Pharmacology: MSK Drugs

Question 1

What is the mechanism of action of most NSAIDs?

Answer 1

Act as nonselective inhibitors of the cyclooxygenase (COX) enzymes

Question 2

What is the mechanism of action of toclizumab?

Answer 2

Inhibits IL-6

Question 3

What is the mechanism of action of oral bisphonates?

Answer 3

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

Question 4

What is the mechanism of action of teriparatide?

Answer 4

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

Question 5

Why is certolizumab safe throughout pregnancy/breastfeeding?

Answer 5

Unable to cross the placental barrier due to its pergolated component

Question 6

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

Answer 6

Corticosteriods

Question 7

What is the mechanism of action of zoledronic acid?

Answer 7

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

Question 8

What is the mechainsm of action of febuxostat?

Answer 8

Xanthine oxidase inhibitor

Question 9

What is the mechanism of action of methotrexate?

Answer 9

Folate antagonist, mode of action unknown

Question 10

Name a contraindication of NSAIDs

Answer 10

Peptic ulcer disease

Question 11

What are the main indications for oral bisphonates?

Answer 11

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

Question 12

What is the main contraindication for romosozumab?

Answer 12

Previous MI/CVA

Question 13

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

Answer 13

It is teratogenic

Question 14

What is the mechanism of action of romosozumab?

Answer 14

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

Question 15

What is the main indication of febuxostat?

Answer 15

Gout prophylaxis when allopurinol not tolerated/contraindicated

Question 16

What is the main indication for zoledronic acid?

Answer 16

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

Question 17

What is the main indication for desonumab?

Answer 17

Another second line alternative to oral bisphonates in patients with osteoporosis

Question 18

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

Answer 18

It is teratogenic

Question 19

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

Answer 19

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

Question 20

What is leflunomide?

Answer 20

Second line DMARD with a similar efficacy to methotrexate

Question 21

What is the main indication of teriparatide?

Answer 21

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

Question 22

Name three side effects of desonumab

Answer 22

Hypocalcaemia

Eczema

Cellulitis

Question 23

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

Answer 23

Inflammatory arthritis

Question 24

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

Answer 24

Methotrexate

Question 25

Name a common cutaneous side effect of allopurinol and febuxostat

Answer 25

Rash (vasculitis)

Question 26

What is the mechanism of action of desonumab?

Answer 26

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

Question 27

What is the mechanism of action of allopurinol?

Answer 27

Xanthine oxidase inhibitor

Question 28

What is the mechanism of action of tofacitinib/baricitinib?

Answer 28

Janus kinase inhibitors

Question 29

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

Answer 29

Can cause leukopenia, thrombocytopenia, hepatitis and cirrhosis

Question 30

What is the mechanism of action of rituximab?

Answer 30

Monoclonal antibody against B (CD20) lymphocytes

Question 31

What are the main indications for hydroxycholoroquine?

Answer 31

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)

Question 32

Name a contraindication of allopurinol

Answer 32

Renal impairment

Question 33

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

Answer 33

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

Question 34

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

Answer 34

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

Question 35

What is the main indication of allopurinol?

Answer 35

Gout prophylaxis (first line)

Question 36

What is the mechanism of action of abatacept?

Answer 36

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

Question 37

Why do patients on hydroxychloroquine require annual optometry checkups?

Answer 37

Risk of retinopathy

Question 38

What is the mechanism of action of secukinimab?

Answer 38

Inhibits IL-17

Question 39

Name a contraindication of febuxostat

Answer 39

Ischaemic heart disease

Question 40

What is the main indication of romosozumab?

Answer 40

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

Question 41

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

Answer 41

Folic acid

Question 42

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

Answer 42

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

Question 43

What is sulfasalazine?

Answer 43

DMARD often used in combination with methotrexate in early inflammatory arthritis

Question 44

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

Answer 44

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

Question 45

Name the only anti-TNF licensed in pregnancy/breastfeeding

Answer 45

Certolizumab

Question 46

Name an affect sulfasalazine can have on fertility

Answer 46

(Reversible) oligozoospermia