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RBM2202 Pathophysiology and Pharmacology 2 > Musculoskeletal pharmacology > Flashcards

Musculoskeletal pharmacology Flashcards

1
Q

What effect do COX-1 prostaglandins have?

A

Renal homeostasis, gastric mucosal protection, platelet function.

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2
Q

What effect do COX-2 prostaglandins have?

A

Inflammatory effects - promotes pain, fever, vasodilation, block platelet aggregation

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3
Q

What prostaglandin is used for IOL?

A

Misoprostol

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4
Q

What are non-selective NSAIDs?

A

Inhibit both COX-1 and COX-2 enzymes which blocks the synthesis of prostaglandins.

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5
Q

What is an example of a non-selective NSAID?

A

Ibuprofen, naproxen

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6
Q

What are the ADRs of non-selective NSAID use?

A
  • peptic ulcer due to decrease in mucus secretions
  • kidney issues due to decrease in GFR
  • Increased bleeding time due to platelet function decreased
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7
Q

What are the ADRs of selective COX-2 inhibitors?

A
  • Increase risk of CVD complications
  • dose/time dependent HTN effects
  • renal insufficiency
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8
Q

What are 2 examples of selective COX-2 inhibitors?

A

Meloxicam

Celecoxib

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9
Q

An allergy to ________ or other NSAIDs is a contraindication for selective COX-2 inhibitor use.

A

Sulphonamides (OHA)

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10
Q

When the COX-2 enzyme is blocked the blood vessels ________, this results in ____tension

A

vasoconstrict, hypertension.

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11
Q

What are sign of decreased renal function from NSAID use?

A

unexplained weight gain, oedema, swelling feet or reduced urine output.

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12
Q

If a pt has a risk of GI issues a classic NSAID should be combined with which drug?

A

Anti-ulcer medication

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13
Q

Why do NSAIDs need to be avoided when pt is taking anticoagulants and corticosteroids?

A

Decreased platelet aggregation which leads to bleeding. The effects of anticoagulants and corticosteroids would be magnified.

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14
Q

What is a DMARD?

A

Disease Modifying Anti-Rheumatic Drug.

An anti-inflammatory and immunosuppressant.

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15
Q

What is the 1st line DMARD??

A

MTX (methotrexate.

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16
Q

What is MTX used for?

A

Anticancer (antineoplastic) drug and immunosuppressant so can be used for RA. It is the gold standard RA treatment.

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17
Q

MTX is a _____ antagonist.

A

folic acid.

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18
Q

MTX has a fast/slow onset.

A

fast.

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19
Q

How does MTX work?

A

Stops DNA synthesis and blocks reproduction of immune cells. It also decreases damage to the joints.

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20
Q

What can alleviate MTX ADRs?

A

folic acid.

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21
Q

Can MTX be taken during pregnancy?

A

No, as it is a folic acid antagonist it can cause neural tube defects.

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22
Q

Why is folic acid important?

A

It is a key material for RBC production.

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23
Q

What are the ADR of MTX?

A
  • hepatoxicity
  • stomatitis (due to folic acid antagonism)
  • bone marrow suppression
  • alopecia
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24
Q

MTX can cause ______, ______ and ______ due to bone marrow suppression.

A

anaemia, thrombocytopenia, infections

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25
Q

_____, an anti-seizure drug, cannot be co-prescribed with MTX.

A

Phenytoin

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26
Q

______, _____ and ______ function should be monitored when on MTX.

A

haematology, hepatic and renal

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27
Q

True/False: Taking folate supplement on the same day as MTX reduces ADR.

A

Folate should be taken on a different day

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28
Q

What is the antidote for MTX OD?

A

Leucovorin.

29
Q

What is the management of OA?

A
  • paracetamol
  • NSAID + antiulcer OR COX-2 inhibitor
  • short term intra-articular corticosteroid injection
30
Q

What is the management of RA?

A
  • Pain management - simple analgesics or NSAID
  • DMARDs - to slow progression.
  • biological DMARDs (bDMARDs)
  • low dose corticosteroid therapy.
31
Q

What is the second line DMARD?

A

Gold compound chrysotherapy - Auranofin.

32
Q

What is a bDMARD?

A
  • TNF a-antagonist: etanercept (ETN)

- Cytokine modulators: abatacept

33
Q

When is bDMARD used?

A

severe or established RA

34
Q

How does Auranofin work?

A

Modifies the immune response by affecting the migration of immunocompetent cells to sites of inflammation.

35
Q

Why is Auranofin 2nd line treatment for RA?

A

It has a slower onset.

36
Q

What are the 3 things that corticosteroids INCREASE?

A
  • fluid retention
  • Vasoconstriction (hypertension)
  • Blood glucose levels
37
Q

What are the 3 things that corticosteroids DECREASE?

A
  • Immune suppression
  • Bone density (osteoporosis)
  • Potassium (hypokalaemia - CV issues)
38
Q

What is an example of a corticosteroid?

A

Dexamethasone.

39
Q

How do corticosteroids work?

A
  • reduce infiltration and activity of inflammatory cells

- reduce synthesis of inflammatory mediators

40
Q

What do corticosteroids do to blood vessels?

A

decrease permiability

41
Q

what do corticosteroids do to immune cells, tissues and organs?

A

Anti-inflammatory effect
Immunosuppressant
anti-allergy
2ndary pain relief

42
Q

What effect do corticosteroids have on the skin?

A

thinning

43
Q

What effect do corticosteroids have on the metabolism?

A

Can produce a Cushing’s appearance.

Increase BGL, weight and fluid retention

44
Q

What is the management for osteoporosis?

A
  • Ca
  • Vit D
  • Bisphosphonates (Alendronate)
  • Exercise
45
Q

How does oestrogen effect bone density?

A

Oestrogen promotes osteoblasts (bone rebuilding). So reduced oestrogen can decrease bone density by throwing off the clast:blast balance.

46
Q

What regulates bone metabolism?

A

Ca, Vit D, PTH

47
Q

What affects Ca absorption?

A

Vit D, PTH and oxalic acid

48
Q

What are the ADR of Ca?

A

renal calculi, GI upset

49
Q

Can Ca be administered IM or SC?

A

Never. Can be given IV but pt must have cardiac monitoring.

50
Q

What is the active form of Vitamin D?

A

Calcitriol

51
Q

What is Calcitriol?

A

a fat soluble hormone formed in the kidney. The active form of Vit D.

52
Q

How does Calcitriol work?

A
  • Stimulates Ca and PO absorption from the sml intestine and REabsorption from the kidneys.
  • regulates Ca levels
  • regulates bone mineralisation.
53
Q

How do you get Vit D?

A

The sun or supplementation

54
Q

___ and ____ converts to Calcitriol in the liver and kidneys.

A

D3 or D2

55
Q

True/False: D3 and D2 are active forms of Vit D

A

False.

56
Q

Those with renal dysfunction may be at risk of ______ if given high dose of Vit D.

A

hypercalcaemia

57
Q

What serum and urine levels should be monitored when pt is taking vit D?

A

Ca, K, phosphate.

58
Q

What antacids need to be restricted when taking Vit D?

A

Mg based antacids

59
Q

What are the indications or Vit D?

A

Rickets/osteomalacia

osteoporosis

60
Q

When are bisphosphonates indicated?

A

Osteoporosis in post-menopausal women.

Paget’s disease.

61
Q

What is an example of a bisphosphonate?

A

Alendronate.

62
Q

How does Alendronate work?

A

Blocks the breakdown of bone and prevent reabsorption.

63
Q

What are the ADR of alendronate?

A

GIT upset, oesophageal erosion, muscle/bone pain.

64
Q

What is the major consideration when taking alendronate?

A

Take with a full glass of water and remain upright for 30mins to avoid oesophageal erosion.

65
Q

What dental condition can result from alendronate?

A

Osteonecrosis jaw. ONJ. This can occur if dental procedures done during treatment.

66
Q

What is a sign of Aspirin toxicity?

A

Tinitis

67
Q

Which non-selective or COX-2 inhibitor NSAID have a greater adverse effect on cardiovascular system?

A

COX-2 inhibitor. Increase risk of CVD complications such as thrombus formation.

68
Q

When taking MTX, what is a dry cough a sign of?

A

pneumonitis

RBM2202 Pathophysiology and Pharmacology 2 (11 decks)

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