Rheum2 Flashcards

Question

What is a side effect of allopurinol which patients should be informed of?

Answer 1

Allopurinol Hypersensitivity syndrome Maculopapular rash can be Desquamating fever hepatitis Eosinophilia Usually occurs in first 3 months of treatment CAN BE FATAL! **Tell patients to seek urgent medical attention if a skin rash develops**

Answer 2

Asian descent (esp Han Chinese) HLA B\*5801 allele also ppl who commence on high dose renal impairment elderly **PROBENECID** is an alternative

Answer 3

vertebral bodies distal radius proximal humerus pelvis proximal femur **CONSIDER OP in any person over 50 with a min trauma fracture** (NB fractures of fingers/toes/face/skull are usually not osteoporotic)

Answer 4

-1 to -2.5 = osteopenia Below minus 2.5 is osteoporosis Above minus 1 is normal bone This is number of SD's away from 'young normal mean' at any major skeletal site This is mainly done in older people

Answer 5

In premenopausal women, men younger than 50 and kids Z is the number of SD"s away from AGE and SEX matched mean **A Z score below -2 is below the expected range and warrants investigation for a secondary cause of low bone density**

Answer 6

**Plain xrays** can identify fractures Vert fractures are painless in 70% of cases but can be used in patients with significant loss of height - **3cm or more or Kyphosis.** _{specialists use bone turnover markers like serum fasting P1NP and CTX (gps dont use these regularly)}

Answer 7

1. Age over 50 with a minimal trauma fracture of **hip or vertebrae** 2. Age over 50 with minimal trauma fracture at proximal femur/humerus or distal radius AND BMD of less than **1.5(if bmd is higher - then refer to specialist)** 3. In a patient over 70 who is being screened for OP with a BMD of less than -2.5 (if BMD higher then do Garvan fracture risk calculation) 4. In a patient under 70 with risk factors for OP with a BMD of less than -2.5 (If BMD higher then do Garvan fracture risk calculation)

Answer 8

Anyone over 70 Anyone under 70 with risk factors for OP

Answer 9

Ageing Female White/Asian race Previous low impact fracture Late Menarche Post Menopausal Family history of OP short stature

Answer 10

Smoking Nutritional deficiencies - vitamin D deficency and low calcium intake Alcohol intake Sedentary lifestyle Immobilisation

Answer 11

**CDC FEM W** **Chronic** - heart/liver/kidney **Drugs** - antiepileptics, thiozolidenediones, aromatase inhibitors, glucocrticoids **Connective tissue disease** - eg Rheumatoid **Falls** - visual impairment, balance disorders, muscle weakness, sedating drugs **Endocrine** - cushings, sex hormone deficiencies in women and men, hyperthyroid, hyperparathyroid **Malabsorption** - Coeliac disease, gastric/bowel resection, bariatric surgery **Weight** - low body weight, increased weight loss eg anorexia nervosa

Answer 12

Do a BMD If Less than - 1 - commence treatment as primary prevention

Answer 13

Pre-menopausal women young men (less than 50 years) SEEK SPECIALIST ADVICE TO GUIDE MX In men think about - hypogonadism, smoking, steroids, anti epileptics, etoh excess, vitamin D deficiency

Answer 14

ALP CMP TSH VITAMIN D LFT and UEC Then for different causes - eg PTH, Urine and serum protein electrophoresis, coeliac serology, sex hormones, 1mg overnight dexamethasone suppression test

Answer 15

1. Secondary cause suspected 2. women of child bearing age and preg women 3. post transplant 4. patients with osteoporosis and CKD (esp if gfr is less than 35)

Answer 16

1. Falls Prevention * Podiatric check for neuropathy * Podiatrist - cut toe nails * Podiatrist - optimise foot wear * OT home assessment - carpets, walking aids, lighting * Exercise FOR mobility, balance and strength * Review meds that can cause OP and Postural hypotension * Opthalmology review - assess and optimise vision * Referral to a FALLS prevention clinic 2. Advise and assist all patients at risk of minimal trauma fracture - PHYSIO review for improving balance and exercise program - 30mins/most days and 2-3 resistance sessions - Avoid Excess alcohol or coffee - Stop smoking - Maintain ideal body weight - Ensure adequate vitamin D and calcium intake CONSIDER an oral calcium supplement (600mg) if calcium intake is insufficient

Answer 17

1. BISPHOSPHONATE - Alendronate 70mg once weekly on an empty stomach Bisphosphonates inhibit osteoclasts to minimise upper GI adverse affects - 1. Take FIRST THING in the morning on an empty stomach 2. Remain upright at least 30 minutes after taking them 3. Avoid food and drink immediately after (affects absorption) no supplements eg calcium for 2 hours after. CONTRAINDICATIONS to BISPHOSPHONATES Dysphagia Achalasia unable to remain upright for 30 minutes

Answer 18

Upper GI - gastritis, oesophagitis, nausea, constipation, Rarely osteonecrosis of the jaw Maintain good oral hygiene and see dentist before commencement

Answer 19

5mg IV yearly Can cause flu like symptoms (usually at first dose) Can cause **hypocalcaemia - esp if low vit D or renal issues** Safe for use as long as: **Vitamin D over 50** **normal serum calcium** **EGFR is over 35** **Patient is well hydrated**

Answer 20

in High risk continue bisphosponates for 10 years and zoledronic for 6 years - 75 and older - previous hip or verteberal frac - Hip Tscore less than -2.5 - had a min trauma frac after commencement of treatment IF LOW RISK - then 5 years after bisphos or 3 years after zoledronic - consider stopping

Answer 21

Direct measurements of BMD at hip and spine 2 years after starting treatment 1-2 years after significant change in treatment If High risk patient or on glucocorticoid therapy consider more frequent monitoring

Answer 22

Its a MONOCLONAL ANTIBODY **60mg subcutaneous ever 6 months** which is also anti resorptive Decreases osteoclast formation and increases Apoptosis ITS a SUBCUTANEOUS DOSE every six months (useful if patient has adverse GI side effects) - WITHDRAWL OF Denosumab has been associated with MULTIPLE FRACTURES **CAN BE GIVEN TO RENAL PATIENTS**

Answer 23

IN women at risk of BREAST CANCER - can reduce risk most appropriate for younger Post menopausal women (under age of 60) Does increase VTE Risk and increases hot flushes

Rheum2 Flashcards

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