Musculoskeletal System Flashcards
(31 cards)
First line treatment for rheumatoid arthritis
DMARDS
- Methotrexate
- leflunomide
- sulfasalazine
- hydroxychloriqine (mild)
PLUS NSAIDS FOR PAIN RELIF
- Can be withdrawn when response to DMARD is enough
second line treatment for rheumatoid arthritis
Monoclonal antibodies
- adalimumab
- infliximab
- tocilizumab
what can be used to bridge treatment with DMARDS when rapid suppression is required?
Corticosteroids
can you give methotrexate and ibuprofen together?
OTC- NO!
On prescription- yes, monitoring is required
- can reduce MTX clearance -> increase risk of toxicity
How often is MTX given?
What is given with it?
Once weekly- DAY clarified on prescription with NUMBER of tablets and TOTAL dose
- e.g. take 6 tablets (15mg) on a monday
Folic acid is co-prescribed
- given on a DIFFERENT day of the week
What signs must a patient be aware to report?
- 3
Blood disorders- bruising, bleeding, signs of infections, mouth ulcers
Liver toxicity- dark urine, nausea and vomiting, itchy skin
Respiratory effects- SOB, chest pain, coughing
what is the antidote for methotrexate toxicity?
Folinic Acid (calcium folinate)
Which monitoring tests should be done when starting MTX
How often are these done?
FBC
Renal Function
LFTs
- 1-2 weeks until stable
- 2-3 months thereafter
Can MTX be used in pregnancy?
NO
- screen for pregnancy before treatment
What is the advice surrounding contraception with MXT treatment?
Use during treatment and for 6 months after
- for MEN as well as women
Which other anti-folate drugs should be avoided with MTX use?
Trimethoprim (and co-trimoxazole)
Phenytoin
Which other hepatotoxic drugs should be avoided with MTX use?
Rifampicin
Antifungals
what is the interaction with omeprazole and esomeprazole and MTX?
Reduced MTX clearance -> increases risk of toxicity
What is Gout?
Increased uric acid concentration in blood
- causes uric acid crystals in joints and tissues
which drug is likely to exacerbate gout?
Bendroflumethiazide
what is the acute treatment of gout?
Colchicine or high dose NSAID + PPI
- not aspirin
What is the dose of colchicine given?
500MCG 2-4 times a day for MAX 3 days
- do NOT repeat course within 3 days
When is colchicine used over an NSAID?
If they are on a diuretic
- NSAIDs increase fluid retention
When is chronic treatment for gout offered?
Offered in frequent acute gout attacks
- 2 or more in one YEAR
What is given for chronic treatment of gout?
First line: allopurinol
Second line: Febuxostat
What is a common side effect of allopurinol?
Rash
- severe = discontinue immediately
- mild = discontinue until resolved, reintroduce carefully
What can be used for nocturnal leg cramps?
Quinine sulfate- reduces frequency
- trialled for 4 weeks, continue if benefit
- stop every 3 months and review
What are the two properties of NSAIDs
Anti-inflammatory
Analgesic
Who are NSAIDs contraindicated in?
Asthmatics
- due to increased risk of bronchospasms
