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PRE-REG-Thuri > MUSCULOSKELETAL > Flashcards

MUSCULOSKELETAL Flashcards

1
Q

What is rheumatoid arthritis?

A

Immune system attack synovium= causes inflammation

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2
Q

What are 3 symptoms of rheumatoid arthritis?

A

Joint pain - swollen, heat, stiff, motion loss

Rheumatic nodules

affect hands + feet

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3
Q

What are 4 specific symptoms of rheumatoid arthritis?

A

malaise, fatigue, fever, and weight loss

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4
Q

What is Palindromic rheumatism?

A

Rare form of inflammatory arthritis.

Causes attacks of joint pain & swelling similar to rheumatoid arthritis, but joints return to normal in between attacks.

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5
Q

What is 1st line drug treatment for rheumatoid arthritis?

A

Conventional DMARD

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6
Q

What is 2nd line drug treatment for rheumatoid arthritis?

A

Combination therapy

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7
Q

What is 3rd line drug treatment for rheumatoid arthritis?

A

Cytokine modulators e.g. (TNF) alpha inhibitor

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8
Q

What 2 drugs are given for severe active RA?

A

Mtx + rituximab

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9
Q

What drug is used to manage short-term bridging treatment or flare up of RA?

A

Steroids

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10
Q

What 5 drugs effect immune response which are DMARDS?

A

MTX

azathioprine

ciclosporin

cyclophosphamide

leflunomide

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11
Q

What DMARD requires contraceptive after treatment + is hepatotoxic?

A

leflunomide

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12
Q

What 2 antimalarial drugs are DMARDS?

A

hydroxychloroquine

Chloroquine

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13
Q

What 3 cytokine modulators are are DMARDS?

A

TNF a inhibitor

targeted synthetic

Other biological

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14
Q

What DMARD colours urine + produces orange tears?

A

Sulfasalazine

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15
Q

What is MOA of methotrexate?

A

Blocks dihydrofolate reductase = prevents purine/ pyrimidine production

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16
Q

What are 4 conditions MTX is used in?

A

RA

Crohn’s disease

Psoriasis

Cancer

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17
Q

What should MTX be prescribed by?

A

Brand

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18
Q

What counts as a missed dose of MTX?

A

More than 3 days of not taking

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19
Q

What is dosing for mtx?

A

Once weekly

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20
Q

What is a MHRA warning for mtx?

A

Once weekly for autoimmune diseases - specific day each week.

Do not take daily, report overdose, provide pt with alert card + treatment booklet.

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21
Q

What is given with mtx to reduce SE?

A

Folic acid

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22
Q

What are the possible folic acid regimens?

A

5mg weekly- diff day to mtx day

1 or 5mg OD- except mtx day

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23
Q

What are 5 main SEs of MTX?

A

Blood disorders

nephrotoxicity

hepatotoxicity

Pulmonary toxicity

GI toxicity

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24
Q

What is antidote for mtx overdose?

A

folinic acid rescue

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25
Q

Can mtx be taken in pregnancy?

A

NO- teratogenic - contraceptive

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26
Q

How long is contraceptive needed for men + women for MTX

A

During + 6 M after

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27
Q

How to handle mtx?

A

Avoid contact with skin + avoid in pregnant women

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28
Q

What is monitored for mtx?

A

LFTs, FBC, renal - every 1 to 2 weeks until stable.

Then 2-3 monthly

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29
Q

What symptoms should be reported if patient on mtx?

A

Infection, sore throat

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30
Q

What 2 GI issues to stop MTX in?

A

Stomatitis or diarrhoea

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31
Q

What is the issue if there are symptoms of persistant vomiting, abdo pain, dark urine + jaundice?

A

Hepatotoxicity

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32
Q

What are 3 main contra-indications of MTX?

A

Ascites, active infection, significant plural effusion (lung)

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33
Q

What should be done to mtx in renal impairment?

A

Reduce dose

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34
Q

What 5 drugs can interact with mtx to increase blood disorders?

A

Trimethoprim**

Clozapine

Phenytoin

Cytotoxic drug

immunosuppressant

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35
Q

What 3 drug classes interacts with MTX to increase toxicity due to reduced renal clearance?

A

NSAIDS

Penicillin

PPI

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36
Q

What 5 drugs/classes interact with MTX to increase nephrotoxicity?

A

Aminoglycosides, cephalosporin, glycopeptide, ciclosporin/tac, NSAID

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37
Q

What 6 drugs interact with MTX to increase hepatotoxicity?

A

Statin, co-amoxiclav, flucloxicillin + tetracyclines, carbamazepine, sodium valproate, fluconazole, isoniazid

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38
Q

What is osteoarthritis?

A

cartilage wears down + prevents smooth movement.

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39
Q

What is 1st line treatment for arthritis?

A

Topical NSAID

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39
Q

What is 2nd line treatment for arthritis if topical NSAID does not work?

A

Oral NSAID – if not then, Paracetamol/weak opioid for short term

39
Q

What are 2 symptoms of osteoarthritis?

A

Joint pain - stiff, motion loss

Affects weight- bearing joints

40
Q

What are used in polyarthritis, oligoarthritis?

A

DMARDs

40
Q

What helps manage pain pain associated with osteoarthritis if knee involved?

A

Topical capsaicin 0.025%

40
Q

What is Spondyloarthritis?

A

group of inflammatory musculoskeletal conditions with shared features which affect both axial & peripheral joints.

40
Q

What is gout?

A

Type of arthritis, where uric acid forms on big toe

40
Q

What is drug tx for Spondyloarthritis?

A

Refer specialist if need help with day to day activities.

Hydrotherapy - add on to improve symptoms.

40
Q

What is Spondyloarthritis 1st line tx?

A

NSAIDS - if at max dose for 2 to 4 weeks, switch to another.

40
Q

monoarthritis 1st line?

A

Local steroid injections

40
Q

What 3 drug classes are used in specialist care for ankylosing spondylitis?

A

Janus kinase (JAK) inhibitors,
biological drugs, (TNF-a) inhibitors

41
Q

What are 3 symptoms of gout?

A

Joint pain- sudden, intense, swollen.

purple red shiny skin

Tophi

42
Q

What 3 types of drugs cause gout?

A

Loop/thiazide diuretic

cytotoxic drugs

ciclosporin + tacrolimus

43
Q

What are 3 treatment options for acute attacks of gout?

A

either:

Colchicine, high doses of an NSAID, oral corticosteroid

44
Q

What NSAID is avoided for gout?

A

Aspirin

45
Q

What is monitored in long term tx of colchicine?

A

FBC periodically in patients on long-term therapy.

46
Q

What is 1st line tx for prevention of gout?

A

Allopurinol or febuxostat

47
Q

What can colchicine be given with safely?

A

Anticoagulants

48
Q

What 4 types of patients should be on urate lowering tx for gout?

A

multiple or troublesome acute attacks

chronic gouty arthritis,
CKD stages 3 to 5,

large crystal deposits (tophi),

those on diuretic therapy

49
Q

What is a contra-indication of colchicine?

A

Blood disorders

50
Q

What is target target serum urate level in gout?

A

Below 360 micromol/litre.

51
Q

What is target target serum urate level in gout for patients with tophi, frequent flares?

A

below 300 micromol/litre

52
Q

When should long term gout treatment be started?

A

at least 2 to 4 weeks after a gout flare has settled but if frequent, then can be started early.

53
Q

What can happen if urate-lowering therapy is increased?

A

Precipitate an acute attack, therefore colchicine should be offered as prophylaxis while the target

54
Q

What are 2 MHRA warnings linked to febuxostat?

A

Hypersensitivity

Increased risk of CVD + mortality

55
Q

What class are allopurinol + fuboxustat?

A

Xanthine oxidase inhibitor

56
Q

What is a label for allopurinol?

A

Take with or just after food with glass of water.

57
Q

What is a SE of allopurinol?

A

Rash -stop and if mild carry on but if it appears, then stop

58
Q

What to do with allopurinol if giving with azathioprine + mercaptopurine?

A

Reduce dose as toxic

59
Q

What drug is for nocturnal leg cramps?

A

Quinine

60
Q

What are 2 SEs of quinine?

A

Toxic - overdose, convulsions + arrhythmias

Blindness, tinnitus

QT prolongation

61
Q

What is a MHRA alert related to quinine?

A

QT prolongation- dose dependent

62
Q

What are 2 symptoms of quinine overdose?

A

Arrhythmias, convulsions

63
Q

What is used for severe spasticity + palliative care?

A

Baclofen

64
Q

What is route of baclofen?

A

Intrathecal - test dose + monitor, resus

65
Q

What are 3 SEs of baclofen?

A

Drowsy - driving x

Muscular hypotonia

avoid stopping suddenly

66
Q

1st line for ocular myasthenia gravis?

A

Anticholinesterases

67
Q

1st line generalised myasthenia gravis?

A

Immunosuppresant +
Anticholinesterases
(add on. Neostigmine)

68
Q

anticholinesterases SEs?

A

Muscarinic

Sweating

increased salivary and gastric secretions, increased gastro-intestinal and uterine motility, and bradycardia

69
Q

What helps treat muscarininc SEs?

A

atropine sulfate.

70
Q

1st line symptomatic treatment of Lambert-Eaton myasthenic syndrome (LEMS)?

A

Amifampridine

71
Q

What drug helps improve walking in patients with MS who have a walking disability?

A

Fampridine

72
Q

MOA of NSAIDS?

A

Blocks COX enzymes involved in making prostaglandins

73
Q

What 3 drugs are COX2 selective?

A

Celecoxib

etoricoxib

Parecoxib

74
Q

What NSAIDs are non-selective

A

ASPIRIN
Diclofenac
ibuprofen

naproxen
indometacin

75
Q

What is 6 main SEs of NSAIDS?

A

Asthma + dyspnoea

Hypersensitivity

Photosensitive - topical

Nephrotoxic

Bleeding

hyperkalaemia

HTN

Oedema

76
Q

What cardiac SE does NSAID have?

A

Worsens HF, RI + LI - oedma caused

77
Q

Can NSAIDs be used in pregnancy?

A

No -Avoid in 3rd timerster

78
Q

What does NSAID do on 3rd timerster?

A

premature closure of foetal ductus in utero

Delays onset of labour + increases duration

Pulmonary HTN in baby :(

79
Q

When to take NSAIDS?

A

With or after food

79
Q

What 2 drugs increase NSAID toxicity via reduced renal clearance?

A

Lithium

MTX

80
Q

What 3 NSAIDS have higher risk of GI toxicity?

A

Piroxicam

Ketoprofen

Kerorolac

81
Q

What 2 NSAIDs have low risk of GI toxicity?

A

COX2 selective,

Ibuprofen less than 1 .2g

82
Q

What are 4 contraindications of NSAIDS?

A

Ative ulcer/bleeding

NSAID induced hx

Recurrent hx of bleeding >2 episodes

83
Q

What heart related conditions are NSAIDS contra in?

A

Severe HF

84
Q

What 3 NSAIDS are high risk of CVD?

A

COX 2 selective

High dose ibu 2.4g

Diclofenac 150mg daily

85
Q

What is extravasation injury?

A

leakage of drugs or IV fluids from the veins or inadvertent administration into the subcutaneous or subdermal tissue

86
Q

What type of preps can increase likelihood of extravasation injury?

A

Acidic or alkaline preparations e.g. alcohol, PEG

87
Q

How to improve the patency of the vessel in patients with small veins?

A

GTN patch distal to the cannula

88
Q

How to manage extravasation?

A

Stop Infusion
Cannula should NOT be removed until after aspirate area to remove drug

Corticosteroids given for inflammation

PRE-REG-Thuri (44 decks)

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