Musculoskeletal System Flashcards
Ibuprofen
NSAID - COX-1 and COX-2 inhibitor.
Used for pain, inflammatory MSK conditions including rheumatoid arthritis, fever.
ADRs: Exacerbation of asthma, GI discomfort, nausea, diarrhoea, bleeding and ulceration (especially in the elderly), hypersensitivity, renal failure
Naproxen
NSAID - COX-1 and COX-2 inhibitor.
Used for pain, inflammatory MSK conditions including rheumatoid arthritis
ADRs: Exacerbation of asthma, GI discomfort, nausea, diarrhoea, bleeding and ulceration (especially in the elderly), hypersensitivity, renal failure
Diclofenac
NSAID - COX-1 and COX-2 inhibitor.
Used for pain, inflammatory MSK conditions including rheumatoid arthritis, acute gout
ADRs: Exacerbation of asthma, GI discomfort, nausea, diarrhoea, bleeding and ulceration (especially in the elderly), hypersensitivity, renal failure
Celecoxib
NSAID - COX-1 and COX-2 inhibitor.
Used for pain & inflammation in rheumatoid arthritis, osteoarthritis & ankylosing spondylitis
ADRs: Exacerbation of asthma, GI discomfort, nausea, diarrhoea, bleeding and ulceration (especially in the elderly), hypersensitivity, renal failure, dyspnoea, flu-like symptoms
Methotrexate
Inhibits dihydrofolate reductase, prevents the recycling of folic acid and hence prevents synthesis of pyrimidine nucleotides.
Uses: Rheumatoid arthritis (also used in malignancy)
ADRs: Oral mucositis, nausea and vomiting, bone marrow suppression, hepatotoxicity
Sulfasalazine
Conjugate of a salicylate and a sulfapyridine, inhibiits proliferation of T cells and IL-2 production, reduces chemotaxis and degranulation of neutrophils.
Uses: Rheumatoid arthritis, IBD
ADRs: Myelosuppression, hepatitis, rash, nausea, abdominal pain, vomiting. Safe in pregnancy
Infliximab, Adalimumab
Anti-TNF monoclonal antibody (expensive, used only if patient has trialled both methotrexate and another DMARD and has clinically active RA). Blocking TNF-alpha reduces inflammation, inhibits the cytokine cascase and recruitment of leukocytes, reduces angiogenesis and reduces joint destruction
ADRs: no increased risk of malignancy except where there had been previous malignancy, risk of infection including skin, soft tissue, TB reactivation
Rituximab
Monoclonal antibody against CD-20, leads to greater elimination of B cells (activates complement mediated lysis, initiates cell mediated cytotoxicity via macrophages, induces apoptosis).
Uses: RA, malignancy
ADRs: hypogammaglobulinaemia, increased infection risk, hypersensitivity, development of HACA (antibodies to drug)
Neostigmine
Acetylcholinesterase inhibitor - increases concentration of acetylcholine present at the neuromuscular junction, enhances neuromuscular transmission in skeletal and smooth muscle.
Indications: Oral or IV (ITU) preparations available for treatment of myasthenia gravis
ADRs: Cholinergic - SSLUDGE - Salivation, sweating, lacrimation, urinary incontinence, diarrhoea, GI upset and hypermotility, Emesis
Pyridostigmine
Acetylcholinesterase inhibitor - increases concentration of acetylcholine present at the neuromuscular junction, enhances neuromuscular transmission in skeletal and smooth muscle.
Indications: Oral preparation available for treatment of myasthenia gravis
ADRs: Cholinergic - SSLUDGE - Salivation, sweating, lacrimation, urinary incontinence, diarrhoea, GI upset and hypermotility, Emesis
Alendronic Acid
Bisphosphonate - inhibits oesteoclast mediated bone reabsorption.
Indications: osteoporosis
ADRs: Oesophageal reactions, abdominal pain and distension, oedema, MSK pain, osteonecrosis of the jaw and external auditory canal (rare)
Calcium
Given in calcium deficiency and at high dose in osteoporosis to slow the rate of bone resorption.
ADRs: GI disturbances
Vitamin D
Give in osteoporosis to maintain an adequate intake of vitamin D.
ADRs: anorexia, lassitude, nausea and vomiting, diarrhoea, constipation, weight loss, polyuria, sweating, headache, thirst, vertigo
Oestrogens
Given in post-menopausal osteoporosis if other therapy isn’t tolerated - inhibits bone resorption.
