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GPhC BNF > MUSCULOSKELETAL SYSTEM > Flashcards

MUSCULOSKELETAL SYSTEM Flashcards

1
Q

WHAT IS RHEUMATOID ARTHRITIS?

A

Chronic systemic inflammatory disease affecting joint synovial membrane

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2
Q

SYNOVITIS PRESENTS AS..?

A

PAIN and STIFNESS- worsens with rest/inactivity/heat in joints

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3
Q

SYMPTOMS OF RHEUMATOID ARTHRITIS?

A 
NODULES
SWELLING
TENDERNESS
MALAISE
FATIGUE
FEVER
WEIGHT LOSS
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4
Q

RHEUMATOID ARTHRITIS- TREATMENT

NON-DRUG THERAPY?

A

PHYSIOTHERAPY
EXERCISE
RELAXATION
STRESS MANAGEMENT

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5
Q

RHEUMATOID ARTHRITIS- TREATMENT

DMARD DRUG THERAPY
1st LINE?
2nd LINE?

rapid suppression needed?

A

DMARD DRUG THERAPY
1st LINE? Methotrexate/Leflunomide/Sulfasalazine (hydroxychloroquine in mild)
2nd LINE? MABs: Adalimumab/Etanercept/Infliximab/Tocilizumab/Baricitinib

rapid suppression needed? Bridge w/ corticosteroids

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6
Q

RHEUMATOID ARTHRITIS

PAIN RELIEF?
GASTRO-PROTECTION

Taking aspirin already?

A

PAIN RELIEF? NSAIDs calm
GASTRO-PROTECTION? PPI

Taking aspirin already? Consider other pain relief before NSAID, bleeding risk

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7
Q

METHOTREXATE & ASPIRIN/IBUPROFEN?

A

OTC BIG NO, but prescribed? Yeah calm

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8
Q

METHOTREXATE KEY COUNSELLING?

A

Take once weekly
Prescription+label- clear dose & frequency
Commonly prescribed w/ folic acid (different days)
IMMEDIATELY REPORT SIGNS OF: blood disorder/liver toxicity/respiratory effects

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9
Q

METHOTREXATE- SIDE EFFECTS?

A

BPLG
BLOOD DISORDERS- sore throat/bruising/mouth ulcers
LIVER - nausea/vomiting/abdominal discomfort/jaundice/dark urine/itchy skin
PULMONARY - SOB/coughing
G-I - stomatitis/diarrhoea

DARK URINE/ABDOMINAL DISCOMFORT
SOB
SORE THROAT
BRUISING
MOUTH ULCERS
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10
Q

METHOTREXATE TOXICITY ANTIDOTE?

A

FOLINIC ACID (calcium folinate)

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11
Q

METHOTREXATE

MONITORING?

SCREENING?

A

MONITORING? FBC+RENAL+LFT:
every 1-2 weeks till stable
every 2-3 months therafter

SCREENING? Pregnancy PRIOR to treatment
Antifolate- harmful to foetus growth
Use effective contraception during+6 months after treatment, both man & woman

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12
Q

METHOTREXATE- INTERACTIONS?

A

NEPHROTOXIC DRUGS- MTX reduces renal function, NO OTC ibuprofen
ANTI-FOLATES- Trimethoprim/Phenytoin
HEPATOTOXIC DRUGS- Rifampicin/Antifungals
OMEPRAZOLE/ESOMEPRAZOLE- reduces clearance+increases toxicity

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13
Q

What is HYPERURICAEMIA/GOUT?

A

Raised uric acid conc. in blood (hyperuricaemia)+ deposition of urate crystals in joints and other tissues

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14
Q

CAUSES OF HYPERURICAEMIA/GOUT?

A

DIET (high salt intake)
Bendroflumethiazide
Chemo

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15
Q

GOUT- ACUTE TREAMENT?

A

COLCHICINE 500mcg BD-QDS, max. 3 days, DO NOT REPEAT COURSE WITHIN 3 DAYS
OR
High dose NSAID+PPI (excluding aspirin)

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16
Q

GOUT PATIENT, TAKING DIURETICS?

A

AVOID NSAIDs, induces fluid retention, so colchicine instead!

17
Q

ALTERNATIVE ACUTE GOUT TREATMENT?

A

Short course oral corticosteroid
OR
IM injection of corticosteroid
canakinumab (gouty arthritis, >/=3 attacks/year)

18
Q

GOUT- CHRONIC TREATMENT
Only offered in?

1st LINE?
2nd LINE?

Acute attack during treatment?

A

Only offered in? >/=2 acute attacks of gout past year

1st LINE? Allopurinol
2nd LINE? Febuxostat

Acute attack during treatment? TAKE BOTH

19
Q

ALLOPURINOL

Side-effect?

Interaction?

A

Side-effect? Hypersensitivity/rash (discontinue therapy; if rash mild re-introduce carefully but discontinue immediately if L again)

Interaction? Allopurinol+Azathioprine/Mercaptopruine
reduce dose of aza/merc

20
Q

NOCTURNAL LEG CRAMPS

Treatment?

Toxicity risk, so only treat if..?

Trial for..?

Stop treatment every..?

A

Treatment? Quinine sulfate

Toxicity risk, so only treat if..? cramps disrupt sleep/painful/other treatments L QT PROLONGATION

Trial for..? 4 weeks, benefit? Continue

Stop treatment every..? 3 months+assess need for further treatment

21
Q

PAIN & INFLAMMATION (NSAIDs)
NSAIDS- analgesics+anti-inflammatory- used in pain related to inflammation (e.g. rheumatoid arthritis, back pain and soft-tissue disorders)
Contraindicated in?

A

Contraindicated in? asthmatic patients (bronchospasm)

22
Q

PAIN & INFLAMMATION (NSAIDs)

2 MAIN SIDE-EFFECTS OF NSAIDs?

A

Gastrointestinal

Cardiovascular

23
Q 
PAIN & INFLAMMATION (NSAIDs)
NSAIDS- GI side-effects
HIGH to LOWEST risk
HIGH?
MEDIUM?
LOW?
LOWEST?
A

HIGH? piroxicam/ketoprofen/ketorolac
MEDIUM? indometacin/diclofenac/naproxen
LOW? ibuprofen
LOWEST? COX-2 selective inhibitors

24
Q

PAIN & INFLAMMATION (NSAIDs)
NSAIDs- CVD side-effects
HIGH?
LOW?

A

HIGH? COX-2 selective inhibitors/ibuprofen 2.4g/diclofenac

LOW? naproxen/ibuprofen 1.2g

25
Q

COX-2 Selective Inhibitors Examples?

A

Celecoxib

Etoricoxib

26
Q

PAIN & INFLAMMATION (NSAIDs)

What increases GI bleed risk/cross-sensitivity?

Use a stomach protectant?

AVOID IN?

A

What increases GI bleed risk/cross-sensitivity? Aspirin

Use a stomach protectant? PPI

AVOID IN?
Renal impairment- risk of fluid retention/further impairment
Pregnancy- caution in breastfeeding
ASTHMA

27
Q

NSAIDS INTERACTIONS?

A

MTX/Lithium- reduces clearance

Cipro- seizures

Blood thinners/SSRIs/Corticosteroids- bleeding

Drugs causing hyperkalaemia, trimethoprim/ACEi/ARB/b-blocker- hyperkalaemia

Drugs causing renal failure- AKI

28
Q
A
29
Q

Hyperuricaemia treatment?

A

Rasburicase

30
Q
A
31
Q

atorvastatin causes?

A

hyperglycaemia

32
Q

GLIPTINS, RTI INFECTION?

A

Yh, interstitial lung disease

33
Q

dose for allopruionol and colchicije and ibuprofen in GOUT

A

allo 100mg mild

300-600mg moderate severe

34
Q

GOUT DOSING?

A

Gout: Acute
1st Line: NSAIDs e.g. Diclofenac, Naproxen
Ibuprofen: initially 300-400mg TDS-QDS
Diclofenac: 75-150mg OD in 2-3 divided doses
Alt: Colchicine: max 500mcg BD-QDS max 6mg per course and do not repeat course in 3 days
Gout: Prevention
1st Line: Allopurinol: Initially 100mg OD
2nd Line: Feboxust
Alt: Sulfinpyrazone (initiation may precipitate an acute attack)

35
Q

IBANDRONIC ACID OSTEOPOROSIS?

A

150mg monthly

36
Q

GOUT

Patient on diuretic+antihypertensive, treatment?

A

COLCHICINE

Avoid NSAID cos hyperkalaemia/renal impairment L

37
Q

GOUT DOSING?

A

Gout: Acute
1st Line: NSAIDs e.g. Diclofenac, Naproxen
Ibuprofen: initially 300-400mg TDS-QDS
Diclofenac: 75-150mg OD in 2-3 divided doses
Alt: Colchicine: max 500mcg BD-QDS max 6mg per course and do not repeat course in 3 days
Gout: Prevention
1st Line: Allopurinol: Initially 100mg OD
2nd Line: Feboxust
Alt: Sulfinpyrazone (initiation may precipitate an acute attack)

38
Q

drug to avoid in gout?

A

bendroflumethiazide

GPhC BNF (48 decks)

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