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Psych-Neuro-Msk Flashcards

1
Q

Acute Agitation

in Delirium DOC

A

Antipsychotic Risperidone or Haloperidol

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2
Q

Acute Agitation

in Dementia DOC

A

Very low dose of Risperidone

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3
Q

Acute Agitation

in Brain Injury DOC

A

Propranolol

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4
Q

Acute Agitation

in DLB DOC

A

Memantine or Anticholinestrase

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5
Q

Acute Agitation

in Psychosis DOC

A

Antipsychotic +|- Lorazepam

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6
Q

Acute Agitation

in Mania DOC

A

Antipsychotic +|- Lorazepam +|- Mood stabilizer

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7
Q

IM Olanzapine Caution

A

Do not use it with parenteral BZPs

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8
Q

Acute Agitation

if Situational Or if caused by drug abuse DOC

A

Both:

Haloperidol 5 mg Oral or IM

+ Lorazepam 2 mg Oral or IM

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9
Q

ADHD Treatment

in below 6 yo

A

Only nonpharma,

no Medications +Behavioral therapy

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10
Q

ADHD

1st line tx: Stimulants Or……..

A

Atomoxetine (NE Reuptake inhibitor)

(If no response or intolerance to stimulants)

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11
Q

ADHD

Two medications with no potential for abuse

A

Atomoxetine

Guanfacin (Alpha 2 Agonist)

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12
Q

ADHD

How to prescribe Methylphenidate SR?

A

Trial for 3-4 w

Then continue for 6-12 months

Then 1-2 months holiday and reassess

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13
Q

ADHD

Wen do you prescribe Alpha 2 agonists?

Guanfacin, Clonidin

A

Both: More effective on hyperactivity and impulsivity

G: less SEs

C: if Tic disorder coexists

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14
Q

Panic disorder DOC

A

SSRI or SNRI

+|- Clonazepam (maximum 6-8 w)

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15
Q

Agoraphobia DOC

A

SSRI or SNRI

+|- CBT

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16
Q

Social Anxiety Disorder

1st line: SSRI or SNRI

2nd line: ………..

A

Moclobemide (MAOI-A, reversible)

Caution: Avoid with SSRI or TCA or Meperidine

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17
Q

Specific Phobia DOC

A

No medication:

Only CBT

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18
Q

GAD 1st line: SSRI or SNRI

If no response or intolerant, then ……….

A

Pregabalin

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19
Q

Anxiety or Mood Disorders

Best SSRIs if Breastfeeding (2)

A

Paroxetine

Sertraline

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20
Q

Smoking Cessation 5”A”s

A

Ask

Advise

Assess

Assist

Arrange

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21
Q

Smoking Cessation: Nonpharma

  1. Pick a Date
  2. Asking for Help
  3. Social support

4,5,6 ?

A

Medications

Counselling

+|- CBT 8-24 W

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22
Q

Smoking Cessation: In Pregnancy

A

Preferably no medications

If not, either Gums or Bupropion

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23
Q

BMD

Acute Episode of Mania DOC

A

Risperidone +|- Li

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24
Q

BMD Episodes of Depression:

1st line

…………. or ……………. or …………..

A

Li or Lamotrigine or Li + Bupropion

(avoid monotherapy with antidepressants)

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25
Q

BMD

Li Monitoring:

  1. Thyroid
  2. Renal function

3,4 ?

A

Electrolytes

24h urine and Clearance of Cr

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26
Q

BMD

Li Overdose signs/symptoms (5)

1,2 Ataxia Tremor

3,4 Diarrhea Vomiting

5,6 ?

A

Sedation/Agitation

Seizures

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27
Q

BMD

Valproate SEs (5)

  1. Teratogenic
  2. Wt gain
  3. Hepatotoxic

4,5 ?

A

Thrombocytopenia

PCOS

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28
Q

BMD

Li SEs (6)

1,2 DI, Hypothyroidism

3,4 Tremor, GI

5,6 ?

A

Wt gain

Impotence

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29
Q

BMD

Li drug interactions

A

Caution with:

Thiazides (Important), NSAIDs, ACEIs, ARBs,

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30
Q

BMD

If cognitive impairment with Li

A

Decrease dosage

Or use SR form of Li

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31
Q

OCD

1st line tx

A

1st. SSRI + CBT
2nd. SNRI + CBT

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32
Q

Anorexia Nervosa

1st line tx

A

Prokinetics:

Domperidone (best)

Metoclopramide

Erythromycin

Prucalopride (new)

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33
Q

Anorexia Nervosa

Adjunctive treatments

  1. Zinc Gluconate
  2. Olanzapine

3,4 ?

A

Thiamine

Cyproheptadine

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34
Q

Bulimia Nervosa: DOC

A

SSRI + CBT (Usually: Fluoxetine)

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35
Q

PTSD Tx

within first month after trauma

A

Avoid BZPs

Avoid Antidepressants

+ Trauma-focused psychotherapy

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36
Q

PTSD

1st line tx

A

SSRI or Venlafaxine

+|- augmentation with Risperidone

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37
Q

PTSD

Why should we avoid monotherapy with BZPs?

A

Abuse, Disinhibition

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38
Q

PTSD

If associated with insomnia DOC

A

Trazodone Or Perazosin

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39
Q

Insomnia 1st line

A

Temazepam 15 mg QHS

or Oxazepam 10-15 mg QHS

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40
Q

Insomnia

Best Agonist of BZPs

A

Zopiclone 3.75 mg QHS

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41
Q

Insomnia

In Pregnancy

A

BZP ~ ok

Zopiclone ~ ok

Zolpidem: No

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42
Q

Dementia Alzheimer’s: 1st line

A

Anti cholinestrase Inhibitors

Donepezil Or Rivastigmine Or Galantamine

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43
Q

Dementia Alzheimer’s: 2nd line

A

NMDA Antagonists Memantine (Ebixa)

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44
Q

Dementia Alzheimer’s:

Anticholonestrase inhibitors SEs

1,2 GI intolerance, PUD or GI Bleeding

3,4 ?

A

Seizures

Worsening of Asthma or COPD

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45
Q

Dementia Alzheimer’s:

Most commonly prescribed drug is…….

A

Donepezil (In all stages of Alzheimer’s)

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46
Q

Dementia

DOC in Lewy Body Dementia

A

Rivastigmine

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47
Q

Dementia Caution in DLB

A

Never prescribe antipsychotics because of

AP Sensitivity Sd:

Irreversible Parkinsonism or Autonomic Disorders or Confusion

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48
Q

RBD in Dementia (Responsive Behaviors in Dementia)

If antidepressant: SSRI

If antipsychotic: very low dose

If movement disorders: …….

A

Quetiapine (Does not cause EPS or movement Disorders)

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49
Q

RBD in Dementia (Responsive Behaviors in Dementia)

If Agitated Or Sundowning Or Insomniac

A

Best: Trazodone

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50
Q

Depression Three antidepressants with lowest Sx SEs

  1. Bupropion 2…….. 3……..
A

Mirtazapine

Moclobemide

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51
Q

Depression

Antidepressants discontinuation Sd is more common with Short half lives like ………

A

Venlafaxine

Paroxetine

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52
Q

Depression

To avoid Antidepressants discontinuation Sd :

A

Decrease 25% dosage per week

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53
Q

Depression

Moclobemide is a 1st line tx

Serotonin Sd?

HTN Crisis?

A

S: yes, with SSRIs or TCAs or Meperidine

H: No

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54
Q

Depression

Three indications for referral

  1. Suicidal 2. …….. 3………
A

Psychotic Features

3 times failure

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55
Q

Depression

Antidepressants in Pregnancy

A

SSRI is ok

But preferably not in 3rd trimester

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56
Q

Depression

Examples of Augmentation tx

Li, T3, Atypical AP, Modafinil, Ritaline, ……….

A

SSRI + Bupropion

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57
Q

Depression

Switching from MAOI to another antidepressant

A

2 weeks wash out

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58
Q

Depression

Switching from an antidepressant (other than Fluoxetine) to MAOI

A

5 half lives wash out

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59
Q

Depression

Switching from Fluoxetine to MAOI

A

5 weeks wash out (=5 half lives)

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60
Q

Depression

Switching from Moclobemide to another antidepressant

A

5 days wash out (=5 half lives)

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61
Q

Stimulants

Withdrawal Tx?

A

SR forms of Amphetamines or Ritaline

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62
Q

Opioids Withdrawal Tx

Three medications: Methadon ……….. ………..

A

Buprenorphine

Buprenorphine + Naloxone

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63
Q

BZPs

Withdrawal Tx?

A

Long Acting BZP like Diazepam And taper slowly

If insomnia: Trazodon

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64
Q

NAS Neonatal Abstinence Sd (Opioids)

Tx:

  1. Nonpharma (7) ?
  2. Diluted tincture of Opium
A

Swaddling, Gentle Rocking

Holding, Pacifier

Low volume high calorie meals, Repetitive diaper change,

Silence + white noise

and +/-

Methadon to the Breastfeeding mother

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65
Q

Psychoses

Three APs that should be taken in the mornings? Aripiprazole, …….., ………

A

Paliperidone

Ziprasidone

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66
Q

Psychoses

Two APs that should be taken with food

A

Lurasidone

Ziprasidone

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67
Q

Psychoses

Caution with Asenapine (2)

A

Oral hyposthesia

Probable hypersensitivity or Angioedema

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68
Q

Psychotic Agitation

Haloperidol 5 mg

+/- Lorazepam 2 mg Or ……..

A

Oral rapid dissolving form of Olanzapine or Risperidone

(If the patient cooperates)

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69
Q

Psychoses

Two APs in which the dosage should be increased rapidly to avoid activation Sd

A

Ziprasidone

XR form of Quetiapine

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70
Q

Psychoses

DOC for smoking Cessation?

A

NRT is preferred

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71
Q

Psychoses

NMS (medical emergency) DOC?

A

Dantrolene IV + hydration and cooling

+|- Bromocriptine Oral

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72
Q

Psychoses

Three SGA APs with highest sedation

Quetiapine, ……., …….

A

Olanzapine

Clozapine

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73
Q

Psychoses

Two SGAs with highest risk of EPS

A

Risperidone

Paliperidone

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74
Q

Psychoses

Tx of Akathisia:

  1. Decrease dosage
  2. …….
A

Propranolol or BZP

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75
Q

Psychoses

AP with highest CVS SEs

A

Clozapine

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76
Q

Psychoses

In Pregnancy:

  1. Minimum effective dose is recommended

2 ?

A

No AP is preferred to others

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77
Q

Psychoses

DOC Acute Dystonia

A

IM Benztropine

Or IM Diphenhydramine

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78
Q

Acute Pain

Meperidine (Pethidine)

CIs: Hepatic disease, Renal disease, Elderly, ……., …….

A

MAOIs within last 2 weeks

Pain longer than 3 hours

79
Q

Acute Pain

Three examples of local anesthetics

  1. Lidocaine (+/- Epinephrine)

2,3 ?

A

TAC (Tetracaine, Adrenaline, Cocaine)

EMLA (Mixture)

80
Q

Acute Pain

Opioids in Pregnancy?

A

Are safe (if low dose and caution close to term)

81
Q

Acute Pain

Opioids in Breastfeeding

A

Generally Safe

(except for Meperidine, Codein)

82
Q

Bell’s Palsy DOC?

(Tx should be started within first 72 hours)

A

Prednisone Oral 5 days (1 mg/kg)

+|- Acyclovir (Then taper in 5 days)

But If paralysis is complete: CS for 10 days (Then taper in 5 days)

83
Q

Chronic Fatigue Sd Nonpharma:

…………, good nutrition, good sleep, multivitamins, enough salt, CBT

A

GET Graded Exercise Therapy: Divide daily tasks to small parts and start with minimal activity, Avoid push/crush cycles

84
Q

Chronic Fatigue Sd

4 medications that “might be” helpful

1,2 Mg, NADH

3,4 ?

A

Vit D

L carnitine

85
Q

Chronic Spasticity

1st line Tx

86
Q

Chronic Spasticity

Baclofen SEs

  1. Highly sedative
  2. ………
A

If suddenly discontinued:

Confusion, Seizures, Hallucinations

87
Q

Chronic Spasticity

2nd line Tx

A

Tizanidine (Alpha2 Agonist)

(SEs: Dry mouth, drowsiness)

88
Q

Chronic Spasticity

Alternative Tx: For nighttime symptoms?

A

Diazepam or Clonazepam

89
Q

Chronic Spasticity Alternative Tx:

  1. If associated with neuropathy: Gabapentine
  2. If associated with MS and pain?
A

Sativex (THC buccal Spray)

90
Q

Chronic Spasticity

If Focal?

A

Injection of Phenol every 6 months

Or Injection of Botox every 3 months

91
Q

Fibromyalgia

Only two drugs are approved in Canada: 1………. 2………

A

Duloxetine

Pregabaline (Preferably low dose)

92
Q

Fibromyalgia

Tx in Pregnancy

A

Preferably nonpharma

Duloxetine is ok But Pregabaline is NOT safe

93
Q

Fibromyalgia

Nonpharma:

……….., CBT, Massage, TENS, Education, Meditation, Acupuncture

A

GAE Graded Aerobic Exercises

94
Q

Muscle Cramps

If severe and not iatrogenic, Tx?

A

Quinine Sulfate for 4-6 weeks

(Never longer than 3 months)

95
Q

Muscle Cramps

Quinine Sulfate:

Monitoring ?

Other SEs ? (3)

A

Bleeding because of thrombocytopenia

Other SEs: Arrhythmia, SJS, Vasculitis

96
Q

Muscle Cramps

Tx in Pregnancy

A

Mg 2-4 weeks

97
Q

Persistent Hiccups (2-30 days)

1st line Tx

A

Chlorpromazine IV

25-50 mg IV slowly within 30 min in ER (Sometimes Oral trial)

98
Q

Persistent Hiccups

2nd line Tx

3rd line Tx

A

2: Haloperidol IM or Oral
3: Metoclopramide IV or Oral

99
Q

Intractable Hiccups (over 1 month) Tx

A

Baclofen (Then taper slowly)

100
Q

Restless Leg Sd

1st Line if Intermittent type

A

Levodopa/Carbidopa

Or BZP

Or Codeine (low potency opioid)

101
Q

Restless Leg Sd

1st Line if chronic persistent type

A

Pramipexol or Ropinirol (Dopamine agonists)

Or Pregabaline

102
Q

Restless Leg Sd

Chronic Persistent type: a transdermal patch?

A

Ritogotin (Dopamine Agonist)

103
Q

Restless Leg Sd

Tx in Pregnancy or Breastfeeding

A

No dopaminergic No GABA

But BZP or Opioids are not contraindicated

104
Q

Neuropathic Pain

Acute pain in Herpes Zooster (Shingles)

A

Acyclovir Oral

+|- Gabapentin or Amitryptyline

105
Q

Neuropathic Pain

Chronic Radiculopathies

A

Acetaminophen/ Codeine/ NSAIDs

106
Q

Neuropathic Pain

Chronic Peripheral Neuropathies

1st line Tx

A

TCA or GABA

107
Q

Neuropathic Pain

Chronic Peripheral Neuropathies

2nd line Tx

3rd line Tx

A
  1. SNRI or Lidocaine
  2. Opioids (Preferably transdermal or SR)
108
Q

Neuropathic Pain In Pregnancy

A

No GABA, No Carbamazepine

Caution with Opioids

Others are +|- ok

109
Q

Neuropathic Pain

In Breastfeeding

A

No GABA, No BZP

Caution with Opioids, Others are ok

110
Q

Neuropathic Pain

Relative CIs for Opioids (5)

  • Hx of addiction
  • Frequent Migraine
  • Fibromyalgia

…………, ………..,

A

Tensions Headache

Psychosomatic pains

111
Q

Gout Nonpharma

Avoid: liver, kidney, ……, alcohol, high fructose foods, beef, lamb, pork, ……., gravies, desserts, sweetened beverages, high fat diaries

A

Sweet breads, Sardine, Shellfish

112
Q

Gout

Allopurinol Hypersensitivity Sd (AHS) may result in SJS or TEN. Three Risk factors ?

A

Thiazides

Renal Dysfunction

Starting with high doses

113
Q

Gout

Chronic Phase: If renal function is impaired, Tx?

A

Febuxostat (But it may increase liver enzymes)

114
Q

Gout

Three rules for Uricosurics like Probenecid or Losartan

A
  1. Not 1st line
  2. No monotherapy
  3. Not recommended if ClCr < 50 or if hx of renal stones
115
Q

Gout Alluporinol interactions:

  • Increases risk pf rash with Amoxicillin
  • …………
A

Inhibits hepatic metabolism of Warfarin (Bleeding)

116
Q

Gout

Colchicine interaction

A

May increase myopathy with Statins

117
Q

Headache

Triptans CIs (3)

-Cardiac diseases

………, ………

A

HTN

Basilar or hemiplegic Migraine

118
Q

Headache, Acute Phase

1st line Acetaminophen, ASA, NSAIDs

2nd ………

A

DHE Spray

or Oral Triptans

119
Q

Headache Prophylaxis

CCBs: Verapamil or ……….

A

Flunarizine

(CI: hx of depression)

120
Q

Headache In Pregnancy

A

Ergot derivatives: CI

Triptans: CI

Other: +|- ok

121
Q

Headache in Children:

watch for ……. when prescribing 1st line meds

A

ASA and Reye Sd

122
Q

Headache in Children

Prophylaxis: In younger children? In others?

A

Y: Cyproheptadine

O: Flunarizine (CCB), (watch for depression)

123
Q

Headache in Children

The Only approved treatment for acute headache in 12-18 yo (in Canada)

A

Almotriptan

124
Q

Headache Prophylaxis

for Migraine around menses

A

Triptans Start 2 days before menses, Continue for 1 week

125
Q

MS

1st Line Tx (2)

A

Glatiramer, Interferon beta

126
Q

MS Serious SEs:

Glatiramer: is usually well tolerated,

Interferon beta?

A

Rare: Severe Hepatotoxicity

127
Q

MS

Serious SEs: Alemtuzumab?

A

Autoimmunity often in thyroid

128
Q

MS

Serious SEs: Dimethyl Fumarate (2)

A

Pr Uria

Increased Liver Enzymes

129
Q

MS

Serious SEs: Fingolimod Monitoring

A

Regular LFT

130
Q

MS

Serious SEs: Mitoxantrone (2)

A

Cardiotoxicity

Leukemia

131
Q

MS

Serious SEs: Natalizumab

A

PML

(Progressive Multifocal Leukoencephalopathy)

132
Q

MS

Serious SEs: Teriflunomide Caution

A

CI in Pregnancy And washout is needed

133
Q

MS

In Canada, ……… is approved for gait disturbances in MS (Adjunctive Tx)

A

Fampridine

134
Q

MS

Vit D?

A

Recommended 1000 IU daily To all patients

135
Q

Seizures

DOC in Focal (Partial) Seizures, Including Simple and Complex

A

Carbamazepine

136
Q

Seizures

DOC in Generalized Seizures:

  1. Petit mal: Ethosuximide
  2. Grand mal?
  3. Atonic?
  4. Myoclonic?
A

All: Valproate

137
Q

Seizures

Monitoring for Valproate (2)

A

CBC for Plts

LFT

(and Not recommended for women in fertility ages)

138
Q

Seizures

Most of antiepileptic medications are enzyme inducers, except for ……..

A

Valproate Which is Inhibitor

139
Q

Antiepileptics SEs

  • Vigabatrin ?
  • Levetiracetam?
A
  • V: Visual field defects
  • L: Psychiatric SEs
140
Q

Carbamazepine

Serious SEs (2)

A

Cardiac Conduction disturbances

Neutroenia

141
Q

Phenytoin

Serious SEs (3)

  1. Gyngival Hypertrophy
  2. Coarse facies
  3. ……….
A

Folate deficiency

142
Q

Headache

Migraine Prophylaxis

  1. Beta blocker

2 to 6 ?

A

Valproate, Topiramate, Verapamil, Lithium, Flunarizine

143
Q

Headache

Cluster headache Prophylaxis

  1. Verapamil

2,3 ?

A

Lithium

Flunarizine

144
Q

Headache

Cluster: Acute Attack

…………….. or …………. or High flow Oxygen or Intranasal lidocaine

A

Sumatriptan Or Dihydroergotamine

145
Q

Headache

Migraine Acute Attack

1st line Acetaminophen or ASA +|- Caffeine

2nd line NSAIDs

3rd line ……….

A

5HT Agonists (Sumatriptan) +|- Antiemetic

146
Q

Parkinson’s disease

Recommended medications based on age:

A

Above 60 yo: Start with Levodopa/ Carbidopa

Below 60 yo: Start with Ropinirol/ Pramipexol

147
Q

Parkinson’s disease

Four SEs of Levodopa/ Carbidopa

  1. On/Off 2. ……… 3……….. 4………..
A
  1. Peak-dose dyskinesia
  2. Off period dystonia
  3. Diphasic dyskinesia
148
Q

Parkinson’s disease

Why is Bromocriptine less commonly used?

A

Pulmonary Fibrosis

149
Q

Parkinson’s disease

SEs of Ropinirol/ Pramipexol/ Bromocriptine

  1. Sleepiness during the day
  2. Impulse control problems
  3. …………
A

Psychiatric: Hallucinations, Confusion

(and GI, Ortho-Hypo)

150
Q

Parkinson’s disease

Transdermal patch

A

Rotigotine

151
Q

Parkinson’s disease

MAO-B Inhibitors:

Example………… Indication………..

A

Selegiline Only initial Tx in mild Parkinson’s

152
Q

Parkinson’s disease:

NMDA Antagonist: ………….

SEs: 1. Edema 2. Erythema 3…………

A

Amantadine

  1. Livedo reticularis
153
Q

Parkinson’s disease:

Amantadine

Indication: Movement Disorders with Levodopa

Two CIs ?

A
  1. Cognitive disorder
  2. Confusion
154
Q

Parkinson’s disease:

Anticholinergics: THF, Benztropine

Indication……….

A

Only effective on tremor at rest

155
Q

Parkinson’s disease

COMT Inhibitors, example……… Indication……….

A

Entacapone

Only with Levodopa for wearing off

156
Q

Parkinson’s disease

COMT Inhibitors: Entacapone

SE (1)

A

Urine color change (benign)

157
Q

Parkinson’s disease

If we abruptly discontinue dopamine agonists, ………. might happen.

A

Parkinsonism Hyperpyrexia Sd. (Similar to NMS)

158
Q

Low back pain If acute:

watch for Red Flags

Example: Epidural Abcess? IV drug abuser, Fever, …….., ……..,

A

Pain which is not related to position, Sensory, motor problems

159
Q

Low back pain

If a pregnant woman needs imaging?

A

MRI (without Contrast)

160
Q

Neck pain and Whiplash

WAD Classification:

WAD 1. Only pain,

WAD 2. ………., WAD 3. ……….,

WAD 4. Fx or Dx or Instability

A
  1. ROM is decreased
  2. Sensory or Motor or Reflex deficit
161
Q

Neck pain and Whiplash

Bone and Joint Classification:

BJ 1. NL activity is ok

BJ 2. ………. BJ 3. ……….

BJ 4. Structural lesion

A
  1. NL activity is impaired
  2. Neurological findings
162
Q

Neck pain and Whiplash

Nonpharma:

WAD 1,2: ………..

WAD 3: ………

WAD 4: Urgent refer

A

1,2: symptomatic Tx, no collar, no immobilization

3: rest + semi-hard collar for 3-6 weeks

163
Q

Sport Injuries

Nonpharma Tx

A

RICE Protocol

Rest/ Ice: 20 min QID/ Compress/ Elevation

164
Q

Sports Injuries

Local injection of Triamcinolone is a good choice in most of sports injuries, except for: 1……… 2……..

A

Patella, Achilles

165
Q

Sports Injuries

Nitroglycerin patch may be used in ………

A

Chronic pains

1/4 of a patch per day, Regularly change the site

166
Q

Sports Injuries

Platelet Rich Plasma (PRP) May be used in: 1. …….. 2 ……

A

Elbow, Achilles

167
Q

Sports Injuries:

Ankle Sprain Tx:

Grade 1,2: Rice, Symptomatic Tx

Grade 3: ?

A

G3: Removable cast brace If no response after 6-8 weeks, then refer

168
Q

Giant Cell Arthritis (Temporal Arthritis) 1st line?

A

Prednisone Oral ASAP 40-60 mg daily

169
Q

Polymyalgia Rheumatica 1st line Tx

A

Prednisone Oral 10-20 mg daily

170
Q

In PMR and in GCA, our long term management includes: 1. Bisphosphonates

  1. Ca, Vit D
  2. ……….
A

Try to decrease dosage of Prednisone to less than 7.5 mg daily

171
Q

Osteoporosis

Nonpharma Tx

  1. Ca, Vit D, decrease alcohol
  2. Smoking Cessation
  3. …….. 4. ……..
A
  1. Regular impact type exercise
  2. Decrease falls risk in elderly
172
Q

Osteoporosis

DOC if Osteoporosis is secondary to CS

A

Bisphosphonates

173
Q

Osteoporosis

Two best Bisphosphonates

  1. Alendronate
  2. ……..
A

Residronate (Both are Oral)

174
Q

Osteoporosis

Bisphosphonates: …………… IV is only used once in a year

A

Zoledronate

175
Q

Osteoporosis

Bisphosphonates SEs

  1. Esophagitis or Ulcer
  2. AFib
  3. ……… 4……….
A
  1. ONJ Osteonecrosis of the Jaw
  2. AFSF Atypical Femoral Shaft Fx
176
Q

Osteoporosis

a drug that works through RANK receptor

177
Q

Osteoporosis

SERMs: Raloxifen SE? (1)

178
Q

Osteoporosis

A possibly good candidate for HRT?

A

Recently menopause with severe hot flushes

179
Q

Osteoporosis

Anabolics (PTH Analogues)

Example……… (Max: for 2 years) Possible SE……….

A

Teriparatide

Possible Osteosarcoma (Daily SC injection)

180
Q

Rheumatoid Arthritis

MTX, SEs:

  1. Stomatitis 2. Abortogenic 3. Teratogenic 4…………. 5………….
A
  1. Hepatotoxic 5. Pneumonitis
181
Q

Rheumatoid Arthritis

MTX should be prescribed with…….

A

Folic Acid or Folinic Acid (8-12h later)

182
Q

Rheumatoid Arthritis

Hydroxychloroquine, SEs:

  1. ………….. 2. Severe Hypoglycemia
A

Retinal Deposition

Monitoring: eye exam once a year

183
Q

Rheumatoid Arthritis

Sulfasalazine,

SEs: Hepatotoxicity - ……… , …………..

A
  • Hemolytic anemia -
  • Reversible Oligospermia
184
Q

Rheumatoid Arthritis

Leflunomide SE ?

A

Hepatotoxic (avoid alcohol, avoid MTX)

185
Q

Rheumatoid Arthritis

Biological Treatments:

1- monitor for latent TB

2- Discontinue in time of infection or surgery

3- with live vaccinations?

A

No live vaccines

186
Q

Rheumatoid Arthritis

DOC in Pregnancy

A

CS is the safest (No MTX, Leflunomide, biological)

187
Q

SLE

Tx for Malar rash or discoid rash?

A

Topical CS

or Topical Tacrolimus

188
Q

SLE

ASA and NSAIDs are used to treat serositis. Why shouldn’t we use high doses?

A

They increase the risk of aseptic meningitis if prescribed high dose

189
Q

SLE

Intervals needed to Pregnancy -

MTX: 3-6 months -

Micophenolate: …………

Leflunomide …………

A
  • Mic: 6 weeks
  • Lef: 11 days washout
190
Q

SLE

DOC in Pregnancy

A

Chloroquine or CS

191
Q

SLE

Why should we avoid SMX/TMP?

A

Increases rashes Or causes flares

192
Q

SLE

Azathioprine Monitoring

A

CBC weekly for 1 month

(Leukopenia or thrombocytopenia)

+ LFT and Cr monthly

193
Q

SLE

Micophenolate Monitoring

A

CBC weekly for 1 month (Anemia, Leukopenia or thrombocytopenia) + LFT and Cr monthly

Med (6 decks)

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