3
Q

If a patient has arthritis and is on low dose aspirin, how would their pain managment differ from a regular artitis patient>

A

Paracetamol first, then consider opioid before starting an NSAID

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4
Q

first line management of patient with detected RA

A

DMARD monotherapy e.g. MTX, lefluonamide, sulfasalazine or hydroxychloroquine (weak DMARD)

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5
Q

How long can conventional DMARDS take to be effective?

A

2-3 months

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6
Q

What can DMARDS be brridge with give a more rapid effect of symptomatic control?

A

Corticosteroids

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7
Q

If there is inadequate responce using 2 DMARDS, what else can be offered?

A

TNF alpha inhibitor, biological DMARD,

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8
Q

Example of TNF alpha inhibitors

A

Adalimumab, Golimumab, etanercept, certolizumab pegol

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9
Q

Abatercept, Sarliumab and Tocilizumab are examples of what?

A

Biological DMARDS

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10
Q

If a patient is intolerant to DMARDS and a TNF alpha inhibitor, what else can be trialled?

A

RTX in combination with MTX

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11
Q

What needs to be monitored wiht patients on hydorxychloroquine / chloroquine?

A

Ocular function - risk of retinopathy

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12
Q

What organ needs to be monitored in patients using Toculizumab?

A

Hepatic function

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13
Q

First line treatment of an acute gout attack

A

NSAIDS

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14
Q

If NSAIDS are contraindicated, what is next in line to treat an acute gout attack?

A

Colchicine

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15
Q

Long term management of gout

A

Xanthine oxidase inhibitors e.g. Allopurinol or febuxostat or the uricosuric drug sulfinpyrazone

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16
Q

When should xanthine oxidase inhibitor never be started?

A

During an acute gout attack

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17
Q

When are xanthine oxidase inhibitors started in regards toa gout attack?

A

1 to 2 weeks adter the attack has settled

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18
Q

If an acute attack of gout starts during treatment of a xanthine oxfidase inhibitor, should they be stopped?

A

No - continue

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19
Q

max dose of colcichine per course

A

6mg

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20
Q

How many days should colchicine course not be repeated within?

A

3 days

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21
Q

At what eGFR should colchicine be avoided?

A

<10

22
Q

Should allopurinol be taken with food?

A

Preferably after food

23
Q

Common side effect of allopurinol

A

Rash

24
Q

Febuxostat has 2 MHRA warnings regarding what?

A
  1. hypersensitivity reactions

2. Increase risk of CV death

25
Q

Common side effect with colcichine

A

Diarrhorea, abdominal pain

26
Q

Muscarinic side effects of anticholinesterase drugs

A

increase sweating, bradycardia, increase salivary and gastric seretions

27
Q

Pyridostigmine nad neostigmine ar eexamples of what drug class

A

muscarinics / anticholinesterase

28
Q

Signs of anticholinesterase drug overdose

A

Nystagmus, miosis, bronchoconstriction, bradycardia, lacrimation, heart block, excessive sweating

29
Q

What drug is used to treat nocturnal leg cramps

A

Quinine

30
Q

Acute low back pain should be treated with which analgesics?

A

NSAIDS

31
Q

Is paracetamol alone effective for treating lower back pain?

A

No - if intolerate to NSAID add in opioid

32
Q

What enzyme do NSAIDS inhibit?

A

COX enzyme thereby inhibiting prostagladin production

33
Q

Which COX enzyme is associated with less GI intolerance

A

COX 2

34
Q

If a patient is on Mercaptopurine or Azathioprine and is due to start Allopurinol what dose alteraction is required?

A

Reduce dose by 1/4 to 1/2 with allopurinol

35
Q

What is a risk with quinine toxicity

A

QT prolongation

36
Q

Celecoxib, etorocoxib and parecoxib are examples of what type of NSAID

A

COX 2 selective

37
Q

Why should NSAIDS be used in caution in asthmatic patients

A

risk of bronchospasm

38
Q

If a patient is in AKI what should be done to the NSAID

A

stop temporarily

39
Q

Ketoprofen, piroxicam and ketolorac are the highest risk of what side effect

A

GI toxicity

40
Q

Lowest risk NSAIDS of GI toxicity

A

COX 2 selective (COXIBS)

41
Q

What NSAIDS are at high risk of CV events

A

Cox 2 selectives, High dose ibuprofen (>2.4g), Diclofenac

42
Q

Can NSAIDS be given in severe heart failure?

A

No - always contraindicated

43
Q

Are NSAIDS safe in pregancy?

A

No - they delay labour, cause pulmonary hypertension and premature closure of ductus arteriosus

44
Q

If a patient is taking an ACEi / Ciclosporin / Tacrolimus / Diuretics with an NSAID - what is the risk

A

risk of AKI

45
Q

NSAID taken alongiside SSRI, Warfarin, aspirin, venlafaxine increases the risk of what?

A

Bleeding

46
Q

Potassium sparring diuretic + NSAID interaction

A

Hyperkalaemia

47
Q

Quinolones + NSAID interaction

A

Risk of convulsions

48
Q

Methotrexate / Lithium + NSAID interaction

A

Risk of toxicity

49
Q

Naproxen can be sold OTC to women aged ….?

A

15 to 50 years for dysmenorrhea

50
Q

How many days is naproxen OTC used for?

A

3 days - pack size 9 x 250mg tabs

BNF musculoskeletal (1 decks)

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