MSK drugs Flashcards by Jasmine Henson

Allopurinol mechanism of action

xanthine oxidase inhibitor
lowers serum uric acid levels
should not be started until acute flare completely settled
should not be stopped if patient already on allopurinol has acute flare (unless contraindications eg renal failure)

How well did you know this?

Not at all

Perfectly

Paracetamol indications

analgesia

anti-pyretic

How well did you know this?

Not at all

Perfectly

Allopurinol alternative

febuxostat

selective xanthine oxidase inhibitor

How well did you know this?

Not at all

Perfectly

What drugs interact with allopurinol and what are the effects?

azathioprine:
- increased risk of haematological toxicity (bone marrow suppression)

trimethoprim:

bone marrow suppression
increased infection risk
anemia due to low RBC
severe bleeding due to low platelets

How well did you know this?

Not at all

Perfectly

Colchicine mechanism of action

tubulin disruption

How well did you know this?

Not at all

Perfectly

Colchicine indications

management of acute gout where NSAIDs are contra-indicated

How well did you know this?

Not at all

Perfectly

Colchicine side effects

abdominal pain
diarrhoea
vomiting
nausea

How well did you know this?

Not at all

Perfectly

Colchicine contra-indications

should not be given if history of peptic ulcers

How well did you know this?

Not at all

Perfectly

Allopurinol side effects

skin rash

How well did you know this?

Not at all

Perfectly

Allopurinol contra-indications

metabolised in liver

dose should be lowered for hepatic + renal impairment

How well did you know this?

Not at all

Perfectly

Paracetamol mechanism of action

weak inhibitor of cyclooxygenase (COX)
reduce prostaglandin (PGE2) concentrations in thermoregulatory centre of hypothalamus
specificity for COX-2

How well did you know this?

Not at all

Perfectly

Bisphosphonates mechanism of action

inhibit action of osteoclasts

net effect = reduction in bone loss + improvement in bone mass

How well did you know this?

Not at all

Perfectly

Bisphosphonates indications

osteoporosis (reduce risk of osteoporotic fragility fractures)
Paget’s disease (reduce bone turnover and pain)

How well did you know this?

Not at all

Perfectly

Bisphosphonates side effects

oesophagitis
hypophosphataemia
osteonecrosis of the jaw
atypical femoral fracture

How well did you know this?

Not at all

Perfectly

Bisphosphonates contra-indications

renally excreted - avoid in severe renal impairment
hypocalcaemia
upper GI disorders
care taken in smokers + dental disease (due to risk of osteonecrosis of the jaw)

How well did you know this?

Not at all

Perfectly

Bisphosphonates administration

tablets swallowed whole
on an empty stomach
30 mins before food/other medications
plenty of water
remain upright for 30 mins

How well did you know this?

Not at all

Perfectly

Bisphosphonates examples

alendronic acid
risedronate sodium
zoledronic acid

How well did you know this?

Not at all

Perfectly

Penicillin antibiotics mechanism of action

inhibit enzymes responsible for cross-linking peptidoglycans in bacterial cell walls
weakens cell walls
bactericidal
beta-lactam ring = responsible for antimicrobial activity

How well did you know this?

Not at all

Perfectly

Penicillin antibiotics indications

Streptococcal infection (tonsillitis, pneumonia, endocarditis, skin/soft tissue infection)
Clostridial infection (tetanus)
Meningococcal infection (meningitis, septicaemia)

How well did you know this?

Not at all

Perfectly

Penicillin antibiotics contra-indications

penicillin allergy (presentation = skin rash)
dose reduction in renal impairment

How well did you know this?

Not at all

Perfectly

Penicillin antibiotics interactions

Study These Flashcards

reduce renal excretion of methotrexate - increasing toxicity risk

Macrolide antibiotics indications

Study These Flashcards

alternative to penicillin if allergy present

Macrolide antibiotics mechanism of action

Study These Flashcards

inhibit bacterial protein synthesis
bind to 50s subunit of bacterial ribosome and block translocation
bacteriostatic (stops bacteria growth)

Macrolide antibiotics adverse effects

Study These Flashcards

nausea
vomiting
diarrhoea
thrombophlebitis when given IV

Macrolide antibiotics interactions

Erythromycin + Clarithromycin (but not Azithromycin) inhibit cytochrome P450 enzymes increases plasma concentrations + risk of adverse effects with drugs metabolised by P450 enzymes (warfarin = increased bleeding risk, statins = increased myopathy risk)

NSAIDs indications

mild-to-moderate pain - alternative or in addition to paracetamol regular treatment for pain related to inflammation

NSAIDs mechanism of action

inhibit cyclooxygenase - inhibiting synthesis of prostaglandins from arachidonic acid COX-2 inhibition = therapeutic effects COX-1 inhibition = adverse effects

NSAIDs adverse effects

GI toxicity renal impairment increased risk of cardiovascular events

NSAIDs contra-indications

``` severe renal impairment heart failure liver failure NSAID hypersensitivity prior peptic ulcer disease/GI bleeding ```

Coxibs mechanism of action

selective COX-2 inhibitors

DMARDs definition and examples

``` disease-modifying anti-rheumatic drugs methotrexate sulfasalazine leflunomide hydroxychloroquine ```

Methotrexate indications

rheumatoid arthritis as part of chemotherapy regimens severe psoriasis/psoriatic arthritis that is resistant to other therapies should always be prescribed with folic acid (methotrexate monday, folic acid friday)

Methotrexate mechanism of action

dihydrofolate reductase inhibitor | also has anti-inflammatory + immunosuppressive effects

Methotrexate adverse effects

bone marrow suppression hepatotoxicity hepatic cirrhosis pulmonary fibrosis

Methotrexate contra-indications

severe renal impairment (renally excreted) abnormal liver function pregnancy (it is teratogenic)

Methotrexate monitoring

monthly blood tests (more frequent at first and before starting treatment) - FBC, LFT, U+E

Rituximab mechanism of action

monoclonal antibody targeting CD20

Risks of biologics

reactivation of TB

TNF-alpha inhibitors examples

adalimumab etanercept infliximab

Corticosteroids indications

treat allergic/inflammatory disorders suppression of autoimmune disease treat some cancers hormone replacement in adrenal insufficiency/hypopituitarism

Corticosteroids mechanism of action

add

Corticosteroids adverse effects

immunosuppression metabolic = diabetes mellitus, osteoporosis proximal muscle weakness skin thinning easy bruising gastritis mood/behavioural changes = insomnia, confusion, psychosis mineralocorticoid actions = hypertension, hypokalaemia, oedema

Why should you not withdraw corticosteroids suddenly?

risk of Addisonian crisis | - slow withdrawal allows recovery of adrenal function after adrenal atrophy caused by prolonged treatment

Corticosteroid warnings

prescribed with caution in children (can suppress growth) and those with infection increase risk of peptic ulceration + GI bleeding when used with NSAIDs enhance hypokalemia in patients taking Beta2-agonists, theophylline, loop/thiazide diuretics reduce immune response to vaccines

Opioids indications

acute, severe pain | chronic pain when other analgesics were insufficient

Opioids mechanism of action

activation of opioid mu receptors in CNS (activation of these G protein-coupled receptors = reduce neuronal excitability + pain transmission)

Opioids adverse effects

respiratory depression neurological depression (in higher doses) nausea + vomiting pupillary constriction constipation tolerance + dependance --> potential withdrawal response on cessation

Opioid warnings

renal + hepatic excretion | dose reduced in hepatic failure, renal impairment + in elderly

What drugs can be used for neuropathic pain?

amitriptyline pregabalin gabapentin

Bisphosphonates alternative and mechanism of action

Denosumab fully human monoclonal antibody binds to and inhibits RANKL blocks osteoclast maturation, function and survival --> reducing bone resorption

MSK drugs Flashcards

(50 cards)