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Pradeepa's notes > Musculoskeletal System > Flashcards

Musculoskeletal System Flashcards

1
Q

Rheumatoid arthritis

A

-chronic inflammatory disease affecting join synovial membrane

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2
Q

Rheumatoid arthritis symptoms

A

-pain + stiffness worsen with rest, inactivity, heat in joints
-nodules, swelling, tenderness, malaise, fatigue, fever + weight loss

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3
Q

Rheumatoid arthritis non drug tx

A

physiotherapy
excerise
relaxation
stress management

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4
Q

Rheumatoid arthritis drug tx

A

-1st line: methotrexate, ifluriomide, sulfalaszine (hydroxychloroquine = mild)
-2nd line: MoAbs - adalimumbab, etanercept, infliximab, tocilizumab, baricitinib
-bridge with corticoteroids when rapid supression needed
-NSAIDs for pain relief but when response to 1st + 2nd line is enough

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5
Q

methorexate

A

-OW same day
-prescription + label = dose + frequency
-methotrexate commonly co-prescribed with folic acid x same day

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6
Q

methotrexate report signs of

A

blood disorder, liver toxicity + respiratory effects

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7
Q

methotrexate s/e

A

blood disorders
liver toxicity
pulmonary toxicity
GI toxicity

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8
Q

blood disorders

A

sore throat
bruising
mouth ulcers

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9
Q

liver toxicity

A

n+V
abdominal discomfort
dark urine
jaundice
itchy skin

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10
Q

pulmonary toxicity

A

SoB
coughing

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11
Q

GI toxicity

A

stomatitis
diarrhoea

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12
Q

toxicity antidote

A

folinic aicd (calcium folinate)

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13
Q

methotrexate monitoring

A

-FBC, renal function tests, LFT
->every 1-2wk until stable
->every 2-3MT

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14
Q

methotrexate screening

A

-screen no pregn prior to tx
->antifolate = harmful to fetus
->use effective contraception during + 6mt after

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15
Q

methotrexate interactions

A

-nephrotoxic drugs (MTX reduces renal function) x otc ibuprofen NSAIDs
-antifolates - trimethoprim + phenytoin
-hepatotoxic drugs = rifampicin + antifungals
-omeprazole/esomeprazole = lowers clearance + inc toxicity

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16
Q

hyperuricaemia + GOUT

A

-raised uric acid conc in blood (hyperuricaema) + deposition of urate crystals in joints + other tissues

17
Q

hyperuricaemia + GOUT causes

A

-diet high salt intake
-medications = bendroflumethiazide/chemo drugs

18
Q

hyperuricaemia + GOUT acute tx

A

-start asap
-colchicine/high dose of NSAIDs + PPI x aspirin
->colchicine 500mcg 2-4 x 3DY x repeat within 3DY
-NSAIDs induces fluid retention (interaction diuretic)
-alternative
_>short course of oral corticosteroids
->IM injection of corticosteroids or cankinumab

19
Q

hyperuricaemia + GOUT tx chronic

A

-offered in frequent acute attacks of GOUT (2/more in yr)
-uric acid may be used with xanthine-oxidase inhibtors
-1st line = allopurinol
-2nd line = febuxostat
-if acute attacks happen during tx continue chronic tx + start acute tx

20
Q

allopurinol

A

when restarting flare-prophylaxis with colchine/NSAIDs = recommend allopurinol

21
Q

allopurinol s/e

A

-rash
-x if not mild restart carefully but if reccurence stop immediateyl

22
Q

allopurinol interaction

A

azathioprine + mercaptopurine

23
Q

nocturnal leg cramps

A

-quinine suflate = lowers freq
-potential toxicity - quinine x routinely recommend
-> use if cramps disrupt sleep, v.painful/other tx x work
-trial for 4wk if benefit continue
-stop tx every 3mt + assess need to continue

24
Q

NSAIDs

A

analgesic + anti-inflammatory use in pain related to inflammation e.g. rheumatoid arthritis, back pain, soft tissue disorder

25
Q

NSAIDs CI

A

asthmatics

26
Q

NSAIDs interactions

A

-low dose aspirin = inc GI bleed risk (only use if needed)
-alcohol = inc GI bleed risk
-use PPI

27
Q

NSAIDs hypersensitivity

A

reactions - cross senstivity with aspirin

28
Q

NSAIDs avoid in

A

renal impairmenets ( risk of fluid retention + further impairment)
-avoid in pregn/caution in BF

29
Q

NSAIDs high risk level

A

GI S/E
->piroxicam, ketorolac, ketoprofen
Cardiovascular S/E
-> COX2 selective inhibitors

30
Q

NSAIDs medium risk level

A

GI S/E
->indometacin, diclofenac, naproxen

31
Q

NSAIDs low risk level

A

GI S/E
->ibuprofen
Cardiovascular S/E
->naproxen, ibuprofen 2.4g

32
Q

NSAIDs lowest risk level

A

GI S/E
-> cox-2 selective inhibitors

33
Q

NSAIDs interactions

A
  • MTX/lithium - reduces clearance
    -ciprofloxacin - inc risk of seizures
    -blood thinners - high risk of bleeding
    -drugs - hypokalaemia
    -drugs = renal failure = AKI

Pradeepa's notes (12 decks)

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