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Top 100 Drugs > Musculoskeletal system > Flashcards

Musculoskeletal system Flashcards

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1
Q

common indications for allopurinol (3)?

A
  1. prevent recurrent attacks of gout
  2. prevent uric acid and calcium oxalate renal stones
  3. prevent hyperuricaemia and tumour lysis syndrome
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2
Q

MOA of allopurinol?

A

xanthine oxidase inhibitor

(lowers plasma uric acid conc and reduces precipitation of uric acid in joints and kidneys)

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3
Q

adverse effects of allopurinol (2)?

A

can trigger or worsen acute attack of gout

skin rash (common- can be mild or more serious hypersensitivity reaction i.e. Stevens-johnsons syndrome)

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4
Q

allopurinol should NOT be started under which conditions (3)?

A
  1. acute attacks of gout
  2. recurrent skin rashes
  3. signs of severe hypersensitivity
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5
Q

allopurinol dose should be reduced in pateints with what conditions (2)?

A

renal impairment

hepatic impairment

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6
Q

allopurinol is metabolised in the ____ and excreted by the _____?

A

liver

kidneys

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7
Q

co-prescription of allopurinol with which drugs increases risk of (1) hypersensitivty and (2) skin rash?

A

ACE inhibitors/ thiazides

amoxicillin

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8
Q

how is allopurinol prescribed (start dose and titration)?

A

taken orally w a low start dose and then titrated up according to serum uric acid conc

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9
Q

when starting allopurinol for gout what should be co-prescribed?

A

NSAID e.g. naproxen

or/ colcochine

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10
Q

when allopurinol is used as part of cancer treatment it should be given before/after commencing chemotherapy?

A

before chemotherapy

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11
Q

when should allopurinol be taken in the day?

A

after meals

pts should be encouraged to maintain good fluid intake (2-3litres)

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12
Q

how could you communicate allopurinols purpose to the pt?

A

reduce attacks of gout (or formation of kidney stones)

if they develop a rash seek medical advice!

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13
Q

how should allopurinol use be monitored?

A

serum uric acid conc at 4 weks after starting Tx

(aiming for uric acid conc to < 300umol/L)

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14
Q

treatment with which drugs can increase serum uric acid conc causing gout (3)?

A

thiazides

loop diuretics

aspirin inhibits renal excretion of uric acid and can trigger acute attack

(should always consider drug-induced gout as a cause of new onset joint pain in these pts)

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15
Q

mesalazine and sulfasalazine belong to which drug class?

A

aminosalicyates

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16
Q

common indications for mesalazine and sulfasalazine (2)?

A
  1. mesalazine is first line for mild UC
  2. sulfasalazine is an option for managing RA
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17
Q

sulfasalazine is a DMARD- what does this stand for?

A

Disease- Modifying AntiRheumatic Drug

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18
Q

MOA of mesalazine and sulfasalazine?

A

release 5-aminosalicyclic acid (5-ASA)

(has anti-inflammatory and immunosuppressive effects)

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19
Q

side effects of mesalazine and sulfasalazine (

A

GI upset and headache (common)

blood abnormlaities (rare but serious)

renal impairment

sulfasalazine can also cause oligospermia in men

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20
Q

lasalazine and sulfasalazine are salicylates like which other drug?

A

aspirin

pts with aspirin hypersensitivity should not take these drugs

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21
Q

common indications for azathioprine (3)

A
  1. maintainance of remission of Crohns and UC
  2. DMARD in RA and autoimmune conditions
  3. prevent organ rejection in transplant recipients
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22
Q

what is the main metabolite of azathioprine and its MOA?

A

6-mercaptopurine

(inhibit synthesis of purines therfoer inhibiting DNA and RNA replication)

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23
Q

which enzymes are involved in the metabolism and elimination of azathioprine (2)?

A

xanthine oxidase

thiopurine methyltransferase (TPMT)

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24
Q

adverse effects of azathioprine (4)?

A

nausea (common)

hypersensitivity (D&V, rash, fever, myalgia)

bone marrow suppression (v serious)

hepatotoxicity/ inc tumour risk i.e. lymphoma (rare but serious)

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25
what test should be performed before starting azathioprine therapy?
TPMT phenotyping those with absent TPMT activity should not recieve prescription (those w low activity should only be treated by specialist)
26
dosage of azathioprine should be reduced in what circumstances (2)?
hepatic and renal impairment
27
is azathiprine safe in pregnancy?
unclear- shoul dnot be initiated in pregnancy but can be continued in those already established on Tx where benefits outweigh risk
28
is azathioprine safe to be coprescribed with allopurinol?
No- reduce metabolism of azathioprine and inc risk of toxicity
29
how is azathiorpine administered?
oral (preferred) and IV (should be diluted and given as infusion)
30
pts taking azathioprine should seek urgent medical advice if the develop the following (3)?
sore throat/fever (infection) bruising/bleeding (low platelet count) D&V/abdo pain (hypersensitivity)
31
how should azathiorpine be monitored?
FBC weekly for first 4 weeks and 3 monthly thereafter
32
common indications for calcium and vitamin D (5)?
1. osteoporosis 2. chronic kidney disease 3. severe hyperkalaemia (calcium) 4. hypocalcaemia 5. vitamin D deficiency (rickets and osteomalacia)
33
why does the body require calcium?
essential for normal function of muscle, nerves, bone and clotting
34
how is calcium homeostasis managed?
parathyroid hormone and vitamin D
35
calcium and vitamin D should be avoided under which circumstances?
hypercalcaemia
36
oral calcium reduces the absorption of which drugs (4)?
iron biphosphonates tetracyclines levothyroxine
37
Calcium administered IV should never be allowed to mix with what other substance?
sodium bicarbonate- risk of precipitation
38
how should pts with severe hyperkalaemia be monitored after admin of calcium gluconate?
12 lead ECG
39
what dose of calcium gluconate should be given as first line treatment in hyperkalaemia?
10mL calcium gluconate 10% IV over 5-10 mins
40
common indications for methotrexate (3)
1. disease modifying for RA 2. chemotherapy adjuvant 3. severe psoriasis (inc. psoriatic arthritis)
41
MOA of methotrexate?
inhibits dihydrofolate reductase has an antinflammatory and immunosuppressive effect
42
adverse effects of methotrexate (3)
mucosal damage (sore mouth, GI upset) bone marrow suppression (neutropenia, inc risk of infection) hepatic cirrhosis/ pulmonary fibrosis (long term effects)
43
is methotrexate safe in pregnancy?
No- teratogenic men and women should use effective contraception for 3 months after stopping treatment
44
methotrexate is contraindicated in what condition?
severe renal impairment should also be avoided in those with abnormal liver function
45
how often is methotrexate prescribed?
once weekly
46
what should be emphasised when explaining methrotrexate to the patient?
only taken once a week not daily to seek urgent medical advice if they develop a sore throat/fever
47
how should methotrexate be monitored?
monitor symptoms- examine sore joints blood tests for inflammatory markers FBC, liver and renal function prior to Tx and 1-2 times weekly until established 2-3 times monthly thereafter
48
role of F1 in methrotrexate prescribing?
should NOT initiate prescription may review and continue but always seek senior advice
49
examples of NSAIDs (3)?
naproxen ibuprofen etoricoxib
50
common indications for NSAIDs (2)
1. 'as needed' for mild-moderate pain 2. treat regular pain related to inflammation e.g RA
51
MOA of NSAIDs?
inhibit prostaglandin synthesis from arachidonic acid by inhibiting COX
52
adverse effects of NSAIDs (3)?
GI toxicity renal impairment inc risk of cardio event i.e MI/stroke
53
NSAIDs should be avoided under which circumstances (4)?
severe renal impairment heart failure liver failure NSAID hypersensitivity
54
how long for NSAIDs before full antiinflammatory effect is seen?
3 weeks
55
to minimise GI upset how should NSAIDs be taken?
with or after food
56
how should NSAIDs be monitored?
assess symptoms Biochemical if existing renal impairment
57
what should be considered as being coprescribed with NSAIDs paerticularly in those \>65yrs ?
gastroprotection i.e PPI such as lansoprazole daily
58
common indications for paracetamol (2)?
1. first line analgesic of acute and chronic pain 2. antipyretic that can reduce fever
59
MOA of paracetamol?
poorly understood weak inhibitor of COX/ weak antiinflammatory
60
paracetamol overdose causes what?
liver failure
61
in paracetamol overdose which toxic metabolite accumulates? what does this result in?
NAPQI (N-acetyl-p-benzopuinone imine) hepatocellular necrosis
62
paracetamol dosing should be reduced in which pt groups (3)?
those w inc risk of liver toxicity (excess alcohol use) reduced glutathione stores (malnutrition/low body weight (\<50kg)) severe hepatic impairment
63
what is prescribed to combat paracetamol overdose?
acetylcysteine
64
when prescribing paracetmol what is important to check on the pts chart?
co-drugs such as co-codamol with 'hidden' paracetamol
65
common indications for quinine (2)?
1. night-time leg cramps 2. plasmodium falciparum malaria
66
adverse effects of quinine?
usually safe at recommended doses however potentially v toxic and fatal in overdose tinnitus, deafness, blindness GI upset hypersensitivity reactions hypoglycaemia
67
what effect does quinine have on the hearts rythym?
prolongs the QT interval and can predispose to arrythmias
68
quinines should be prescribed with caution in which pt groups?
those with hearing or visual loss G6PD deficiency pts takign drugs that prolong the QT interval (i.e amiodarone, antipsychotics, quinolones) pregnancy
69
how should quinine be monitored?
after 4 weeks if no improvement in leg cramps stop prescription as unlikely to see any benefit advise patient to report any hearing loss/ visual disturbance/ palpitations immediately
70
before starting quinine for nocturnal leg cramps what should be considered first (2)?
reversible causes- electrolyte disturbances / drug causes (statins) non pharmacological management i.e passive stretching exercises

Top 100 Drugs (13 decks)

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