Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Pre-reg > Chapter 10- Muscoskeletal System > Flashcards

Chapter 10- Muscoskeletal System Flashcards

(87 cards)

Start Studying
1
Q

What’s used for pain relief in osteoarthritis and soft tissue disorders

A

Paracetamol first line

Topical NSAID or capsaicin considered especially in knee or hand osteoarthritis

+- Oral NSAID

Opioid if still not adequate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

When should opioid be considered before NSAID in osteoarthritis

A

If the patient is on low dose aspirin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What’s rheumatoid arthritis

A

Chronic systemic inflammatory disease that causes persistent inflammation of the synovial joint (typically the small joints of the hands and feet)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What worsens rheumatoid arthritis

A

At rest or periods of inactivity
Swelling
Tenderness
Heat in the affected joints

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What do DMARDs include

A 
Methotrexate 
Azathioprine 
Ciclosporin 
Antimalarials 
Leflunomide 
Cytokines modulators
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

When can you consider doing when starting DMARD for newly diagnosed rheumatoid arthritis

A

Short term bridging with with a corticosteroid as dmards have a slow onset of action and can take 2-3 months to take effect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Of the DMARDS which are preferred and why

A

Methotrexate or sulfanazine

They are better tolerated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What should be given in newly diagnosed active rheumatoid arthritis

A

Combination of DMARDS
(MTX + other)

And short term corticosteroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How is Gold used as a suppressing drug

A

It’s given as sodium aurothiomalate
Given by deep IM injection and the area gently massaged
If effective treatment continued for 5 years
If not improvement in 2 months alternative treatment should be given

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

When should gold treatment be discontinued

A 
Bleeding disorder 
GI bleeding 
Ulcers 
Proteinuria
Rash and pruritis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How long would penicillamine treatment take to work and how long should you give it before discontinuing if no improvement

A

6-12 weeks

1 year

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is used to treat acute gout attacks

A

High dose NSAID (not aspirin)
Colchicine is an alternative
Corticosteroids if resistant to other treatment

Allopurinol, febuxostat and uricosuric are not indicated in attacks as they can exacerbate it

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Why is colchicine preferred over NSAIDs in heart failure

A

Unlike nsaid it does not induce fluid retention

Given to patients on anticoagulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How is long term gout managed

A

Xanthines oxidase inhibitors (allopurinol, febuxostat)

Or uricosuric drug- sulfapyrinazone (increases excretion of Uris acid in the urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

When are management drugs for gout started?

A

1-2 weeks after the attack has settled

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How is hyperuricaemia treated?

A

Febuxostat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How long is gout management treatment for in recurrent attacks

A

Indefinitely to prevent further attacks of gout by correcting hyperuricaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What can be being for long term management in resistant gout

A

Allopurinol with sulfinpyrazone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

MHRA alert for feboxustat

A

Rate but serious case of hypersensitivity (stevens Johnson syndrome)
And acute anaphylactic shock

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What increases the chance of developing gout

A

Renal impairment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

in patients regularly taking allopurinol and experiance a gout attack should they stop?

A

No carry on the allopurinol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

When should allopurinol be withdrawn

A

If the patient develops a rash

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Apart from gout, when else could allopurinol be taken

A

Hyperuricaemia associated to cytotoxic drugs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What can be used in myasthenia gravis

A

First line- Anticholinestrase (eg: neostigmine)

Immunosuppressant therapy

Corticosteroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Side effects of anticholinestrate used is myasthenia gravis
Muscarinic side effects: Sweating Excessive salivation Bradycardia
26
When are muscle relaxants used and which ones can be used
Used for chronic muscle spasm and spasticity with MS or neurological damage. Baclofen depresses the CNS Cannabis can be used for spasticity in MS Diazepam can also be used
27
What’s the purpose of anticholinestrase
To enhance neuromuscular transmission in voluntary and involuntary muscle Prolong action of Ach
28
How can the acetylcholinestrase adverse effects be antagonised
Atropine
29
What can be given for nocturnal leg cramps
Quinine
30
What severe adverse effects has the use of cytokines modulators been associated with
Infection risk such as: Tuberculosis Septicaemia Hepatitis b reactivation
31
Why should allopurinol be taken with a full glass of water
To prevent kidney stone and promote uric acid excretion Excreted via the kidneys
32
Counselling for allopurinol
May take several months to work Increase fluid intake to prevent kidney stones Not for acute attacks (prevent long term)
33
Counselling points for baclofen used as a muscle relaxer
Dizziness is expected No alcohol Do not stop abruptly (slowly reduce dose over 1-2 weeks)
34
Initiation of gout prevention may precipitate a gout attack, what can you do to prevent this
Give allopurinol as the prevention but give colchicine/ NSAID for 1 month after hyerpuriceamia is corrected
35
What provides analgesic affect in gout
NSAID
36
What’s the first choice for pain and stiffness from inflammation
NSAID
37
How long does it take for NSAIDs to reach its full analgesic and full inflammatory effect
Analgesic reached in 1 week Inflammatory reached in 3 weeks Mild- moderate pain relief with first dose
38
How do NSAIDs work
Reduce production of prostaglandin by inhibiting cyclooxygenase (COX)
39
What’s an advantage and disadvantage of cox 2 inhibitors over non selective ones
Less GI effects More CV risk
40
What effects does ibuprofen have
Anti inflammatory Anti pyretic Analgesic
41
Examples of NSAIDs that are propionic acid derivatives
Naproxen Fenoprofen Ketoprofen Tioprofenic acid
42
Selective cox 2 inhibitor NSAIDs
``` Parecoxib Etoricoxib Celecoxib Diclofenac Ibuprofen ```
43
Counselling point for patients taking the NSAIDs ketoprofen topically
Photosensitivity reactions during and 2 weeks after treatment
44
Cautions and contraindications with nsaid use
``` Elderly Asthma Coagulation defects- warfarin Cv disease Gastro problems Pregnancy Avoid in renal and hepatic impairment ```
45
What NSAIDs have the highest gastro effects
Piroxicam Ketoprofen Ketorolac
46
Which NSAIDs have intermediate gastro effects
Indometacin Diclofenac Naproxen
47
Which nsaid has the lowest gastro risk
Ibuprofen
48
What nsaid meds and dose are associated with cv events
All nsaid are associated with increased risk of thrombotic events Ibuprofen 2.4mg daily and diclofenac 150mg daily is associated with increased risk
49
CHM advice for piroxicam
Increased risk of GI side effects and serious skin reaction Not to be used as first line Limited to RA, Oa Dose shouldn’t exceed 20mg Review every 2 weeks when starting Offer GI protection Topical use excluded from these restrictions
50
Which nsaid can cause severe cystitis
Tiaprofenic acid
51
After how long of taking ibuprofen should you switch to another nsaid if it is not effective
3 weeks
52
Max dose of ibuprofen
OTC 400mg TDS Prescription 800mg TDS
53
What’s long term used of ibuprofen associated to
Reversibly decreasing female fertility
54
Drugs most NSAIDs interact with
Warfarin- increased risk of bleeding Reduced excretion of methotrexate and lithium ACEi and diuretic- aki Potassium sparing diuretic- hyperkalaemia Quinolones- increased risk of convulsion Gliclazide (ibuprofen)
55
Which drugs when given with NSAIDs increase GI risk
SSRI Corticosteroids Aspirin Clopidogrel
56
Side effects of NSAIDs
GI disturbances Nausea, vomiting, diarrhoea bleeding, ulceration Hypersensitivity Headache, dizziness Blood disorder Sodium and water retention
57
When can corticosteroid injections be used
In highly inflamed joints esp in RA
58
What’s used short term to rapidly improve symptoms of RA
Corticosteroids
59
Why’s nsaid contraindicated in severe HF
Increased risk of thrombotic event
60
Which NSAIDs have the highest risk in increasing CV events
Ibuprofen 2.4g daily Cox 2 selective Diclofenac
61
Which NSAIDs have the lowest GI risk
Cox 2 selective
62
Uses of methotrexate
Rheumatoid arthritis Cancer Psoriasis Crohn’s disease
63
When taking folic acid weekly for methotrexate, after how many missed days should you wait for the next dose
>3
64
Patient counselling for methotrexate
``` Weekly dosing Avoid otc NSAIDs Annual flu vaccine Methotrexate treatment booklet Teratogenic and causes blood dyscrasias ```
65
Side effects of methotrexate
Blood dyscrasias (low wbc, low rbc, low platelet) Hepatotoxicity Nephrotoxicity Pulmonary toxicity GI toxicity Teratogenic (contraception even 3 months after for men and women) Handling (avoid skin contact)
66
What’s gout?
A condition that causes sudden severe pain, swelling and redness in the joints caused by the accumulation of uric acid crystals forming in the joints
67
Drugs that cause hyperuricaemia
Diuretics Ciclosporin/ tacrolimus Cytotoxic Cancer
68
How long should you not repeat colchicine course
Do not repeat course in 3 days
69
Max dose per course of colchicine
6mg
70
Allopurinol interactions
Reduce dose of mercaptopurine and Azathioprine with allopurinol (Increased risk of toxicity)
71
When is quinine indicated
Sleep is regularly disturbed Cramps are very painful and frequent Treatable causes of cramps are excluded No pharmacological treatments have not worked
72
Serious side effects of quinine
QT prolongation Convulsions Arrhythmia
73
How often should quinine treatment be assessed
Every 3 months
74
Why should you avoid NSAIDs in pregnancy
Delays labour Causes pulmonary hypertension in new born child Premature closure of foetal ductus arteriosus
75
What nsaid is licensed for migraines
Tolfenamic acid
76
Which NSAID causes severe cystitis
Tiaprofenamic acid
77
Which nsaid should you caution taking while driving
Indometacin
78
Why should you temporarily stop NSAIDs on ‘sick days’ (acute kidney injury)
NSAIDs reduce glomerular filtration (eGFR) | NSAID excreted via the kidneys
79
NSAIDs interactions
Increased risk of AKI (ACEi, dieuretics, tacrolimus, ciclosporin) Increased risk of bleeding (warfarin, noac, antiplatelet, heparin, SSRI, steroid) Reduced renal secretion (methotrexate, lithium) Increased risk of hyperkalaemia (k sparing) Increased risk of convulsions (quinolones)
80
From what age can diclofenac be sold otc
14 and over
81
When can naproxen be sold otc
250mg tabs for period pain- dysmenorrhea (max 3 tabs daily) Age 15-50
82
What age can topical NSAIDs be sold to patients
Above 12
83
What’s the most effective topical nsaid
Ketoprofen
84
What should you avoid doing with sprains, strains and bruising
Heat products Alcohol consumption Running exercise Massage
85
From what age can paracetamol and ibuprofen be sold otc
Paracetamol 2 month | Ibuprofen 3 months
86
What’s the maximum quantity of paracetamol and aspirin that can be sold otc
No more than 100 non-effervescent tablets/ capsules No legal limit on effervescent products
87
What’s the maximum quantity of co-codamol that can be sold otc
32 to over 18s

Pre-reg (27 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions