Musculoskeletal Flashcards

1
Q

What drugs are considered DMARDs?

A

Methotrexate, cytokine modulators, azathioprine, ciclosporin, cyclophosphamide, leflunomide, penicillamine, gold, antimalarials and sulfasalazine.

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2
Q

What is the next step in pain relief for a patient taking 75mg aspirin, 4g paracetamol, 5mg Ramipril and 20mg simvastatin daily with osteoarthritis.

A

Opioid. Considered before NSAID if taking low dose aspirin.

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3
Q

Is paracetamol or an NSAID started in first instance with axial spondyloarthritis?

A

NSAIDs

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4
Q

What combination is given to patients newly diagnosed with active rheumatoid arthritis and within what ideal time frame?

A

DMARD and short term corticosteroid. Ideally within 3 months of onset of persistent symptoms.

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5
Q

How long does leflunomide take for therapeutic effect to start?

A

4 - 6 weeks

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6
Q

Which drugs are most commonly used in juvenile idiopathic arthritis?

A

Methotrexate, sulfasalazine if not systemic onset. Cytokine modulators.

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7
Q

What monitoring requirements are there with hydroxychloroquine?

A

Opthalmological examination and continue to ask about visual symptoms

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8
Q

A patient is 90kg and 165cm tall, the maximun dose this patient can receive in a day is 585mg (6.5mg/kg). True or false.

A

False. Must use ideal body weight

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9
Q

What monitoring and advice is given with leflunomide?

A

Discontinue treatment or reduce dose with liver function abnormalities. Use contraception at least 2 years after treatment and 3 months in men unless washout procedure used (colestyramine/charcoal) until metabolise less than 20mcg/l. Monitor FBC and blood pressure also.

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10
Q

What advice should be given with penicillamine?

A

Must go for regular tests for platelets and proteinuria - can be a sign of nephropathy. Discontinue if toxicity occurs. Tell doctor if sore throat, fever, bleeding, bruising, mouth ulcers or rashes occur.

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11
Q

What is used in acute gout?

A

High dose NSAIDs. Colchicine if contraindicated eg heart failure where fluid retention would occur, or when recieveing anticoagulants.

Corticosteroids, canakinumab

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12
Q

When are xanthine oxidase inhibitors started? What may be started alongside?

A

1 - 2 weeks after an episode of gout has settled, to prevent further. Antiinflammatories or colchicine should be used as they can precipitate an actual attack, and continue for one month after Hyperuricaemia corrected (3-6 months)

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13
Q

What should be advised with allopurinol treatment?

A

Ensure adequate fluid intake (2-3 litres per day) especially in first few weeks or with cancer therapy. Rash may occur and discontinue (may reintroduce if mild)

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14
Q

What action should be taken if an acute attack of gout occurs while on prophylactic therapy?

A

Continue prophylactic and treat attack as well

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15
Q

Do anticholinesterases enhance or impair neuromuscular transmission?

A

Normally enhance. But impair at excessive dosage

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16
Q

What side effects are associated with anticholinesterases? What drugs may be given alongside?

A

Sweating, increased saliva, gastro intestinal and uterine motility and bradycardia. Antimuscarinics eg atropine or propantheline.

17
Q

How are pyridostigmine and neostigmine compared?

A

Pyridostigmine less powerful and slower but longer duration of action (less frequent dosing). Better for patients whose muscles are weak on waking and it’s smoother action

18
Q

How should baclofen be introduced and stopped and why?

A

Slowly to avoid major side effects of sedation and muscular hypotonia. Stopped over 1-2 weeks also.

19
Q

How long until quinine is effective and how often should it be reviewed?

A

Up to 4 weeks and review every 3 months.

20
Q

What should be monitored with tizanidine?

A

Liver function monthly and in unexplained nausea anorexia or fatigue. Discontinue if enzymes persistently raised.

Monitor blood pressure on withdrawal and risk of rebound hypertension and tachycardia. (discontinue gradually)

21
Q

How long does the anti inflammatory effects of NSAIDs take to achieve?

A

Up to 3 weeks

22
Q

Are the risks of serious upper GI events higher with selective or non selective COX inhibitors? Examples?

A

Non selective
Piroxicam, ketoprofen, ketorolac highest risk.
Indomethacin Diclofenac, naproxen intermediate

23
Q

Which NSAIDs are associated with higher risk of thrombotic events?

A

Diclofenac, naproxen and ibuprofen. Etoricoxib

24
Q

What can occur with alcohol consumption and NSAIDs?

A

Haemorrhage and AKI

25
Q

Which is most suitable for lower back pain if NSAIDs are not suitable - opioid or paracetamol?

A

Opioid alone or with paracetamol. Paracetamol alone is ineffective.

26
Q

What risks are associated with nsaid use in pregnancy?

A

Closure of fetal ductus arteriosus in utero and pulmonary hypertension if used in third trimester. Onset of labour may be delayed and duration increased.

27
Q

What extra advice should be given to females using NSAIDs?

A

Long term use is associated with reduced fertility. Reversible on stopping.

28
Q

What is often done to prevent relapse when reducing corticosteroid doses in rheumatoid arthritis?

A

Pulse doses

29
Q

What doses of prednisolone are given in rheumatoid arthritis? How long?

A

Under 7.5mg daily for 2 - 4 years

30
Q

How is extravasation managed?

A

Corticosteroids, antihistamines, analgesics.
Localise and neutralise - vesicant drugs using antidote and cold compress 3-4 times daily
Or spread and dilute - saline, warm compress, elevation, hyaluronidase.

31
Q

What are the different strengths of capsaicin used fir?

A

0.025% for hand or knee osteoarthritis
0.075% postherpetic neuralgia after lesions or diabetic neuropathy
8% non diabetic neuropathic pain