musculoskeletal system Flashcards
What is osteopenia
Reduction in bone mineral content
what is osteoporosis
Reduction in bone mass
What are the main causes of osteoporosis
1) post menopausal oestrogen deficiency
2) Age related bone haemostasis deterioration
3)long term levothyroxine use
4) long term glucocorticoid therapy
5) Myeloma (bone marrow cancer)
what is osteomalacia
softening of bones
Pharmalogical treatment osteoporosis
1)Bisphosphonates
- given if BMD is -2.5 or lower e.g. alendronate, risedronate, zoledronic acid).
- usually paired with calcium and vitamin D (colecafierol).
2) SERMs: e.g. Raloxifene to increase osteoblast activity and reduce osteoclast activity
- low bioavailability but is well distributed
3) Strontium ranelate: Reduces osteoclast activity and increases osteoblast activity.
4) PTH (teriparatide, abaloparatide) : increase bone mass by stimulating increase in number of osteoblasts, and decreasing osteoblast apoptosis.
- They act on PTh-1 receptors and activate adenylyl cyclase, to increase Ca2= levels.
5) monoclonal antibodies (Denosumab): Binds to RANKL to inhibit osteoclast formation.
6) Romosozumab: inhibits sclerostin, causing increase in bone matrix production by osteoclasts.
7) Hormone replacement therapy (HRT)
Non Pharmalogical management to treat osteoporosis
1) Excercise
2) Smoking cessation
3) reducing alcohol intake
4) more calcium (at least 700mg a day) and viatamin D
5) weight loss
non Pharmalogical management for OA
mobility aids
Exercise
weight management
Pharmalogical management for OA
1) Topical nsaids
2) oral nsaids
combo with gastro protective to (e.g. PPI:
omeprazole).
3) intra articular corticosteroid injection
pharmalogical mangement for RA
DMARDs (methotrexate, sulfasalazine).
NSAIDs to control symptoms
also if DMARDs given then, short term bridging treatment with glucocorticoids is also given.
DMARDs can take 2-3 months to be effective.
What is a cDMARD
conventional DMARD
just normal DMARDs like methortrexate etc
examples of biologicla DMARDs used to treat RA
Adalimumab
etanercept
infliximab
certolizumab pegol
golimumab
tocilizumab
abatacept
1) top 5 inhibit activity of tumor necrosis factor alpha, and a pro-inflammatory mediator responsible for damge to joints.
2) Adacept binds to APCs, preventing activation of t lymphocytes, disrupting inflmmatory process.
3) Tocilizumab inhibits interleukin-6 (pro-inflammaootry mediator resposible for joint pain in RA).
what is the suffix for a monoclinal antiboy
mab
methotrexate mechanism of action
prevents the conversion of folic acid to tetrahydrofolate inhibiting DNA synthesis during s phase of cell cycle, and increases t cell apoptosis, causing decrease in immune response.
examples of JAK inhibitors to treat RA
Tofacitinib x2 a day
Baricitinib
upadacitinib
filgotinib
draw backs for pharmalogiccal treatment for RA
increased risk of ifection, due to constant supression or decrease in immune response with DMARDs etc
