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BNF > Chaper 10 Musculoskeletal > Flashcards

Chaper 10 Musculoskeletal Flashcards

(73 cards)

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1
Q

Pain and Stiffness resulting for inflammatory rheumatic disease

A

NSAID

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2
Q

Other analgesics in RA

A

Paracetamol or Codeine can also be used

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3
Q

DMARDs

A

Drugs used to influence the rheumatic disease process its self

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4
Q

DMARDs include:

A 
Methotrexate 
Cytokine Modulators 
Azathioprine
Cyclosporin 
Cyclophosphamide 
Leflunomide
Penicillamine 
Gold 
Antimalarials ( chloroquine and hudroxychloroquine) 
Sulfasalazine
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5
Q

Which two antimalarials can be used as DMARDs?

A

Chloroquine and Hydroxychloroquine sulfate

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6
Q

Corticosteroids have a significant role in?

A

Rheumatoid Arthritis

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7
Q

Drugs which may affect the disease process in psoriatic arthritis include:

A 
Sulfasalazine,
Gold,
Azathioprine,
Methotrexate,
Leflunomide,
Cytokine modulators
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8
Q

For pain relief in osteoarthritis and soft tissue disorders what should be used first?

A

Paracetamol and may need to be taken regularly

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9
Q

Topical NSAID or topical capsaicin 0.025%

A

Should be considered particularly in knee or hand osteoarthritis

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10
Q

Can be substituted for or used in addition to paracetamol in OA

A

Oral NSAID

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11
Q

Further pain relief in OA

A

The addition of an opioid analgesic may be considered, but with a substantial risk of adverse effects

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12
Q

Patient on low dose aspirin

A

Opioid analgesic considered before a NSAID in patients taking low dose aspirin

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13
Q

Intra-articular corticosteroid injections

A

May produce temporary benefit in osteoarthritis, especially if associated with soft tissue inflammation

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14
Q

Non drug measures:

A

Weight reduction and exercise should be encouraged

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15
Q

Not recommended for treatment of OA

A

Glucosamine and Rubefacients

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16
Q

Hyaluronic and its derivative available for OA of the knee

A

But are not recommended

May reduce pain over 1-6 months

Associated with short term increase in knee inflammation

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17
Q

NSAIDs are only used for

A

Symptom control

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18
Q

DMARDs can affect the progression of disease

A

But may require 2-6 months of treatment for a full therapeutic response

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19
Q

Respond to DMARDs may allow

A

NSAID dose to be withdrawn or reduced

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20
Q

All patients with suspected inflammatory joint disease

A

Should be referred to a specialist as soon as possible to confirm diagnosis and evaluate disease activity; early initiation of DMARDs is recommended to control the signs and symptoms, and to limit joint damage

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21
Q

DMARDs similar in efficacy

A

Methotrexate
Sulfasalazine
Intramuscular gold
Penicillamine

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22
Q

DMARDs better tolerated

A

Methotrexate

Sulfasalazine

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23
Q

Patient with newly diagnosed active RA

A

A combination of DMARDS (including methotrexate and at least one other DMARD) and a short term corticosteroid

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24
Q

Treatment initiation to patients with newly diagnosed active RA

A

Within 3 months of the onset of persistent symptoms

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25
If use of a particular DMARD is contraindicated and combination therapy is not possible
Mono therapy with a suitable DMARD should be given and the dose rapidly increased until clinically effective
26
Patients with established and stable RA
Cautiously reduce drug doses to the lowest that are clinically effective
27
When should DMARD be replaced by another
Drug does not lead to objective benefit within 6 months
28
Sodium aurothiomolate
Gold for active progressive RA | Given by deep IM and the area gently massaged
29
Test dose followed by doses at weekly intervals
Until there is definite evidence of remission
30
In patients who do respond
The interval between injections is then gradually increased to 4 weeks and treatment is continued for up to 5 years after complete remission
31
Relapse occurs
Dosage frequency immediately increased and once control obtained again should dosage frequency be decreased
32
When to seek alternative treatment
If no response within 2 months
33
Why avoid complete relapse
Since second courses of gold usually ineffective
34
Penicillamine
Similar action to gold More able to continue treatment than with gold but side effects are common
35
Patients should be warned with penicillamine
Not to expect improvement for 6-12 weeks after treatment is initiated
36
When should penicillamine be discontinued
No improvement within 1 year
37
Beneficial effect in suppressing the inflammatory activity of RA
Sulfasalazine
38
Used by specialist in the management of psoriatic arthritis affecting peripheral joints
Sulfasalazine
39
Haematological abnormalities
Occur usually in the first 3 to 6 months of treatment with sulfasalazine and are reversible on cessation of treatment
40
Which antimalarial is reserved if other drugs fail
Chloroquine
41
Effective for mild systemic lupus erythematosus
Chloroquine and hydroxychloroquine
42
Not to be used for psoriatic arthritis Better tolerated than gold and penicillamine Retinopathy rarely occurs provided doses are not exceeded
Chloroquine and hydroxychloroquine
43
Drugs affecting the immune response:
Methotrexate Leflunomide Ciclosporin Cyclophosphamide
44
By mouth once a week
Methotrexate
45
Mucosal and Gastrointestinal side effects with methotrexate
Folic acid given every week
46
Therapeutic effect starts after 4-6 weeks and improvement may continue for a further 4-6 months
Leflunomide
47
Leflunomide
Similar efficacy to sulfasalazine and methotrexate, may be chosen when these drugs cannot be used
48
Licensed for severe active rheumatoid arthritis when conventional second line therapy is inappropriate or ineffective
Ciclosporin
49
Some evidence that
Ciclosporin may retard the rate of erosive progression and improve symptom control in those who respond only partially to methotrexate
50
Cyclophosphamide
RA with severe systemic manifestation Toxic and regular blood counts ( including platelet counts) should be carried out
51
Should be used under specialist supervision
Cytokine modulators
52
Inhibit activity of TNF-alpha
Adalimumab, certolizumab, etanercept, golimumab and infliximab
53
Important to distinguish drugs used
For the treatment of acute attacks of gout from those used in the long term control of the disease The latter exacerbates and prolongs the acute manifestation of started during an attach
54
The management of four in adolescents requires
Specialist supervision
55
Acute attack of gouts
Usually treated with high doses of NSAIDs such as diclofenac and naproxen
56
Alternative treatment in acute attack of gout in those in which NSAIDs contraindicated
Colchicine
57
Aspirin
Not indicated in gout
58
Allopurinol, febuxostat and uricosuric
Not affective in treating an acute attack and may prolong it indefinitely if started during an acute episode
59
Restricted by development of toxicity in higher dose
Colchicine
60
Benefits of colchicine
Unlike NSAIDs can be used in HF, does not induce fluid retention It can be given in patients receiving anticoagulant
61
Effective alternative in those who cannot tolerate NSAIDS or who are resistant to other treatments
Oral or parenteral corticosteroids
62
Long term treatment of gout
Started 1-2 weeks after the attack has settled
63
Allopurinol
Especially useful in renal impairment or urate stones when uricosuric drugs cannot be used
64
Can cause rashes
Allopurinol
65
Adequate urine output
With uricosuric drugs as crystallisation can occur in urine
66
Antagonise uricosuric drugs
Aspirin and other salicylate
67
Drugs that enhance neuromuscular transmission
Anticholinesterase are used as first line treatment in ocular myasthenia gravis
68
when anticholinesterases do not control symptoms completely
Corticosteroids are used
69
Frequently used to reduce dose of corticosteroids
Second line immunosuppressant such as azathioprine is used
70
Excessive dosage of anticholinesterases
Can impair neuromuscular transmission and precipitate cholinergic crisis by causing depolarisation block
71
Muscarinic side effects of anticholinesterases
Increased sweating Increased salivary and gastric secretions Increased gastrointestinal and uterine motility Bradycardia
72
Parasympathetic effects antagonised by
Atropine sulfate
73
Neostigmine
Produces a therapeutic effect for up to 4 hours

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