MSK

Question 1

NSAIDs: Indications

Answer 1

As needed for mild to moderate pain, especially inflammatory

Question 2

NSAIDs: Mechanism of Action

Answer 2

Principally by COX2 inhibition, so lower levels of prostaglandins. COX2 is the inducible isoform, so is more related to inflammation. COX1 is the baseline isoform so accounts for the side effects

Question 3

NSAIDs: ADRs

Answer 3

GI bleeding, renal impairment, increased risk of stroke

Question 4

NSAIDs: Warnings and Interactions

Answer 4

Avoid in renal failure, heart failure and liver failure. Avoid in NSAID hypersensitivity

Several drugs increase the risk of GI bleeding: steroids, aspirin, SSRIs
NSAIDs increase risk of bleeding with warfarin

Question 5

NSAIDs: Prescription

Answer 5

Monitor by symptoms

Advise patients to avoid dehydration

Question 6

Bisphosphonates (Alendronic acid): Indications

Answer 6

Osteoporosis

Sever hypercalcaemia of malignancy

Question 7

Bisphosphonates (Alendronic acid): Mechanism of Action

Answer 7

They are incorporated into bone. They inhibit osteoclasts and induce apoptosis so reduce bone turnover.

Question 8

Bisphosphonates (Alendronic acid): ADRs

Answer 8

Oesophagitis when taken orally, hypophosphataemia, jaw osteonecrosis when large doses are used IV

Question 9

Bisphosphonates (Alendronic acid): Warnings and Interactions

Answer 9

They are really excreted so should be avoided in renal failure. Predictably, they are contraindicated in hypocalcaemia.

They bind calcium in the GI tract so should not be taken with calcium supplements (incl. milk)

Question 10

Bisphosphonates (Alendronic acid): Prescription

Answer 10

Monitor efficacy by DEXA, be alert to side effects

Question 11

Methotrexate: Indications

Answer 11

RA DMARD
Chemotherapy
Treatment resistant severe psoriasis

Question 12

Methotrexate: Mechanism of Action

Answer 12

Inhibits DTFR so prevents cellular replication. It also inhibits inflammatory mediators e.g. TNFa but these mechanisms are not fully understood

Question 13

Methotrexate: ADRs.

Answer 13

mucosal damage, bone marrow suppression, hypersensitivity reactions, pulmonary fibrosis

Question 14

Methotrexate: Warnings and Interactions

Answer 14

It is teratogenic. It is really excreted so should be avoided in renal failure.

Toxicity is more likely if it is used alongside drugs which reduce renal function e.g. NSAIDs. Other folate antagonists e.g. trimethoprim increase the risk of haematological issues

Question 15

Methotrexate: Prescription

Answer 15

Taken once a week
Monitoring for efficacy by symptoms and inflammatory markers
Monitor by safety: FBC, LFT and renal function

Question 16

Aminosalicylates (sulfasalazine, mesasalazine): Indications

Answer 16

Mesasalazine is 1st line for UC

Sulfasalazine for RA

Question 17

Aminosalicylates (sulfasalazine, mesasalazine): Mechanism of Action

Answer 17

They release 5-ASA, which has unclear anti-inflammatory and immunosuppressive effects. Sulfasalazine also release sulfapyridine which is probably active in RA

Question 18

Aminosalicylates (sulfasalazine, mesasalazine): ADRs

Answer 18

GI upset (nausea, diarrhoea), headache, leucopenia (rare but serious)

Question 19

Aminosalicylates (sulfasalazine, mesasalazine): Warnings and Interactions

Answer 19

they are aminosalicylates so are contraindicated in aspirin hypersensitivity

Depend on GI pH for breakdown and release e.g. PPIs may cause premature breakdown and lactulose may prevent breakdown and 5-ASA release

Question 20

Aminosalicylates (sulfasalazine, mesasalazine): Presciption

Answer 20

Monitor CRP/symptoms for efficacy and FBC/renal function/LFT for safety

Question 21

Them fancy -mabs (adalilumab, infliximab, rituximab): indications

Answer 21

RA

IBD

Question 22

Them fancy -mabs (adalilumab, infliximab, rituximab): Mechanism of Action

Answer 22

They are monoclonal antibodies. Infliximab and adalilumab inhibit TNFa. Rituximab binds to CD20 on B cells to inhibits and destroys them.

Question 23

Them fancy -mabs (adalilumab, infliximab, rituximab): ADRs

Answer 23

Reactivation of latent infections, immunosuppression,