MSK Drugs

Question 1

Name some NSAIDs

Answer 1

Ibuprofen
Aspirin
Naproxen
Diclofenac
Indometacin
Etodolac
Celecoxib

Question 2

When to use Etodolac?

Answer 2

symptomatic relief of osteoarthritis and rheumatoid arthritis.

Question 3

Side Effects of Indometacin?

Answer 3

headache, dizziness, and gastro-intestinal disturbances

Question 4

When to use Celecoxib?

Answer 4

relief of pain in osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis

Question 5

MoA of Ibuprofen

Answer 5

It is a propionic acid derivative with anti-inflammatory, analgesic, and antipyretic properties.

Question 6

MoA of NSAIDS

Answer 6

They reduce the production of prostaglandins by inhibiting the enzyme cyclo-oxygenase.

Question 7

Why do you need to stay on NSAIDS for a while?

Answer 7

Pain relief starts soon after taking the first dose and a full analgesic effect should normally be obtained within a week, whereas an anti-inflammatory effect may not be achieved (or may not be clinically assessable) for up to 3 weeks.

Question 8

Why is Naproxen good to use in clinical practice?

Answer 8

because it combines good efficacy with a low incidence of side-effects

Question 9

When are NSAIDS contraindicated?

Answer 9

Asthmatics

GI patients- prescribe in combination with a PPI to protecti GI tract.

Question 10

Name some Analgesics

Answer 10

Paracetamol 
Codeine
Co-codamol
Dihyrocodeine 
Tramadol
Amytriptyline 
Gabapentin
Morphine

Question 11

Name some Disease Modifying Anti-Rheumatoid Drugs (DMARDS)

Answer 11

Methotrexate
Sulphasalazine
Leflunomide
Hydroxychloroquine

Question 12

MoA of Methotrexate

Answer 12

inhibition of enzymes involved in purine metabolism

Question 13

MoA of Sulphasalazine

Answer 13

Suppression of IL-1 & TNF-alpha, induce apoptosis of inflammatory cells and increase chemotactic factors

Question 14

MoA of Leflunomide

Answer 14

Pyrimidine synthesis inhibitor

Question 15

MoA of Hydroxychloroquine

Answer 15

induces apoptosis of inflammatory cells and decrease chemotaxis

Question 16

Side effects of Methotrexate

Answer 16

• hepatitis, cirrhosis, pneumonitis, rash, ulcers, reduction of white blood cells,
• it’s teratogenic

Question 17

What should be done whilst on Methotrexate?

Answer 17

• on contraceptives

- Regular LFTs and FBCs

Question 18

Name some Anti-TNFs?

Answer 18

Etanercept 
Adalimumab
Certolizumab
Infliximab
Golimumab

Question 19

How are Anti-TNFs given?

Answer 19

Subcutaneous injection

Question 20

How can Anti-TNFs become more effective?

Answer 20

by being taken alongside DMARDS

Question 21

What are side effects of Anti-TNFs?

Answer 21

Risk of infection, especially TB

Question 22

MoA of Anti-TNFs

Answer 22

They suppress the physiologic response to tumour necrosis factor (TNF), which is part of the inflammatory response.

Question 23

Name some Biologics

Answer 23

Rituximab
Tocilizumab
Abatacept
Ustekinumab
Secukinumab

Question 24

MoA of Rituximab

Answer 24

monoclonal antibody against B lymphocytes

Question 25

MoA of Tocilizumab

Answer 25

inhibits IL6

Question 26

MoA of Abatacept

Answer 26

composed of CTLA-4 Ig- that blocks activation of T lymphocytes

Question 27

MoA of Ustekinumab

Answer 27

inhibits IL12 and IL23

Question 28

MoA of Secukinumab

Answer 28

inhibits IL17

Question 29

Name some urate-lowering drugs

Answer 29

Allopurinol | Febuxostat

Question 30

When would you use Febuxostat?

Answer 30

For those who cannot tolerate allopurinol

Question 31

MoA of Allopurinol and Febuxostat

Answer 31

xanthine oxidase inhibitors

Question 32

Side effects of Allopurinol

Answer 32

rash in elderly / renal patients | interacts with azathioprine

Question 33

MoA of Azathioprine

Answer 33

Azathioprine inhibits purine synthesis. Purines are needed to produce DNA and RNA. By inhibiting purine synthesis, less DNA and RNA are produced for the synthesis of white blood cells, thus causing immunosuppression.

Question 34

What kind of drug is azathioprine?

Answer 34

Immunosuppressant

Question 35

What should you always prescribe with Allopurinol?

Answer 35

NSAIDS- as Gout can be exacerbated due to rapid reduction in uric acid level

Question 36

Name some Uricosuric drugs

Answer 36

Probenecid Sulphinpyrazone Benzbromarone

Question 37

MoA of Uricosuric drugs

Answer 37

they increase the excretion of uric acid in the urine by acting on the proximal tubule

Question 38

When are uricosuric drugs contraindicated?

Answer 38

Renal patients

Question 39

MoA of Colchicine

Answer 39

interrupts the cycle of monosodium urate crystal deposition in joint tissues and the resultant inflammatory response that initiates and sustains an acute attack

Question 40

Side effects of colchicine

Answer 40

GI upset | Dont's take with macrolides: erythromycin/ clarithromycin