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Year 1 > MSK drugs > Flashcards

MSK drugs Flashcards

1
Q

Allopurinol mechanism of action

A

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)

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2
Q

Paracetamol indications

A

analgesia

anti-pyretic

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3
Q

Allopurinol alternative

A

febuxostat

selective xanthine oxidase inhibitor

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4
Q

What drugs interact with allopurinol and what are the effects?

A

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
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5
Q

Colchicine mechanism of action

A

tubulin disruption

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6
Q

Colchicine indications

A

management of acute gout where NSAIDs are contra-indicated

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7
Q

Colchicine side effects

A

abdominal pain
diarrhoea
vomiting
nausea

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8
Q

Colchicine contra-indications

A

should not be given if history of peptic ulcers

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9
Q

Allopurinol side effects

A

skin rash

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10
Q

Allopurinol contra-indications

A

metabolised in liver

dose should be lowered for hepatic + renal impairment

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11
Q

Paracetamol mechanism of action

A

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

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12
Q

Bisphosphonates mechanism of action

A

inhibit action of osteoclasts

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

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13
Q

Bisphosphonates indications

A

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

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14
Q

Bisphosphonates side effects

A

oesophagitis
hypophosphataemia
osteonecrosis of the jaw
atypical femoral fracture

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15
Q

Bisphosphonates contra-indications

A

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)

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16
Q

Bisphosphonates administration

A 
tablets swallowed whole
on an empty stomach
30 mins before food/other medications
plenty of water
remain upright for 30 mins
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17
Q

Bisphosphonates examples

A

alendronic acid
risedronate sodium
zoledronic acid

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18
Q

Penicillin antibiotics mechanism of action

A

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

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19
Q

Penicillin antibiotics indications

A 
Streptococcal infection (tonsillitis, pneumonia, endocarditis, skin/soft tissue infection)
Clostridial infection (tetanus)
Meningococcal infection (meningitis, septicaemia)
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20
Q

Penicillin antibiotics contra-indications

A 
penicillin allergy (presentation = skin rash)
dose reduction in renal impairment
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21
Q

Penicillin antibiotics interactions

A

reduce renal excretion of methotrexate - increasing toxicity risk

22
Q

Macrolide antibiotics indications

A

alternative to penicillin if allergy present

23
Q

Macrolide antibiotics mechanism of action

A

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

24
Q

Macrolide antibiotics adverse effects

A

nausea
vomiting
diarrhoea
thrombophlebitis when given IV

25
Q

Macrolide antibiotics interactions

A

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)

26
Q

NSAIDs indications

A

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

27
Q

NSAIDs mechanism of action

A

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

28
Q

NSAIDs adverse effects

A

GI toxicity
renal impairment
increased risk of cardiovascular events

29
Q

NSAIDs contra-indications

A 
severe renal impairment
heart failure
liver failure
NSAID hypersensitivity 
prior peptic ulcer disease/GI bleeding
30
Q

Coxibs mechanism of action

A

selective COX-2 inhibitors

31
Q

DMARDs definition and examples

A 
disease-modifying anti-rheumatic drugs
methotrexate 
sulfasalazine
leflunomide 
hydroxychloroquine
32
Q

Methotrexate indications

A

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)

33
Q

Methotrexate mechanism of action

A

dihydrofolate reductase inhibitor

also has anti-inflammatory + immunosuppressive effects

34
Q

Methotrexate adverse effects

A

bone marrow suppression
hepatotoxicity
hepatic cirrhosis
pulmonary fibrosis

35
Q

Methotrexate contra-indications

A

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

36
Q

Methotrexate monitoring

A

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

37
Q

Rituximab mechanism of action

A

monoclonal antibody targeting CD20

38
Q

Risks of biologics

A

reactivation of TB

39
Q

TNF-alpha inhibitors examples

A

adalimumab
etanercept
infliximab

40
Q

Corticosteroids indications

A

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

41
Q

Corticosteroids mechanism of action

A

add

42
Q

Corticosteroids adverse effects

A

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

43
Q

Why should you not withdraw corticosteroids suddenly?

A

risk of Addisonian crisis

- slow withdrawal allows recovery of adrenal function after adrenal atrophy caused by prolonged treatment

44
Q

Corticosteroid warnings

A

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

45
Q

Opioids indications

A

acute, severe pain

chronic pain when other analgesics were insufficient

46
Q

Opioids mechanism of action

A

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

47
Q

Opioids adverse effects

A

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

48
Q

Opioid warnings

A

renal + hepatic excretion

dose reduced in hepatic failure, renal impairment + in elderly

49
Q

What drugs can be used for neuropathic pain?

A

amitriptyline
pregabalin
gabapentin

50
Q

Bisphosphonates alternative and mechanism of action

A

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

Year 1 (41 decks)

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