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Pre Reg > Muskuloskeletal > Flashcards

Muskuloskeletal Flashcards

1
Q

What are the symptoms of rheumatoid arthiritis?

A

Swollen, hot, stiff and motionless joints

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2
Q

What are the risks of DMARDs

A

Blood dyscrasia
- high risk of infections

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3
Q

Which DMARD causes orange tears and urine?

A

Sulfasalazine

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4
Q

What are the risks of cyclophosphamide?

A

Haemorrhagic cystitis and permanent male sterility

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5
Q

What are the risks of leflunomide?

A

Hepatotoxicity
Effective contraception after treatment - men for 3 months and women for 2 years

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6
Q

What are the risks of chloroquine?

A

Retinopathy - screen for ocular toxicity

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7
Q

What is the treatment pathway for arthiritis?

A

1st line: conventional DMARD
- oral methotrexate, lefluonmide, sulfasalazine

2nd line: combination of 2 conventional DMARDs

3rd line: cytokine modulators

DMARDs can take 2-3 months to reduce inflammation therefore, corticosteroids (or sometimes NSAIDs) can be used for this short-term and during flare-ups

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8
Q

How do you treat severe active RA?

A

methotrexate + rituximab

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9
Q

How is methotrexate taken for autoimmune conditions?

A

Once weekly on a specific day

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10
Q

What are the MHRA warnings for methotrexate?

A

overdose of methotrexate for non-cancer treatments
- only one strength tablet is prescribed
- decide on a day of the week to take

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11
Q

What is the missed dose advise for methotrexate?

A

If the missed dose is >3 days = continue with next schedule dose

If day or two later - take as soon as they remember

If vomit within a few hours of taking - do NOT take a second dose

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12
Q

What if the purpose of prescribing folic acid with methotreaxte?

A

Help reduce anti-folate side effects of methotrexate e.g. mucositis and may also prevent hepatotoxicity

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13
Q

When should folic acid be taken?

A

DO NOT take on the same day as methotrexate because it will reduce the therapeutic effects of methotrexate and antagonise it

Possible regimens:
- 5mg once weekly, different day to methotrexate
- 1 or 5mg daily except on the day methotrexate is taken

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14
Q

What are the side effects of methotrexate?

A
  • Immunosuppression - can occur if take daily instead of weekly
  • Blood disorders e.g. neutropenia and low red blood cells which can lead to anaemia and thrombocytopenia
    (low white blood cell weakens immune system = increases risk of infections)
  • Nephrotoxicity (monitor renal function)
  • Hepatotoxicity: monitor LFTs, report liver disorders
    C/I ascites
  • Pulmonary toxicity: report respiratory effects
    C/I significant pleural effusion
  • GI toxicity: stop if stomatitis or diarrhoea
  • Phototoxicity: sunburns and blisters
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15
Q

What are the contraindications of methotrexate?

A

Active infections
Immunodeficiency syndromes e.g. HIV

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16
Q

What counselling do you need to provide to a patient taking methotreaxte?

A

Fever
Sore throat
Mouth ulcers
Bruising
Bleeding

17
Q

What can be used for acute methotrexate toxicity?

A

Folinic acid

Also prevents immunosuppression especially when used to treat cancer with high doses

18
Q

How long after methotrexate must contraception continue?

A

6 months - men and women
- may be present in breastmilk, do not breastfeed

19
Q

What drugs interact with methotrexate?

A

Blood disorder:
- Trimethoprim - both are anti-folate drugs and can cause bone marrow suppression = blood disorders
- Clozapine
- Phenytoin (anti-folate)
- Cytotoxic
- Immunosuppressants

Reduced renal clearance = methotrexate toxicity:
- NSAIDs (both nephrotoxic): avoid taking at the same time
- Penicillins
- PPI

Nephrotoxicity
- aminoglycosides
- Cephalosporin
- Ciclosporin
- Tacrolimus
- NSAIDs

Hepatotoxicity
- co-amoxiclav
- fluclox
- tetracyclines
- carbamazepine
- valporate
- fluconazole
- isoniazid
- sulfasalazine

20
Q

What are the symptoms of oesteoarthiritis?

A

Stiff motionless joints
- usually weight-bearing joints

21
Q

What is the treatment for oesteoarthiritis?

A

1st line: topical NSAID
- Oral NSAID
- Paracetamol or weak opioid

22
Q

What are the symptoms of gout?

A

Sudden severe intense joint pain, swelling and purple-red shiny skin

Over time with frequent and severe attacks - tophi can form

23
Q

Which drugs worsen or exacerbate gout?

A

Loop and thiazide diuretics

Cytotoxic drugs

Ciclosporin and tacrolimus

24
Q

How is an acute gout attack treated?

A

NSAIDs - not aspirin

Colchicine - max dose 500mcg BD-QDS
- no repeat course in 3 days

Oral corticosteroid

25
Q

How is the prevention of gout treated?

A

1st line allopurinol
Or
Febuxostat

Never start during attack
Can trigger an acute gout attack when started

If gout attack occurs during prevention - continue as normal and treat gout attack separately

26
Q

What are the MHRA warnings for febuxostat

A

Hypersensitivity reactions - anaphylaxis or steven-johnsons syndrome

Cardiovascular disease

27
Q

How is allopurinol taken?

A

With or just after food

28
Q

What are the side effects of allopurinol?

A

Rash - stop if mild and reintroduce slowly
- stop if reoccurs

29
Q

What are the interactions of allopurinol?

A

Azathioprine and mercaptopurine toxicity = reduce doses of these by 25-50%

Hypersensitivity with ACEi

Skin rash - penicillins

30
Q

What is the uses of quinine?

A

Antimalarial drug

Nocturnal leg cramps
- only use for this if regular sleep disturbances
- failed non-pharmacological treatments
- frequent or very painful

31
Q

What are the side effects of quinine?

A

Toxic in overdose
- convulsions, arrhythmias

Blindness, tinnitus
- C/I: tinnitus and optic neuritis

QT prolongation
- conduction abnormalities
- risk factors = hypokalaemia

32
Q

What is baclofen used for?

A

Chronic severe spasticity e.g. in multiple sclerosis
- in palliative care

33
Q

What is the side effects of baclofen?

A

Drowsiness
Muscular hypotonia
Avoid abrupt withdrawal - withdrawal symptoms

34
Q

What are the side effects of NSAIDs?

A

Asthma and dyspnoea

NSAID hypersensitivity
- asthma attack, urticaria, rhinitis

Photosensitivity - topical

Nephrotoxicity - can cause AKI

Odema

Hypertension

Bleeding

Hyperkalaemia

35
Q

Which NSAIDs cannot be given in any history of GI ulcer or bleeding even if it wasnt cause by an NSAID?

A

Ketoprofen
Ketorolac
Piroxicam

These have the highest risk of GI toxicity

36
Q

What drugs interact with NSAIDs?

A

Nephtotoxicity
- aminoglycosides
- cephlosporin
- glycopeptide
- ciclosporin and tacrolimus
- methotrexate

Renal clearance = toxicity
- lithium
- methotrexate

Bleeding
- alcohol
- anticoagulants
- warfarin
- corticosteroids
- SSRI
- venlafaxine

Hyperkalaemia
- ACEi/ ARB
- ciclosporin and tacrolimus
- heparin
- potassium-sparing diuretics
- trimethoprim

Seizures
- quinolones

Pre Reg (14 decks)

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