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Top 100 Drugs > Musculoskeletal system > Flashcards

Musculoskeletal system Flashcards

1
Q

common indications for allopurinol (3)?

A
  1. prevent recurrent attacks of gout
  2. prevent uric acid and calcium oxalate renal stones
  3. prevent hyperuricaemia and tumour lysis syndrome
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2
Q

MOA of allopurinol?

A

xanthine oxidase inhibitor

(lowers plasma uric acid conc and reduces precipitation of uric acid in joints and kidneys)

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3
Q

adverse effects of allopurinol (2)?

A

can trigger or worsen acute attack of gout

skin rash (common- can be mild or more serious hypersensitivity reaction i.e. Stevens-johnsons syndrome)

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4
Q

allopurinol should NOT be started under which conditions (3)?

A
  1. acute attacks of gout
  2. recurrent skin rashes
  3. signs of severe hypersensitivity
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5
Q

allopurinol dose should be reduced in pateints with what conditions (2)?

A

renal impairment

hepatic impairment

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6
Q

allopurinol is metabolised in the ____ and excreted by the _____?

A

liver

kidneys

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7
Q

co-prescription of allopurinol with which drugs increases risk of (1) hypersensitivty and (2) skin rash?

A

ACE inhibitors/ thiazides

amoxicillin

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8
Q

how is allopurinol prescribed (start dose and titration)?

A

taken orally w a low start dose and then titrated up according to serum uric acid conc

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9
Q

when starting allopurinol for gout what should be co-prescribed?

A

NSAID e.g. naproxen

or/ colcochine

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10
Q

when allopurinol is used as part of cancer treatment it should be given before/after commencing chemotherapy?

A

before chemotherapy

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11
Q

when should allopurinol be taken in the day?

A

after meals

pts should be encouraged to maintain good fluid intake (2-3litres)

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12
Q

how could you communicate allopurinols purpose to the pt?

A

reduce attacks of gout (or formation of kidney stones)

if they develop a rash seek medical advice!

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13
Q

how should allopurinol use be monitored?

A

serum uric acid conc at 4 weks after starting Tx

(aiming for uric acid conc to < 300umol/L)

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14
Q

treatment with which drugs can increase serum uric acid conc causing gout (3)?

A

thiazides

loop diuretics

aspirin inhibits renal excretion of uric acid and can trigger acute attack

(should always consider drug-induced gout as a cause of new onset joint pain in these pts)

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15
Q

mesalazine and sulfasalazine belong to which drug class?

A

aminosalicyates

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16
Q

common indications for mesalazine and sulfasalazine (2)?

A
  1. mesalazine is first line for mild UC
  2. sulfasalazine is an option for managing RA
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17
Q

sulfasalazine is a DMARD- what does this stand for?

A

Disease- Modifying AntiRheumatic Drug

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18
Q

MOA of mesalazine and sulfasalazine?

A

release 5-aminosalicyclic acid (5-ASA)

(has anti-inflammatory and immunosuppressive effects)

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19
Q

side effects of mesalazine and sulfasalazine (

A

GI upset and headache (common)

blood abnormlaities (rare but serious)

renal impairment

sulfasalazine can also cause oligospermia in men

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20
Q

lasalazine and sulfasalazine are salicylates like which other drug?

A

aspirin

pts with aspirin hypersensitivity should not take these drugs

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21
Q

common indications for azathioprine (3)

A
  1. maintainance of remission of Crohns and UC
  2. DMARD in RA and autoimmune conditions
  3. prevent organ rejection in transplant recipients
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22
Q

what is the main metabolite of azathioprine and its MOA?

A

6-mercaptopurine

(inhibit synthesis of purines therfoer inhibiting DNA and RNA replication)

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23
Q

which enzymes are involved in the metabolism and elimination of azathioprine (2)?

A

xanthine oxidase

thiopurine methyltransferase (TPMT)

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24
Q

adverse effects of azathioprine (4)?

A

nausea (common)

hypersensitivity (D&V, rash, fever, myalgia)

bone marrow suppression (v serious)

hepatotoxicity/ inc tumour risk i.e. lymphoma (rare but serious)

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25
Q

what test should be performed before starting azathioprine therapy?

A

TPMT phenotyping

those with absent TPMT activity should not recieve prescription (those w low activity should only be treated by specialist)

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26
Q

dosage of azathioprine should be reduced in what circumstances (2)?

A

hepatic and renal impairment

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27
Q

is azathiprine safe in pregnancy?

A

unclear- shoul dnot be initiated in pregnancy but can be continued in those already established on Tx where benefits outweigh risk

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28
Q

is azathioprine safe to be coprescribed with allopurinol?

A

No- reduce metabolism of azathioprine and inc risk of toxicity

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29
Q

how is azathiorpine administered?

A

oral (preferred) and IV (should be diluted and given as infusion)

30
Q

pts taking azathioprine should seek urgent medical advice if the develop the following (3)?

A

sore throat/fever (infection)

bruising/bleeding (low platelet count)

D&V/abdo pain (hypersensitivity)

31
Q

how should azathiorpine be monitored?

A

FBC weekly for first 4 weeks and 3 monthly thereafter

32
Q

common indications for calcium and vitamin D (5)?

A
  1. osteoporosis
  2. chronic kidney disease
  3. severe hyperkalaemia (calcium)
  4. hypocalcaemia
  5. vitamin D deficiency (rickets and osteomalacia)
33
Q

why does the body require calcium?

A

essential for normal function of muscle, nerves, bone and clotting

34
Q

how is calcium homeostasis managed?

A

parathyroid hormone and vitamin D

35
Q

calcium and vitamin D should be avoided under which circumstances?

A

hypercalcaemia

36
Q

oral calcium reduces the absorption of which drugs (4)?

A

iron

biphosphonates

tetracyclines

levothyroxine

37
Q

Calcium administered IV should never be allowed to mix with what other substance?

A

sodium bicarbonate- risk of precipitation

38
Q

how should pts with severe hyperkalaemia be monitored after admin of calcium gluconate?

A

12 lead ECG

39
Q

what dose of calcium gluconate should be given as first line treatment in hyperkalaemia?

A

10mL calcium gluconate 10% IV over 5-10 mins

40
Q

common indications for methotrexate (3)

A
  1. disease modifying for RA
  2. chemotherapy adjuvant
  3. severe psoriasis (inc. psoriatic arthritis)
41
Q

MOA of methotrexate?

A

inhibits dihydrofolate reductase

has an antinflammatory and immunosuppressive effect

42
Q

adverse effects of methotrexate (3)

A

mucosal damage (sore mouth, GI upset)

bone marrow suppression (neutropenia, inc risk of infection)

hepatic cirrhosis/ pulmonary fibrosis (long term effects)

43
Q

is methotrexate safe in pregnancy?

A

No- teratogenic

men and women should use effective contraception for 3 months after stopping treatment

44
Q

methotrexate is contraindicated in what condition?

A

severe renal impairment

should also be avoided in those with abnormal liver function

45
Q

how often is methotrexate prescribed?

A

once weekly

46
Q

what should be emphasised when explaining methrotrexate to the patient?

A

only taken once a week not daily

to seek urgent medical advice if they develop a sore throat/fever

47
Q

how should methotrexate be monitored?

A

monitor symptoms- examine sore joints

blood tests for inflammatory markers

FBC, liver and renal function prior to Tx and 1-2 times weekly until established

2-3 times monthly thereafter

48
Q

role of F1 in methrotrexate prescribing?

A

should NOT initiate prescription

may review and continue but always seek senior advice

49
Q

examples of NSAIDs (3)?

A

naproxen

ibuprofen

etoricoxib

50
Q

common indications for NSAIDs (2)

A
  1. ‘as needed’ for mild-moderate pain
  2. treat regular pain related to inflammation e.g RA
51
Q

MOA of NSAIDs?

A

inhibit prostaglandin synthesis from arachidonic acid by inhibiting COX

52
Q

adverse effects of NSAIDs (3)?

A

GI toxicity

renal impairment

inc risk of cardio event i.e MI/stroke

53
Q

NSAIDs should be avoided under which circumstances (4)?

A

severe renal impairment

heart failure

liver failure

NSAID hypersensitivity

54
Q

how long for NSAIDs before full antiinflammatory effect is seen?

A

3 weeks

55
Q

to minimise GI upset how should NSAIDs be taken?

A

with or after food

56
Q

how should NSAIDs be monitored?

A

assess symptoms

Biochemical if existing renal impairment

57
Q

what should be considered as being coprescribed with NSAIDs paerticularly in those >65yrs ?

A

gastroprotection i.e PPI such as lansoprazole daily

58
Q

common indications for paracetamol (2)?

A
  1. first line analgesic of acute and chronic pain
  2. antipyretic that can reduce fever
59
Q

MOA of paracetamol?

A

poorly understood

weak inhibitor of COX/ weak antiinflammatory

60
Q

paracetamol overdose causes what?

A

liver failure

61
Q

in paracetamol overdose which toxic metabolite accumulates?

what does this result in?

A

NAPQI

(N-acetyl-p-benzopuinone imine)

hepatocellular necrosis

62
Q

paracetamol dosing should be reduced in which pt groups (3)?

A

those w inc risk of liver toxicity (excess alcohol use)

reduced glutathione stores (malnutrition/low body weight (<50kg))

severe hepatic impairment

63
Q

what is prescribed to combat paracetamol overdose?

A

acetylcysteine

64
Q

when prescribing paracetmol what is important to check on the pts chart?

A

co-drugs such as co-codamol with ‘hidden’ paracetamol

65
Q

common indications for quinine (2)?

A
  1. night-time leg cramps
  2. plasmodium falciparum malaria
66
Q

adverse effects of quinine?

A

usually safe at recommended doses however potentially v toxic and fatal in overdose

tinnitus, deafness, blindness

GI upset

hypersensitivity reactions

hypoglycaemia

67
Q

what effect does quinine have on the hearts rythym?

A

prolongs the QT interval and can predispose to arrythmias

68
Q

quinines should be prescribed with caution in which pt groups?

A

those with hearing or visual loss

G6PD deficiency

pts takign drugs that prolong the QT interval (i.e amiodarone, antipsychotics, quinolones)

pregnancy

69
Q

how should quinine be monitored?

A

after 4 weeks if no improvement in leg cramps stop prescription as unlikely to see any benefit

advise patient to report any hearing loss/ visual disturbance/ palpitations immediately

70
Q

before starting quinine for nocturnal leg cramps what should be considered first (2)?

A

reversible causes- electrolyte disturbances / drug causes (statins)

non pharmacological management i.e passive stretching exercises

Top 100 Drugs (13 decks)

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