Musculoskeletal System Flashcards
Rheumatoid arthritis
-chronic inflammatory disease affecting join synovial membrane
Rheumatoid arthritis symptoms
-pain + stiffness worsen with rest, inactivity, heat in joints
-nodules, swelling, tenderness, malaise, fatigue, fever + weight loss
Rheumatoid arthritis non drug tx
physiotherapy
excerise
relaxation
stress management
Rheumatoid arthritis drug tx
-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
methorexate
-OW same day
-prescription + label = dose + frequency
-methotrexate commonly co-prescribed with folic acid x same day
methotrexate report signs of
blood disorder, liver toxicity + respiratory effects
methotrexate s/e
blood disorders
liver toxicity
pulmonary toxicity
GI toxicity
blood disorders
sore throat
bruising
mouth ulcers
liver toxicity
n+V
abdominal discomfort
dark urine
jaundice
itchy skin
pulmonary toxicity
SoB
coughing
GI toxicity
stomatitis
diarrhoea
toxicity antidote
folinic aicd (calcium folinate)
methotrexate monitoring
-FBC, renal function tests, LFT
->every 1-2wk until stable
->every 2-3MT
methotrexate screening
-screen no pregn prior to tx
->antifolate = harmful to fetus
->use effective contraception during + 6mt after
methotrexate interactions
-nephrotoxic drugs (MTX reduces renal function) x otc ibuprofen NSAIDs
-antifolates - trimethoprim + phenytoin
-hepatotoxic drugs = rifampicin + antifungals
-omeprazole/esomeprazole = lowers clearance + inc toxicity
hyperuricaemia + GOUT
-raised uric acid conc in blood (hyperuricaema) + deposition of urate crystals in joints + other tissues
hyperuricaemia + GOUT causes
-diet high salt intake
-medications = bendroflumethiazide/chemo drugs
hyperuricaemia + GOUT acute tx
-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
hyperuricaemia + GOUT tx chronic
-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
allopurinol
when restarting flare-prophylaxis with colchine/NSAIDs = recommend allopurinol
allopurinol s/e
-rash
-x if not mild restart carefully but if reccurence stop immediateyl
allopurinol interaction
azathioprine + mercaptopurine
nocturnal leg cramps
-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
NSAIDs
analgesic + anti-inflammatory use in pain related to inflammation e.g. rheumatoid arthritis, back pain, soft tissue disorder
