summary of drugs used in MSK conditions

Question 1

what drugs are used for acute flare ups of gout?

Answer 1

NSAIDs and colchicine

Question 2

what drug is used for chronic prevention of gout

Answer 2

allopurinol

Question 3

dose of NSAIDs for gout

Answer 3

usually high dose for a few weeks
ibuprofen 400-800mg
naproxen - 750mg stat then 250mg tds for 7 days

Question 4

efficacy of NSAIDs for gout

Answer 4

moderate to good

Question 5

safety of NSAIDs for gout

Answer 5

short term ok
can cause GI bleed, renal or heart failure if high dose for long term taken

Question 6

suitability of NSAIDs for gout

Answer 6

inexpensive
easy to take
contraindications with GI or cardiac disease

Question 7

efficacy of colchicine for gout

Answer 7

very good

Question 8

safety of colchicine for gout

Answer 8

nausea and diarrhoea very common
bone marrow suppression and renal failure over longer term

Question 9

suitability of colchicine for gout

Answer 9

good option if cannot taken NSAIDs
similar efficacy to naproxen but 2x greater risk of diarrhoea

Question 10

dose of colchicine for gout

Answer 10

0.5 mg ds for 3-4 days
stop if D/V
should not exceed 6mg in one course

Question 11

mechanism of colchicine

Answer 11

depolarisation of microtubules to inhibit granulocyte migration and lymphocyte migration and division
tubulin disruptor

Question 12

which corticosteroids are used for gout

Answer 12

local injection if only a single joint is affected
systemic (tablets) oral prednisolone if severe

Question 13

suitability of corticosteroids for gout

Answer 13

great for those who cannot have NSAIDs or colchicine
usually elderly with comorbidities

Question 14

mechanism of allopurinol

Answer 14

xanthine oxidase inhibitor

Question 15

efficacy of allopurinol for gout

Answer 15

very good

Question 16

interactions of allopurinol

Answer 16

purine analogues, theophylline

Question 17

dosage of allopurinol for gout

Answer 17

100mg daily unitially
check uric acid levels after a few weeks
up-titrate to desired level

Question 18

mechanism of febuxostat

Answer 18

non-purine xanthine oxidase inhibitor

Question 19

how do bisphosphonates work for osteoporosis

Answer 19

analogues of pyrophosphate
attach to bone crystals and inhibit osteoclast breakdown of bone

Question 20

safety of bisphosphonates

Answer 20

GI upset is main problem

Question 21

how does denosumab work for osteoporosis

Answer 21

monoclonal antibody - RANK ligand inhibitor
reduces osteoclast activation, differentiation, and survival

Question 22

suitability of denosumab for osteoporosis

Answer 22

recommended by NICE if patient cannot have bisphosphonate
only needs 1 subcut injection every 6 months

Question 23

other drugs for osteoporosis

Answer 23

raloxifene - oestrogen like molecule
teriparatide - recombinant PTH, intermittent use activates osteoblasts to deposit bone

Question 24

older DMARDs for RA

Answer 24

sulfasalazine
methotrexate
leflunomide
gold

Question 25

how does methotrexate work

Answer 25

anti IL-2 agent folic acid antagonist

Question 26

side effects of methotrexate

Answer 26

immunosuppression liver toxicity lung damage

Question 27

mechanism of infliximab

Answer 27

human mouse monoclonal antibody TNF alpha blocking agent

Question 28

mechanism of etanercept

Answer 28

recombinant DNA human TNF alpha receptor p75 fusion protein binds to TNF to stop its activity

Question 29

mechanism of adalimubab

Answer 29

human monoclonal antibdoy TNF alpha blocking agent

Question 30

main drugs for ankylosing spondylitis

Answer 30

adalimubab or etanercept

Question 31

main drugs for psoriatic arthritis

Answer 31

adalimubab etanercept infliximab

Question 32

main drug for juvenile idiopathic arthiritis

Answer 32

etanercept

Question 33

whihc steroids are given via local injection in rheumatology

Answer 33

triamcinolone methylprednisolone

Question 34

whicih steroid is taken orally in rheumatology

Answer 34

prednisolone

Question 35

which steroids are taken via IV in rheumatology

Answer 35

hydrocortisone methylprednisolone

Question 36

side effects of too many steroids

Answer 36

Cushings disease - osteoporosis - obeisty - moon face - hypertension - hy[erglycaemia - striae - hypokalaemia- - myopathy - psychiatric symptoms

Question 37

side effects of too little steroids

Answer 37

addisons disease - nausea/vomiting - headache - joint pain - fever - hypoglycaemia - hypotension - hyperkalaemia