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TDM > MSK > Flashcards

MSK Flashcards

1
Q

Colchicine

Dose in Acute Gout Attack

A

NB! <36H

1,2mg PO stat

then 0,6mg PO in 1 hour

then 0,6mg PO BD

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2
Q

Colchicine

Drug Class

A

Antimitotic

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3
Q

Colchicine

Side Effects

A

Common:
GIT: Abdo pain | NVD
SKIN: Rash | Alopecia
MSK: Muscle pain

Rare:

  • Neutropenia
  • Myopathy
  • Rhabdomyolysis
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4
Q

Colchicine

Contraindications

Cautions

A

CI:

  1. Solid organ transplant
  2. Blood dyscrasia
  3. Renal / Hepatic impairment

Caution: Decreased renal fnx = Decreased dose

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5
Q

Colchicine

Drug Interactions

A

COLCHICINE TOXICITY (Fever | Leukopenia | GI sx)

  • ARVs
  • Azoles
  • CCB (Verapamil)
  • Cyclosporin
  • MACROLIDES
  • Statins

FATAL REACTION:
Erythromycin & Clarithromycin
- Leukopenia, Myopathy, multi-organ failure

MYOTOXIC
Statins

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6
Q

Colchicine

Monitoring

A

CBC (Leukopenia | Neutropenia)
CK (Myopathy)
Renal functions (dose adjustments)

q6monthly

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7
Q

Gout

Indications for Urate Lowering Medication

A
  1. Tophi
  2. > 2 attacks per year
  3. eGFR <89
  4. Past urolithiasis
  5. Low dose ASA
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8
Q

Gout

Target for serum urate

A

<360 umol/L

but if tophi = <300 umol/L

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9
Q

Gout

First-line choices for urate lowering therapy

A

Allopurinol

Febuxostat (Renal friendly)

Class: Xanthine Oxidase Inhibitors

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10
Q

Systemic corticosteroids

Common short term side effects

Common long term side effects

A

ST:

  • Hypertension
  • Hyperglycemia
  • GIT upset
  • Insomnia
  • Mood changes

LT:

  • PUD / GI bleeding
  • Osteoporosis
  • Increased risk of heart disease
  • Increased risk of infections
  • Skin thinning
  • Cataracts
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11
Q

Osteoporosis

Classes & medications used

A

BISPHOSPHONATES
Alendronate 70mg PO weekly
Zolendronate 5mg IVI annually

LIGAND INHIBITORS
Denosumab 60mg SC 6monthly

SELECTIVE ESTROGEN RECEPTOR MODULATORS
Raloxifene

HORMONAL THERAPY
Estrogen & Progesterone

CALCITONIN

PTH ANALOGUE
Teriparatide 20micro per day SC x 2 years

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12
Q

NSAIDS

Cardiovascular Side effects

& Best NSAID to use in pt with CVD

A

Edema
Hypertension

Increased risk of

  • MI
  • AF
  • Heart failure
  • VTE
  • Ischemic stroke

Least CV risks = low dose Naproxen (<750mg per day)

Naproxen 250mg PO TID

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13
Q

NSAIDS

GIT Side effects

& best NSAID to use in GI pt

A

Dyspepsia
Nausea
Diarrhoea

GI ulcers

GI bleeding and perforation

use: Topical Diclofenac or Acetominophen
NSAID: Celecoxib 200mg PO dly with PPI

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14
Q

NSAIDS

Side Effects

A
  • GIT:
  • Dyspepsia
  • GI ulcers
  • GI bleeding
  • GI perforation
  • Cardiovascular
  • Hypertension
  • Oedema
  • Increased risk of: MI, AF, HF, Stroke
  • Nephrotoxic
  • Acute kidney injury
  • Chronic kidney disease
  • Oedema
  • Renal insufficiency
  • CNS:
  • Tinnitus
  • Stroke
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15
Q

Osteo-arthritis

Step wise pharmacology

A

TOPICAL ANALGESICS
Diclofenac K

v

SIMPLE ANALGESICS
Acetominophen max: 4g per day

v

NSAIDS
CVD pt: Naproxen 250mg TID
GI pt: Celecoxib 200mg PO dly + PPI

v

SNRI
Duloxetine

v

OPIOIDS
Tramadol

v

GLUCOSAMINE
Glucosamine sulfate

v

CORTICOSTEROIDS
Prednisone

v

INJECTING TREATMENT

  • Intra-articular corticosteroid injections
  • Hyaluronic acid injections
  • Platelet-rich Plasma injections
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16
Q

NSAIDS & Pregnancy

A

Only indicated for short-term therapy in T1 & T2

NOT in T3

  • Oligohydramnios
  • Premature closure of the ductus arteriosus
  • Neonatal Pulmonary Hypertension

Also avoid topical Diclofenac K

17
Q

Fibromyalgia

Drug classes and medications

A

SNRI
Duloxetine

TCA
Amitriptyline

SSRI
Fluoxetine

GABA derivatives
Pregabalin

NO PLACE FOR:
Opioids
Cannabis

18
Q

Allopurinol

Class

Dose

A

Xanthine Oxidase Inhibitor

start: Allopurinol 100mg PO dly
increase to: Allopurinol 300g PO dly
Max: 800mg PO dly

19
Q

Allopurinol

Side effects

A 
HYPERSENSITIVITY 
RASH 
HEPATOTOXIC 
GIT UPSET 
BM SUPRESSION

HYPERSENSITIVITY REACTION

  • SJS
  • TEN
  • Eosinophilia
  • Vasculitis
  • Cytopenia
  • Fever
  • Organ damage

RASH

GI UPSET

  • Nausea
  • Diarrhoea
  • Abdominal pain

BM SUPRESSION
- Fever

20
Q

Febuxostat

Class

Dose

A

Xanthine Oxidase Inhibitor

Febuxostat 40mg PO dly then 80mg PO dly in 2 weeks

21
Q

Febuxostat

Side effects

A

NVD

Arthralgia

Derange liver enzymes

Increased risk of MI or stroke

22
Q

Gout

Name all medications that can be used for Urate-Lowering-Therapy

A
  1. Allopurinol
  2. Febuxostat
  3. Probenecid
  4. Losartan
  5. Fenofibrate
23
Q

Fibromyalgia

Non-pharmalogical advices

A
  • Cognitive behavioural therapy
  • Pain reduction techniques
    • Cold/heat pads
    • Massage
    • Electroacupuncture
  • Graded aerobic exercises
  • Sleep hygiene
  • Stress management
  • Relaxation techniques
  • Empathy & acknowledgement of suffering
  • Self management
  • Comprehensive, multidisciplinary education
24
Q

Fibromyalgia

3 classes & example

A

SNRI - Duloxetine
TCA - Amitriptyline
Gaba derivatives - Gabapentin

25
Q

Patient with fibromyalgia on Ibuprofen 800mg BD PO
36 weeks pregnant

Advices regarding painkillers and rationale

A

Stop ibuprofen in T3
because:
- Oligohydramnios
- Premature closure of ductus arteriosus
- Persistent pulmonary hypertension of the newborn

TDM (7 decks)

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