Therapeutics Flashcards
Drugs causing osteoporosis
- Glucocorticoids
- Immunosuppressants
- Antiseizure medicines (esp phenobarbital, phenytoin)
- Aromatase inhibitors
- GnRH agonist & antagonists (e.g. leuprolide)
- Heparin
- Cancer chemotherapy
- Long-term PPI
5 components of GMP
- Purity of raw materials
- Premises and equipment well maintained for operational readiness
- Personnel adequately trained
- Manufacturing procedures utilise latest science and technology
- Processes documented to show compliance
Sources of impurities
- Raw materials
- Components of manufacturing
(reagents, solvents, reaction vessels) - Atmospheric contamination
- Manufacturing hazards
(particulate/microbial/cross contamination, process/packing errors) - Storage
(filth, physical/chemical instability, temperature effects, reaction with container)
Risk factors for OA
- Genetic
- Anatomic (varus, valgus)
- Injury
- Obesity (load; metabolic OA)
- Ageing
- Gender (M < 50; F > 70)
- Occupation
Risk factors for NSAID-induced GI toxicity
- > 65 y.o.
- History of GI ulcer
- Use of chronic NSAID at high doses
- Concomitant corticosteroids/antithrombotics
Risk factors for NSAID-induced nephrotoxicity (AKI)
- > 65 y.o., HTN, atherosclerosis
- CKD (C/I in < 15)
- Volume depletion (true/effective)
- Severe hypercalcemia, renal artery stenosis
- Aminoglycosides, amphotericin B, radiocontrast media
- Diuretics, ACEi/ARB use
Urgent referrals for soft tissue injuries
- Fractures
- Malignancy
- Infections
- Ligament rupture
- Referred visceral pain
Etiology of tendonitis
- Overuse
- Sports injury
- Calcium apatite deposits
- Rheumatoid conditions
- Fluoroquinolones, statins
Etiology of bursitis
Acute:
- Gouty bursitis
- Infections
- Trauma
Chronic:
- Inflammatory
- Overuse
- Prolonged pressure
Differentials for heel pain
Neuro:
- Nerve impingement
- Neuropathic pain
- S1 reticulopathy
Skeletal:
- Stress fractures
- Bone contusions
- Osteomyelitis
- Cancer
Soft tissues:
- Archilles tendinopathy
- Fat pad atrophy
- Retrocalcaneal bursitis
- Plantar fascia rupture
- Painful heel syndrome
Inflammatory:
- Rheumatoid conditions
- Sarcoidosis
Differentials for lower back pain
Mechanical:
- Cauda equina compression
- Osteoporotic vertebral fracture
- Radiculopathy
Non-mechanical:
- Cancer
- Osteomyelitis
- Epidural abscess
Visceral:
- Kidney stones
- Gall stones
- Prostatitis
- Pyelonephritis
Drugs causing hyperuricemia
Increased production:
Alcohol
Cytotoxic drugs
Fructose
Reduced excretion:
Thiazide/loop diuretics
Cyclosporin, tacrolimus
Low dose salicylate
Ethambutol
Pyrazinamide
Levodopa
Laxative abuse
Salt restrictions
Risk factors for osteoporosis
- FH of osteoporosis/fragility fracture
- Hx of fragility fracture
- Advance age
- Low body weight
- Height loss of >2 cm in 3 years
- Early menopause (45 and younger)
- Medications
- Medical conditions
- Insufficient Ca intake (<500 mg/day)
- Alcohol abuse
- Cigarette smoking
- Immobility
- Hx of falls
Contraindications for intraarticular glucocorticoids
- Periarticular infection
- Septic arthritis
- Periarticular fracture
- Joint instability
- Juxtaarticular osteoporosis
Monitoring for methotrexate
FBC
LFT (AST, LT, albumin, bilirubin)
RP (SCr)
Monitoring for sulfasalazine
FBC
Monitoring for hydroxychloroquine
Ophthalmic exam
Monitoring for leflunomide
FBC
LFT (AST, ALT, albumin, bilirubin)
Safety concerns with bDMARD & tsDMARD
- Injection site reaction
- Myelosuppression
- Infections
- Malignancy
- Autoimmune disease
- Cardiovascular disease
- Hepatic
- Metabolic
- Pulmonary
- GI
- Thrombosis
Checklist before initiating bMARD / tsDMARD
- Check ADR
- Inform about risk of MACE / malignancy
- Screening for TB, HBV, HCV
- Vaccination for HBV, varicella, influenza, pneumococcal
- Schedule for regular screening (CBC, LFT, SCr, lipids)
Criteria for starting urate lowering therapy
- Frequent gout flares (two or more per year)
- Tophi
- Radiographic changes
- History of urolithiasis
Treatment goals for ULT
- Tophaceous gout: <360 mcmol/L
- Non-tophaceous gout: < 300 mcmol/L
Z-score less than -2 means?
Higher risk of osteoporosis due to secondary causes
