Rheumatology Drugs

Question 1

What class of antibiotic does ceftriaxone belong to

Answer 1

cephalosporins

Question 2

Explain the spectrum of activity of cephalosporins

Answer 2

increasing generations of cephalosporins have increasing gram negative activity

Question 3

Explain the MOA of cephalosporins

Answer 3

B-lactam ring inhibits cross-linking of peptidoglycan cell walls leading to osmotic swelling and lysis

Question 4

What is the most common side effect of cephalosporins

Answer 4

GI Upset and antibiotic associated colitis

Question 5

Explain antibiotic associated colitis

Answer 5

Cephalosporins kill normal flora, this can lead to overgrowth of c.difficle and antibiotic associated colitis

Question 6

What is the main complication of antibiotic associated colitis

Answer 6

Toxic megacolon and subsequent perforation

Question 7

What is another side effect of cephalosporins and carbapenams

Answer 7

Neurological toxicity and seizures

Question 8

When are carbapenams most likely to cause neurological side effects and seizures

Answer 8

When prescribed to patients with renal impairment

Question 9

What are 3 relative CI to cephalosporin and carbapenam use

Answer 9

• Renal impairment
• Epilepsy
• Risk of C.difficle infection

Question 10

What is an absolute CI to cephalosporin and carbapenam use

Answer 10

Anaphylaxis to carbapenams, cephalosporins or penicillin

Question 11

What drug may cephalosporins enhance the effect of and why

Answer 11

warfarin - due to destroying normal flora of the gut that produce vitamin K

Question 12

What drug may cephalosporins increase toxicity of

Answer 12

increase renal toxicity of ahminoglycosides

Question 13

Who is allowed to prescribe cephalosporins and why

Answer 13

microbiologists - due to risks of c.difficile

Question 14

Explain the MOA of bisphosphonates

Answer 14

similar structure to pyrophosphate and therefore are incorporated into bone. When in bone, taken up into osteoclasts, where they collect and stimulate apoptosis.

Question 15

What is first-line bisphosphonate for osteoporosis

Answer 15

Aledronic acid

Question 16

What are two common side effects of bisphosphonates

Answer 16

Oeseophagitis

Hypophosphataemia

Question 17

What is a rare but serious side effect of bisphosphonates

Answer 17

Osteonecrosis of the jaw

Question 18

When is osteonecrosis of the jaw most likely

Answer 18

High-dose IV infusion bisphosphonates

Question 19

What is a rare side effect in patient’s on long-term bisphosphonates

Answer 19

Osteonecrosis of the jaw

Question 20

What are 3 absolute CI of bisphosphonates

Answer 20

• Renal impairment
• Hypocalcaemia
• Upper GI disorders

Question 21

What are 2 relative CI for bisphosphonates and why

Answer 21

• Smoker
• Poor dental hygiene
  = due to risk of osteonecrosis

Question 22

What substances may reduce effectiveness of bisphosphonates

Answer 22

As bisphosphonate binds calcium salts its absorption can be reduced by iron, anatacids and calcium salts (eg. milk)

Question 23

What dose of aledronic acid is given for osteoporosis

Answer 23

70mg weekly

Question 24

What bisphosphonate is offered for paget’s disease

Answer 24

IV pamidronate or oral Riserdronate

Question 25

What is the problem with bisphosphonates

Answer 25

Poor absorption

Question 26

How can absorption of bisphosphonates be improved

Answer 26

Take 30m before meals

30m before other medication s

Question 27

How is the risk of oesophageal irritation reduced with bisphosphonates

Answer 27

Remain upright 30m after taking

Question 28

How is the efficacy of bisphosphonates for osteoporosis monitored

Answer 28

DEXA scan every 2 years