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CPT - Other Drugs > Musculoskeletal System > Flashcards

Musculoskeletal System Flashcards

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1
Q

Give 5 examples of NSAIDs

A
  • Celecoxib
  • Diclofenac
  • Etoricoxib
  • Ibuprofen
    (* Aspirin at low dose)
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2
Q

Order the NSAIDs in order of COX-1 selectivity to COX-2 selectivity.

A

Aspirin (low dose), ibuprofen, naproxen, diclofenac, celecoxib, etoricoxib

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3
Q

What happens when you inhibit COX enzymes?

A

Reduce prostaglandin, prostacyclin and thromboxane synthesis

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4
Q

How are NSAIDS useful as analgesics?

A

Less prostaglandin synthesis, less NT release, so less excitability of neurones in pain relay pathway

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5
Q

How are NSAIDs useful as anti-inflammatory agents?

A

Reduced prostaglandin production at site of injury, so reduced vasodilation and oedema - symptomatic relief

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6
Q

How are NSAIDs useful as antipyretics?

A

Prostaglandin usually stimulates pyrogens (cytokines) by acting on the thermoregulatory centre of the hypothalamus - so NSAIDs reduce temp

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7
Q

What are the GI considerations of NSAIDs (ADRs and DDIs)?

A
  • Dyspepsia, nausea, peptic ulceration, bleeding and perforation, can make IBD worse
  • DDIs - aspirin, glucocorticoid steroids and anticoagulants due to bleeding risks (give with PPI)
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8
Q

Who are NSAIDs contraindicated/cautioned in?

A
  • Elderly
  • Prolonged users
  • Smokers
  • Alcohol drinkers
  • Hx of PUD
  • H. pylori
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9
Q

What are the renal considerations of NSAIDs (ADRs, DDIs and contraindications)?

A
  • Lead to reversible reduced GFR and renal blood flow, NSAIDs inhibit prostaglandins inhibition of sodium absorption in the CD - so increased sodium absorption
  • ACEi, ARBs and diuretics
  • Those with CKD or heart failure
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10
Q

What is the advantage of selective COX-2 inhibitors? What is the disadvantage?

A

Less GI ADRs

No anti platelet action, but inhibit PGI2 so could get unopposed platelet aggregation

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11
Q

What is a consideration that is caused by all NSAIDs?

A

All NSAIDs increase the risk of MI in low risk people, due to the fine balance between being cytoprotective (prostacyclin) and cytotoxic (thromboxane) on CVS

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12
Q

What are some indications for NSAIDs?

A
  • Inflammatory joint and soft tissue conditions
  • Osteoarthritis (topical NSAID or paracetamol tried first though
  • Postop pain
  • Mennorrhagia

Use lowest effective dose for shortest time necessary, taking into account patient’s risk factors

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13
Q

Give two examples of anticholinesterase drugs.

A
  • Neostigmine

* Pyridostigmine

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14
Q

What drug is methotrexate - what is it used for, what does it do?

A
  • Used in malignancy or RA

* In RA - indirectly suppresses adhesion molecules on T-cells and neutrophils

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15
Q

What are the ADRs for methotrexate?

A
  • Mucositis
  • Myelosuppression
    ^ both get better with folic acid supplements
  • hepatitis, cirrhosis
  • pneumonitis
  • increased infection risk
  • teratogenic and abortifacient
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16
Q

What drugs are mesalazine and sulfasalazine - what are they used for, what do they do?

A
  • RA (DMARDs)
  • 5-ASA donors - anti-inflammatory and fight infection and inhibit T cell proliferation and reduce neutrophil chemotaxis and degranulation
17
Q

What are the ADRs of sulfasalazine?

A
  • Myelosuppression
  • Hepatitis
  • Rash
  • Nausea and vomiting
  • Abdominal pain

Safe in pregnancy

18
Q

What are infliximab and adalimumab - what are they used for, what do they do?

A
  • RA

* TNF-alpha inhibitors (monoclonal antibodies) - reduce inflammation, angiogenesis and joint destruction

19
Q

What are the ADRs of TNF-alpha inhibitors?

A

There is a risk of TB reactivation if the patient has latent TB as TNF-alpha is released by macrophages and maintains granulomas in TB - so screen for latent TB before starting on these drugs

20
Q

What is Rituximab - what is it used for, what does it do?

A
  • RA

* Causes B cell apoptosis by binding to CD20 B cells

21
Q

What is hydroxychloroquine - what is it used for, what does it do?

A
  • RA

* A DMARD that increases the pH inside macrophage lysosomes

CPT - Other Drugs (11 decks)

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