Chapter 10- Musculoskeletal System

Question 1

DMARDs used in rheumatic disease take how long to work

Answer 1

2-6 months

Question 2

If a DMARD does not lead to an objective benefit within 6 months what should happen?

Answer 2

Replace it with another one

Question 3

Mode of action of the cytokine modulators (adalimumab, certolizumab, etanercept, golimumab, infliximab)

Answer 3

Inhibit the activity of tumour necrosis factor alpha

Question 4

Cautions/further information with chloroquine/hydroxychlorquine

Answer 4

Screening for ocular toxicity

Question 5

Patient and carer advice with hydroxychloroquine

Answer 5

Do not take antacids for at least 4 hours before or after hydroxychloroquine to reduce possible interference with absorption

Question 6

Side effects of leflunomide

Answer 6

Potentially life threatening hepatotoxicity

Question 7

Effective contraception is essential for how longneck in women and how long in men after taking leflunomide

Answer 7

Women - 2 years

Men - 3 months

Question 8

Penicillamine aids the eliminations of what in Wilson’s disease

Answer 8

Copper

Question 9

List some NSAIDs used in acute attacks of gout

Answer 9

Diclofenac 
Etoricoxib
Indometacin
Ketoprofen
Naproxen 
Sulindec

Question 10

What can be used in acute attacks of gout if NSAIDs are contraindicated

Answer 10

Colchicine

Question 11

Name two xantine oxidase inhibitors used for long term control of gout

Answer 11

Allopurinol

Febuxostat

Question 12

Name the uricosuric drug that increases the excretion of Uric acid in the urine used for long term control of gout

Answer 12

Sulfinpyrazone

Question 13

MHRA safety information with febuxostat

Answer 13

Hypersensitivity reactions- Stevens Johnson syndrome

Question 14

Muscarinic side effects of anticholinesterases

Answer 14

Increased sweating
Increased salivary and gastric secretions
Increased GI and uterine motility
Bradycardia

Question 15

Which drug is preferred for neuromuscular disorders: neostigmine and pyridostigmine and why?

Answer 15

Pyridostigmine - less powerful, longer duration of action (smoother action)

Question 16

It may take how long for quinine to work for nocturnal leg cramps

Answer 16

4 weeks

Question 17

How do NSAIDs work?

Answer 17

Reduce the production of prostaglandins by inhibiting the enzyme cyclo-oxygenase

Question 18

For NSAIDs selectivity for cyclo-oxygenase 2 is associated with less or more GI intolerance?

Answer 18

Less GI intolerance

Question 19

Name the active enatiomer of ibuprofen

Answer 19

Dexibuprofen

Question 20

Mefanamic acid has been associated with what which requires discontinuation of treatment

Answer 20

Diarrhoea and haemolytic anaemia

Question 21

Nom selective NSAIDs are more associated with serious upper GI bleeds- name two

Answer 21

Diclofenac

Naproxen

Question 22

All NSAIDs use can be associated with a small increased risk of thrombotic events (MI/stroke) independent of baseline risk or duration of use, name two NSAID with a higher risk?

Answer 22

Diclofenac

Ibuprofen

Question 23

Name three NSAID associated with the highest risk of GI events

Answer 23

Piroxicam
Ketoprofen
Ketorolac

Question 24

Name three NSAIDs associated with intermediate risk of GI events

Answer 24

Indometacin
Diclofenac
Naproxen

Question 25

Name the NSAID with the lowest risk of GI events (although has intermediate risk at high doses)

Answer 25

Ibuprofen

Question 26

Use of NSAIDs in the third trimester has been associated with what

Answer 26

Closure of fetal ductus arteriosus in utero and possibly pulmonary hypertension of the newborn

Question 27

Licensing for ibuprofen

Answer 27

Not licensed in children under 3 months or body weight under 5kg

Question 28

CHMP advice with piroxicam

Answer 28

Increased risk of GI side effects and skin reaction therefore restrictions are in place on the use e.g max 20mg daily (these restrictions do not apply to topical piroxicam)

Question 29

CSM advice with tiaprofenac acid

Answer 29

Reports of severe cystitis

Question 30

Drugs that are likely to cause extravasation injury should be given through what type of line?

Answer 30

Central line

Question 31

General management of extravasation

Answer 31

Corticosteroids Antihistamines Analgesic

Question 32

What's licensed for the extravasation of anthracycline induced extravasation

Answer 32

Dexrazoxane

Question 33

Antimalarials can be used in arthritis - what's the counselling points for hydroxychloroquine

Answer 33

Do not take antacids 4 hrs before or after | Can cause retinopathy

Question 34

When is leflunomide given and what's the side effect

Answer 34

In moderate to severe RA can cause life threatening hepatotoxicity

Question 35

Options for acute attack of gout

Answer 35

High dose NSAIDs (diclofenac/naproxen) Colchicine Oral/parenteral corticosteroid

Question 36

Long term gout prevention ?

Answer 36

Allopurinol | Uricosic drug e.g sulfinpyrazone

Question 37

Counselling points for allopurinol

Answer 37

Take after food | If rash develops needs to be withdrawn

Question 38

Counselling points with uricosic drugs and how do they work

Answer 38

Increase excretion of uric acid- ensure to keep hydrated to prevent crystallisation of urine

Question 39

Selective COX-2 NSAIDS such as celecoxib used for RA/osteoarthritis have what GI side effect profile?

Answer 39

Higher GI risk but lower risk of upper GI s/e

Question 40

Two NSAIDs with highest GI s/e

Answer 40

Ketoprofen | Piroxicam

Question 41

Intermediate GI s/e NSAIDs

Answer 41

Diclofenac Indometacin Naproxen

Question 42

Lowest GI S/E NSAID

Answer 42

Ibuprofen

Question 43

NSAIDs with highest risk of thrombotic effects

Answer 43

(DISc) Diclofenac Ibuprofen Selective COX-2 inhibitors

Question 44

True or false - tiaprofenac is allowed in people with urinary tract disorders

Answer 44

FALSE do not give

Question 45

Ways to prevent extravasation

Answer 45

Central line Change cannula GTN patch locally

Question 46

Two methods of managing extravasation

Answer 46

Localise and neutralise | Spread and dilute