Musculoskeletal System

Question 1

State treatment of osteoarthritis:

Answer 1

1. Paracetamol + topical NSAIDS
2. Oral ibuprofen
3. Codeine
4. Topical capsaicin

Question 2

A patient has osteoarthritis and has been taking first line treatment for OA. Patient is taking aspirin and metformin. What is the next course of action:

Answer 2

Codeine

Question 3

Define rheumatoid arthritis:

Answer 3

Chronic systemic inflammatory disease that causes persistent symmetrical joint synovitis – typically of small joints of hands and feet.
Synovitis presents as pain and prolonged stiffness that tends to be worser at rest or periods of inactivity, swelling, tenderness and heat.
Malaise, fatigue, fever, weight loss

Question 4

State treatment in rheumatoid arthritis:

Answer 4

1. DMARD – methotrexate, leflunomide, sulfasalazine. Can take 2-3 months for effect.
2. Hydroxychloroquine in patients with mild arthritis or those with palindromic
   rheumatism

Question 5

What can be given to rapidly decrease inflammation during rheumatoid arthritis flare ups?

Answer 5

Short-term corticosteroids

Question 6

State treatment of pain relief in patients with rheumatoid arthritis:

Answer 6

1. NSAID or COX-2 (celecoxcib)
2. Paracetamol if patient taking low dose aspirin

Question 7

Hydrotherapy can be offered as an adjunctive In which condition:

Answer 7

Axial spondylarthritis

Question 8

State the drug treatment for axial spondylarthritis:

Answer 8

1. NSAIDs at lowest dose
2. Switch NSAIDS
3. TNF alpha inhibitor or biological DMARD (adalimumab, certolizumab, etanercept,
   golimumab,

Question 9

What is the MHRA alert for hydroxychloroquine?

Answer 9

Administration with azithromycin was associated with increased risk of cardiovascular events.
pyshciatric reactions occurred within first month of treatment. counsel patients to watch out for this.

Question 10

What are the specific side effects for leflunomide?

Answer 10

Discontinue treatment and institute washout procedure in case of serious side effect. Potentially life threatening hepatotoxicity reported in the first 6 months. Discontinue treatment or reduce dose if liver function abnormality.

Question 11

What are the note around contraception with leflunomide?

Answer 11

Effective contraception is essential during treatment and at least 2 years after treatment inn women, and at least 3 months after treatment in men. Waiting time may be reduced with washout procedure

Question 12

What are the monitoring requirements for leflunomide

Answer 12

Monitor full blood count before treatment and every 2 weeks for 6 months, then every 8 weeks. Same for liver function
Monitor BP

Question 13

What is the washout procedure for leflunomide?

Answer 13

Colestyramine or activated charcoal.

Question 14

What is an important safety warning for infliximab?

Answer 14

Adequate resuscitation facilites must be avaialable

Question 15

State treatment for acute attacks of gout:

Answer 15

1. NSAID
2. Colchicine if NSAID C/Is
   Note: aspirin not indicated in gout

Question 16

If patient is taking anticoagulants and is on heart failure medication which one should be given for acute gout attack:

Answer 16

Colchicine

Question 17

What should be prescribed alongside NSAID?

Answer 17

Gastro-protection

Question 18

What limits the use of colchicine?

Answer 18

Side effects

Question 19

For prevention of gout:

Answer 19

1. Allopurinol 2. febuxostat

Question 20

State which medication is licensed for acute gout attacks (atleast 3 in past 12 months):

Answer 20

Canakinumab

Question 21

State a common side effect with allopurinol:

Answer 21

Rash
Discontinue therapy

Question 22

What are the cautions are there for allopurinol?

Answer 22

Ensure fluid intake.

Question 23

Should allopurinol be continued during an acute attack of gout?

Answer 23

Yes

Question 24

State MHRA warning with Febuxostat:

Answer 24

Hypersensitivity reactions steven-johns syndrome, anaphylactic shock
cv disease

Question 25

State monitoring requirements for febuxostat:

Answer 25

LFTS

Question 26

What should be given prophylactically for 6 months with febuxostat/colchicine?

Answer 26

NSAID

Question 27

State MHRA warning with nusinersen:

Answer 27

Hydrocephalus
Increased vomiting, headache, unexplained decrease in consciousness

Question 28

State treatment in nocturnal leg cramps:

Answer 28

Quinine. Can take up to 3 months to work

Question 29

State treatment for lower back pain:

Answer 29

1. NSAID Ibuprofen or naproxen
2. Codeine + paracetamol

Question 30

Which NSAID has a high incidence of headache, dizziness and GI disturbances:

Answer 30

Indometacin

Question 31

Which NSAID permits once daily dosing, and is associated with more frequent skin reactions:

Answer 31

Piroxicam

Question 32

State the varying degree of GI side effects in NSAIDS:

Answer 32

Highest risk = piroxicam, ketoprofen, ketorolac Intermediate risk = naproxen, diclofenac, indomethacin Low risk = ibuprofen
Lowest risk = cox-2 selective inhibitors

Ibuprofen + Aspirin = GI effects = Avoid but only use if necessary

Question 33

Which NSAID is has important consequences in overdosage because it can cause convulsions:

Answer 33

Mefenamic acid

Question 34

What is the MHRA Alert for tiaprofenic acid?

Answer 34

Can cause severe cystitis. Do not give to patients with urinary symptoms until symptoms stopped/resolved.