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MBChB YR2 MSK > Pharmacology: MSK Drugs > Flashcards

Pharmacology: MSK Drugs Flashcards

1
Q

What is the mechanism of action of most NSAIDs?

A

Act as nonselective inhibitors of the cyclooxygenase (COX) enzymes

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2
Q

What is the mechanism of action of toclizumab?

A

Inhibits IL-6

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3
Q

What is the mechanism of action of oral bisphonates?

A

Analogues of pyrophosphate that absorb onto bone within the matrix; ingested by osteoclasts leading to cell death thereby inhibiting bone resorption

Prevent bone loss at all sites vunerable to osteoporosis

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4
Q

What is the mechanism of action of teriparatide?

A

Recombinant parathyroid hormone; stimulates bone growth rather than reduces bone loss (anabolic)

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5
Q

Why is certolizumab safe throughout pregnancy/breastfeeding?

A

Unable to cross the placental barrier due to its pergolated component

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6
Q

Weight gain, skin atrophy and osteoporosis are side affects of which medication used in the management of vasculitis?

A

Corticosteriods

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7
Q

What is the mechanism of action of zoledronic acid?

A

IV bisphosphate - analogues of pyrophosphate that absorb onto bone within the matrix; ingested by osteoclasts leading to cell death thereby inhibiting bone resorption

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8
Q

What is the mechainsm of action of febuxostat?

A

Xanthine oxidase inhibitor

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9
Q

What is the mechanism of action of methotrexate?

A

Folate antagonist, mode of action unknown

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10
Q

Name a contraindication of NSAIDs

A

Peptic ulcer disease

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11
Q

What are the main indications for oral bisphonates?

A

First line in majority of patients with osteoporosis

  • Consider treatment with when T score = -2.5
  • If ongoing steroid requirement >/= 7.5mg prednisolone for 3 months or more or if there is a prevalent vertebral fracture, consider treatment with T score < 1.5

Paget’s disease of bone

May have some benefit in patients with osteogenesis imperfecta in teenage years

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12
Q

What is the main contraindication for romosozumab?

A

Previous MI/CVA

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13
Q

Why must leflunomide be stopped in females at least 3 months before conception?

A

It is teratogenic

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14
Q

What is the mechanism of action of romosozumab?

A

Monoclonal antibody that binds to and inhibits sclerostin (sclerostin inhibits bone formation) to increase bone formation and reduce bone resorption

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15
Q

What is the main indication of febuxostat?

A

Gout prophylaxis when allopurinol not tolerated/contraindicated

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16
Q

What is the main indication for zoledronic acid?

A

Second line for majority of patients with osteoporosis e.g. patients with side effects with oral bisphonates

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17
Q

What is the main indication for desonumab?

A

Another second line alternative to oral bisphonates in patients with osteoporosis

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18
Q

Why must methotrexate be stopped in females at least 3 months before conception?

A

It is teratogenic

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19
Q

When would anti-TNF therapy be indicated in RA, psoriatic arthritis and ankylosing spondylitis?

A

After a failure of 2 DMARDs or in ankylosing spondylitis 2 NSAIDs

20
Q

What is leflunomide?

A

Second line DMARD with a similar efficacy to methotrexate

21
Q

What is the main indication of teriparatide?

A

Recommended over oral bisphosphate in postmenopausal women with at least 2 moderate or 1 severe low trauma vertebral fracture to prevent vertebral fracture

22
Q

Name three side effects of desonumab

A

Hypocalcaemia

Eczema

Cellulitis

23
Q

NSAIDs are indicated in the management of which type of arthritis?

A

Inflammatory arthritis

24
Q

What is the first line DMARD for use in RA, psoriatic arthritis, connective tissue disease, and vasculitis?

A

Methotrexate

25
Q

Name a common cutaneous side effect of allopurinol and febuxostat

A

Rash (vasculitis)

26
Q

What is the mechanism of action of desonumab?

A

Monoclonal antibody which reduces osteoclast activity

Binding to RANKL (receptor activator of nuclear factor-kB ligand) prevents the activation of RANK which inhibits development and activity of osteoclasts, decreasing bone resorption and increasing bone density

27
Q

What is the mechanism of action of allopurinol?

A

Xanthine oxidase inhibitor

28
Q

What is the mechanism of action of tofacitinib/baricitinib?

A

Janus kinase inhibitors

29
Q

Why should FBC + LFTs be monitored in a patient taking methotrexate/leflunomide/sulfasalazine?

A

Can cause leukopenia, thrombocytopenia, hepatitis and cirrhosis

30
Q

What is the mechanism of action of rituximab?

A

Monoclonal antibody against B (CD20) lymphocytes

31
Q

What are the main indications for hydroxycholoroquine?

A

Used in connective tissue diseases - SLE, Sjogren’s syndrome

Can decrease malaise and myalgia in patients with inflammatory arthritis when taken alongside methotrexate (but no effect on joint damage)

32
Q

Name a contraindication of allopurinol

A

Renal impairment

33
Q

Anti-TNF therapy and other biologics increase the risk of infection (especially ___) and may increase risk of malignancy (especially ____ _____)

A

Anti-TNF therapy increases the risk of infection (especially TB) and may increase risk of malignancy (especially skin cancer)

34
Q

Why should a prophylactic NSAID or colchicine be prescribed for at least 6 months after starting a xanthine oxidase inhibitor for gout prophylaxis?

A

Rapid reduction in uric acid level may result in further exacerbation of gout

35
Q

What is the main indication of allopurinol?

A

Gout prophylaxis (first line)

36
Q

What is the mechanism of action of abatacept?

A

CTLA-4 Ig - biologic which blocks full activation of T lymphocytes

37
Q

Why do patients on hydroxychloroquine require annual optometry checkups?

A

Risk of retinopathy

38
Q

What is the mechanism of action of secukinimab?

A

Inhibits IL-17

39
Q

Name a contraindication of febuxostat

A

Ischaemic heart disease

40
Q

What is the main indication of romosozumab?

A

Recommended for postmenopausal women with severe osteoporosis who have had a fragility fracture and are at imminent risk of further fracture (24 months)

41
Q

What can be prescribed with methotrexate to reduce some of its adverse affects?

A

Folic acid

42
Q

Name a side effect of zoledronic acid which occurs in 1/3 patients

A

1/3 acute phase reaction with first infusion - manage with paracetamol

43
Q

What is sulfasalazine?

A

DMARD often used in combination with methotrexate in early inflammatory arthritis

44
Q

Why are oral bisphonates only prescribed for 5-10 years?

A

To reduce risk of (rare) long-term side effects associated with duration of use: osteonecrosis of the jaw, oesophageal carcinoma, atypical fractures

45
Q

Name the only anti-TNF licensed in pregnancy/breastfeeding

A

Certolizumab

46
Q

Name an affect sulfasalazine can have on fertility

A

(Reversible) oligozoospermia

MBChB YR2 MSK (36 decks)

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