Musculoskeletal

Question 1

First line pain relief medication for osteoarthritis and soft tissue injury

Answer 1

Paracetamol regular +/- oral NSAID

Question 2

In knee or hand arthritis, topical preparations of what masy be used?

Answer 2

NSAID or 0.025% capsaicin

Question 3

If a patient has arthritis and is on low dose aspirin, how would their pain managment differ from a regular artitis patient>

Answer 3

Paracetamol first, then consider opioid before starting an NSAID

Question 4

first line management of patient with detected RA

Answer 4

DMARD monotherapy e.g. MTX, lefluonamide, sulfasalazine or hydroxychloroquine (weak DMARD)

Question 5

How long can conventional DMARDS take to be effective?

Answer 5

2-3 months

Question 6

What can DMARDS be brridge with give a more rapid effect of symptomatic control?

Answer 6

Corticosteroids

Question 7

If there is inadequate responce using 2 DMARDS, what else can be offered?

Answer 7

TNF alpha inhibitor, biological DMARD,

Question 8

Example of TNF alpha inhibitors

Answer 8

Adalimumab, Golimumab, etanercept, certolizumab pegol

Question 9

Abatercept, Sarliumab and Tocilizumab are examples of what?

Answer 9

Biological DMARDS

Question 10

If a patient is intolerant to DMARDS and a TNF alpha inhibitor, what else can be trialled?

Answer 10

RTX in combination with MTX

Question 11

What needs to be monitored wiht patients on hydorxychloroquine / chloroquine?

Answer 11

Ocular function - risk of retinopathy

Question 12

What organ needs to be monitored in patients using Toculizumab?

Answer 12

Hepatic function

Question 13

First line treatment of an acute gout attack

Answer 13

NSAIDS

Question 14

If NSAIDS are contraindicated, what is next in line to treat an acute gout attack?

Answer 14

Colchicine

Question 15

Long term management of gout

Answer 15

Xanthine oxidase inhibitors e.g. Allopurinol or febuxostat or the uricosuric drug sulfinpyrazone

Question 16

When should xanthine oxidase inhibitor never be started?

Answer 16

During an acute gout attack

Question 17

When are xanthine oxidase inhibitors started in regards toa gout attack?

Answer 17

1 to 2 weeks adter the attack has settled

Question 18

If an acute attack of gout starts during treatment of a xanthine oxfidase inhibitor, should they be stopped?

Answer 18

No - continue

Question 19

max dose of colcichine per course

Answer 19

6mg

Question 20

How many days should colchicine course not be repeated within?

Answer 20

3 days

Question 21

At what eGFR should colchicine be avoided?

Answer 21

<10

Question 22

Should allopurinol be taken with food?

Answer 22

Preferably after food

Question 23

Common side effect of allopurinol

Answer 23

Rash

Question 24

Febuxostat has 2 MHRA warnings regarding what?

Answer 24

1. hypersensitivity reactions

2. Increase risk of CV death

Question 25

Common side effect with colcichine

Answer 25

Diarrhorea, abdominal pain

Question 26

Muscarinic side effects of anticholinesterase drugs

Answer 26

increase sweating, bradycardia, increase salivary and gastric seretions

Question 27

Pyridostigmine nad neostigmine ar eexamples of what drug class

Answer 27

muscarinics / anticholinesterase

Question 28

Signs of anticholinesterase drug overdose

Answer 28

Nystagmus, miosis, bronchoconstriction, bradycardia, lacrimation, heart block, excessive sweating

Question 29

What drug is used to treat nocturnal leg cramps

Answer 29

Quinine

Question 30

Acute low back pain should be treated with which analgesics?

Answer 30

NSAIDS

Question 31

Is paracetamol alone effective for treating lower back pain?

Answer 31

No - if intolerate to NSAID add in opioid

Question 32

What enzyme do NSAIDS inhibit?

Answer 32

COX enzyme thereby inhibiting prostagladin production

Question 33

Which COX enzyme is associated with less GI intolerance

Answer 33

COX 2

Question 34

If a patient is on Mercaptopurine or Azathioprine and is due to start Allopurinol what dose alteraction is required?

Answer 34

Reduce dose by 1/4 to 1/2 with allopurinol

Question 35

What is a risk with quinine toxicity

Answer 35

QT prolongation

Question 36

Celecoxib, etorocoxib and parecoxib are examples of what type of NSAID

Answer 36

COX 2 selective

Question 37

Why should NSAIDS be used in caution in asthmatic patients

Answer 37

risk of bronchospasm

Question 38

If a patient is in AKI what should be done to the NSAID

Answer 38

stop temporarily

Question 39

Ketoprofen, piroxicam and ketolorac are the highest risk of what side effect

Answer 39

GI toxicity

Question 40

Lowest risk NSAIDS of GI toxicity

Answer 40

COX 2 selective (COXIBS)

Question 41

What NSAIDS are at high risk of CV events

Answer 41

Cox 2 selectives, High dose ibuprofen (>2.4g), Diclofenac

Question 42

Can NSAIDS be given in severe heart failure?

Answer 42

No - always contraindicated

Question 43

Are NSAIDS safe in pregancy?

Answer 43

No - they delay labour, cause pulmonary hypertension and premature closure of ductus arteriosus

Question 44

If a patient is taking an ACEi / Ciclosporin / Tacrolimus / Diuretics with an NSAID - what is the risk

Answer 44

risk of AKI

Question 45

NSAID taken alongiside SSRI, Warfarin, aspirin, venlafaxine increases the risk of what?

Answer 45

Bleeding

Question 46

Potassium sparring diuretic + NSAID interaction

Answer 46

Hyperkalaemia

Question 47

Quinolones + NSAID interaction

Answer 47

Risk of convulsions

Question 48

Methotrexate / Lithium + NSAID interaction

Answer 48

Risk of toxicity

Question 49

Naproxen can be sold OTC to women aged ....?

Answer 49

15 to 50 years for dysmenorrhea

Question 50

How many days is naproxen OTC used for?

Answer 50

3 days - pack size 9 x 250mg tabs