Musculoskeletal system -Non-steroidal anti-inflammatory drugs Flashcards
1
Q
Musculoskeletal system
Non-steroidal anti-inflammatory drugs
Common indications
A
- As needed’ treatment of mild-to-moderate pain (e.g. dysmenorrhoea, dental pain) as an alternative to or in addition to paracetamol.
- Regular treatment for pain related to inflammation, particularly of the musculoskeletal system
2
Q
Musculoskeletal system
Non-steroidal anti-inflammatory drugs
MAO
A
- inhibit synthesis of prostaglandins from arachidonic acid by inhibiting cyclooxygenase (COX). COX exists as two main isoforms. COX-1 is the constitutive form
- COX-1 stimulates prostaglandin synthesis, and inhibit thrombus formation at the vascular endothelium.
- COX-2 stimulates production of prostaglandins that cause inflammation and pain
- COX-2 inhibitors (e.g. etoricoxib) were developed in an attempt to reduce the adverse effects of NSAIDs
3
Q
Musculoskeletal system
Non-steroidal anti-inflammatory drugs
Important adverse effects
A
- gastrointestinal (GI) toxicity, renal impairment and increased risk of cardiovascular (CV) events (e.g. myocardial infarction and stroke)
- All NSAIDs including COX-2 inhibitors can cause renal impairment
- bronchospasm and angioedema, and fluid retention, which can worsen hypertension and heart failure
4
Q
Musculoskeletal system
Non-steroidal anti-inflammatory drugs
Warnings
A
- Avoid NSAIDs in severe renal impairment, heart failure, liver failure and known NSAID hypersensitivity.
- If NSAID use is unavoidable in patients at high risk of adverse effects (e.g. prior peptic ulcer disease or GI bleeding, cardiovascular disease, renal impairment), use the safest NSAID at the lowest effective dose for the shortest possible time
5
Q
Musculoskeletal system
Quinine
Common indications
A
- used for the treatment and prevention of night-time leg cramps
- Quinine is a first-line treatment option for Plasmodium falciparum malaria
6
Q
Musculoskeletal system
Quinine
Mechanisms of action
A
- act by reducing the excitability of the motor end plate in response to acetylcholine stimulation.This reduces the frequency of muscle contraction
- overall effect leads to rapid killing of P. falciparum parasites in the schizont stage in the blood
7
Q
Musculoskeletal system
Quinine
Important adverse effects
A
- Potentially very toxic and can be fatal in overdose. It can cause tinnitus, deafness and blindness (which may be permanent), gastrointestinal upset, and hypersensitivity reactions.
- Quinine prolongs the QT interval, and may therefore predispose to arrhythmias.
- Hypoglycaemia can occur and can be particularly problematic in patients with malaria, which also predisposes to hypoglycaemia
