MUSCULOSKELETAL SYSTEM

Question 1

What is the treatment of osteoarthritis

Answer 1

Treat the symptoms, so primarily through pain relief and psychological/lifestyle interventions such as weight loss to reduce pressure
Paracetamol, COX2 inhibitors/PPI to retard bone resorption at osteoclasts

Question 2

Which drugs can cause osteoporosis?

Answer 2

Long-term gluccocorticoids: alter calcium absorption and elimination leading to secondary hyperparathyrodisim. Inhibitory effect on sex hormone production, direct inhibition on osteoblast function
Inhaled corticosteroids do not decrease bone density at low to moderate degrees but may have some effect at higher dosages

Some bone mass restoration may occur on withdrawal of glucocorticoid therapy

Question 3

How is osteoarthritis treated?

Answer 3

Lifestyle - stop smoking, increase calcium

Pharmacological - bisphosphonates, calcium, vit d, oestrogen, SERM

Question 4

What counselling points should be given with calcium

Answer 4

Take 2 hours apart from tetracyclines

Question 5

What counselling points should be given with bisphosphonates

Answer 5

• Taken at least 30 mins before first food, beverage and medicinal product of the day with plain water only
• Swallowed upon waking up with a full glass of water
• Do not crush or chew
• Don’t lie down for 30 mins
• Should not be taken at bed time
Taken once a week

Question 6

What is the main side effect of alendronic acid

Answer 6

osteonecrosis of the jaw

Question 7

Methotrexate main points

Answer 7

Check dosing days, renaly cleared, can cause immunosuppression, needs a baseline chest x ray due to risk of pulmonary toxicity, can decrease neutrophils and white cells
Take folic acid on alternate days
Ibuprofen interaction

Question 8

How is rheumatoid arthritis typically treated?

Answer 8

Methotrexate and diclofenac