Ortho/Rheum

Question 1

Medications to Treat Gout?

Answer 1

#1 - NSAIDs (Indomethacin, Celecoxib
#1 - Colchicine (used to be 1st line but has a narrow TI).
#2 - Corticosteroids (Prednisone, Triamcinolone).
#3 - Uricosuric Agents (Allopurinol, etc).

Question 2

Identify all Uricosuric Agents?

Answer 2

Probenecid, Allopurinol, Febuxostat, Lesinurad, Pegloticase.

Question 3

Black Box Warning for Lesinurad?

Answer 3

increased risk of ARF when used as monotherapy.

Question 4

Medications to treat SLE?

Answer 4

NSAIDs, Hydroxychloroquine, CS (Methylprednisone, Prednisone), Methotrexate, Cyclophosphamide, Azathioprine, Mycophenolate, Belimumab.

Question 5

What are opioids?

Answer 5

Natural or synthetic compounds that mimic the actions of opiates; they are derived from opium poppy.

Question 6

Name some muscle relaxants?

Answer 6

Baclofen, Carisoprodol, Chlorzoxazone, Cyclobenzaprine, Metaxalone, Methocarbamol, Orphenadrine, Tizanidine.

Question 7

MOI and AEs of Baclofen?

Answer 7

MOI - analog of GABA; works at SC level to reduce both flexor and extensor spasms. May cause hyperpolarization of afferent terminals leading to inhibition of monosynaptic and polysynaptic.

AEs - drowsiness, dizziness, weakness, fatigue, confusion, HA, nausea.

Question 8

MOI and AEx of Carisprodol?

Answer 8

MOI - exact is unknown; may work centrally in SC or in descending reticular formation to produce muscle relaxation.

AEs - drowsiness, dizziness, HA.

Question 9

Indications and Cautions with Carisprodol?

Answer 9

Indications - relief of discomfort assoc. w/acute, painful MSK conditions.

Cautions - use w/other CNS depressants, is a controlled substance w/abuse potential; CI in acute intermittent porphyria, has Idiosyncratic reactions (extreme weakness, dizziness, vision loss, euphoria and confusion).

Question 10

MOI and AEs of Cylclobenzaprine?

Answer 10

MOI - unknown; does not act directly on skeletal muscle or at NMJ. Exerts effect by acting at brain stem to reduce tonic somatic motor activity influencing both alpha and gamma motor neurons.

AEs - drowsiness, dizziness, dry mouth, fatigue, asthenia, N/C, dyspepsia, unpleasant taste, HA, nervousness and confusion.

Question 11

Indications and Cautions with Cyclobenzaprine?

Answer 11

Indication - relief of skeletal muscle spasm assoc. w/acute, painful MSK conditions.

Cautions:

• other CNS depressants; Hx of urinary retention, glaucoma and increased IOP.
• CI in CHF, Hyperthyroidism, Arrhythmias, during acute recovery of MI (due to anticholinergic effects).
• Serotonin syndrome if used w/SSRI’s, SNRI’s, TCAs, etc.

Question 12

MOI and AEs of Orphenadrine?

Answer 12

MOI:

• unknown; structurally similar to Diphenhydramine.
• anticholinergic activity in the brainstem.
• Euphoric and analgesic properties.

AEs - anticholinergic effects, HA, drowsiness, tachycardia, CNS stimulation, dizziness, pruritus, rash, syncope.

Question 13

Indications and Cautions w/Orphenadrine?

Answer 13

Indications -

Cautions:

• other CNS depressants.
• abuse potential.
• injection contains sulfites; CI in sulfa allergy.
• typical anticholinergic cautions/CI.

Question 14

MOI and AEs of Tizanidine?

Answer 14

MOI:

AE:

• dry mouth, drowsiness, asthenia, bradycardia, hypotension, dizziness.
• Monitor LFTs and blurred vision.

Question 15

Indications and Cautions of Tizanidine?

Answer 15

Indications - short-term mgmt of spasticity.

Cautions:

• other CNS depressants.
• Hypotension so cautious use w/other antihypertensives, elderly pt’s.

Question 16

Indications and Cautions w/Baclofen?

Answer 16

Indications - S/Sx of spasticity from MS - flexor spasms and concomitant pain, clonus and muscular rigidity.

Cautions:

• other CNS depressants.
• impaired renal function.
• don’t d/c abruptly; risk of hallucinations and seizures.

Question 17

MOI and AEs of Chlorzoxazone?

Answer 17

MOI:

• unknown; sedative effects.
• may block interneuronal conduction in SC and subcortical brain areas by depressing polysynaptic reflexes.

AEs - drowsiness, dizziness, paradoxical excitement, malaise, rash.

Question 18

Indications and Cautions of Chlorzoxazone?

Answer 18

Indications - relief of discomfort assoc. w/acute, painful MSK conditions.

Cautions - other CNS depressants.

Question 19

Inhibit PG synthesis by decreasing the activity of Cyclooxygenase (reversible)?

Answer 19

NSAIDs - naproxen, ibuprofen, Diclofenac, Indomethacin, Piroxicam, Meloxicam, Celecoxib, ASA.

Question 20

2 BBW of NSAIDs?

Answer 20

• increased risk of adverse CV events.

- increased risk of GI irritation, ulceration, bleeding or perforation.

Question 21

MOI and AEs of Metaxolone?

Answer 21

MOI:
-unknown, no direct effect on skeletal muscle but may disrupt spasm-pain-cycle through general CNS depression.

AEs - N/V, HA, nervousness, drowsiness, dizziness.

Question 22

Indications and Cautions of Metaxolone?

Answer 22

Indications - relief of skeletal muscle spasm assoc. w/acute, painful MSK conditions.

Cautions:

• other CNS depressants.
• Serotonin Syndrome if used w/SSRIs, SNRIs, TCAs, etc.

Question 23

MOI and AEs of Methocarbamol?

Answer 23

MOI:

• unknown; though to work at SC level by inhibiting flexor and crossed extensor reflexes.
• causes sedation.

AEs - N, pruritus, rash, blurred vision, HA, fever, drowsiness, dizziness.

Question 24

Indications and Cautions of Methocarbamol?

Answer 24

Indications - relief of discomfort assoc. w/acute, painful MSK conditions.

Cautions:

• other CNS depressants.
• Abrupt d/c can cause withdrawal Sx.