summary of drugs used in MSK conditions Flashcards
what drugs are used for acute flare ups of gout?
NSAIDs and colchicine
what drug is used for chronic prevention of gout
allopurinol
dose of NSAIDs for gout
usually high dose for a few weeks
ibuprofen 400-800mg
naproxen - 750mg stat then 250mg tds for 7 days
efficacy of NSAIDs for gout
moderate to good
safety of NSAIDs for gout
short term ok
can cause GI bleed, renal or heart failure if high dose for long term taken
suitability of NSAIDs for gout
inexpensive
easy to take
contraindications with GI or cardiac disease
efficacy of colchicine for gout
very good
safety of colchicine for gout
nausea and diarrhoea very common
bone marrow suppression and renal failure over longer term
suitability of colchicine for gout
good option if cannot taken NSAIDs
similar efficacy to naproxen but 2x greater risk of diarrhoea
dose of colchicine for gout
0.5 mg ds for 3-4 days
stop if D/V
should not exceed 6mg in one course
mechanism of colchicine
depolarisation of microtubules to inhibit granulocyte migration and lymphocyte migration and division
tubulin disruptor
which corticosteroids are used for gout
local injection if only a single joint is affected
systemic (tablets) oral prednisolone if severe
suitability of corticosteroids for gout
great for those who cannot have NSAIDs or colchicine
usually elderly with comorbidities
mechanism of allopurinol
xanthine oxidase inhibitor
efficacy of allopurinol for gout
very good
interactions of allopurinol
purine analogues, theophylline
dosage of allopurinol for gout
100mg daily unitially
check uric acid levels after a few weeks
up-titrate to desired level
mechanism of febuxostat
non-purine xanthine oxidase inhibitor
how do bisphosphonates work for osteoporosis
analogues of pyrophosphate
attach to bone crystals and inhibit osteoclast breakdown of bone
safety of bisphosphonates
GI upset is main problem
how does denosumab work for osteoporosis
monoclonal antibody - RANK ligand inhibitor
reduces osteoclast activation, differentiation, and survival
suitability of denosumab for osteoporosis
recommended by NICE if patient cannot have bisphosphonate
only needs 1 subcut injection every 6 months
other drugs for osteoporosis
raloxifene - oestrogen like molecule
teriparatide - recombinant PTH, intermittent use activates osteoblasts to deposit bone
older DMARDs for RA
sulfasalazine
methotrexate
leflunomide
gold
how does methotrexate work
anti IL-2 agent
folic acid antagonist
side effects of methotrexate
immunosuppression
liver toxicity
lung damage
mechanism of infliximab
human mouse monoclonal antibody
TNF alpha blocking agent
mechanism of etanercept
recombinant DNA human TNF alpha receptor p75 fusion protein
binds to TNF to stop its activity
mechanism of adalimubab
human monoclonal antibdoy
TNF alpha blocking agent
main drugs for ankylosing spondylitis
adalimubab or etanercept
main drugs for psoriatic arthritis
adalimubab
etanercept
infliximab
main drug for juvenile idiopathic arthiritis
etanercept
whihc steroids are given via local injection in rheumatology
triamcinolone
methylprednisolone
whicih steroid is taken orally in rheumatology
prednisolone
which steroids are taken via IV in rheumatology
hydrocortisone
methylprednisolone
side effects of too many steroids
Cushings disease
- osteoporosis
- obeisty
- moon face
- hypertension
- hy[erglycaemia
- striae
- hypokalaemia-
- myopathy
- psychiatric symptoms
side effects of too little steroids
addisons disease
- nausea/vomiting
- headache
- joint pain
- fever
- hypoglycaemia
- hypotension
- hyperkalaemia
