Musculoskeletal and Immune Therapies – Module 9

What is the primary mechanism of action of bisphosphonates?

They inhibit bone resorption by preventing osteoclasts from breaking down bone.

Name three bisphosphonates commonly used in clinical practice.

Alendronate (PO), Risedronate (PO), and Zoledronic Acid (IV).

List four major conditions for which bisphosphonates are indicated.

Osteoporosis in post-menopausal women, osteoporosis in men, glucocorticoid-induced osteoporosis, and malignancies with bone metastasis.

Why must serum calcium, vitamin D, and renal function be monitored in patients taking bisphosphonates?

Adequate calcium/vitamin D and normal renal function are needed for therapy effectiveness and to reduce adverse effects.

Which gastrointestinal adverse effects often lead to discontinuation of oral bisphosphonates?

Gastro-esophageal reflux, esophagitis, and esophageal/gastric ulcers.

Name two rare but serious skeletal adverse effects associated with long-term bisphosphonate therapy.

Atypical femur fractures and osteonecrosis of the jaw.

What posture instruction should follow the ingestion of an oral bisphosphonate?

Remain upright (sitting or standing) for at least 30 minutes.

How long before any morning oral intake should a patient take their bisphosphonate tablet?

At least 30 minutes before eating, drinking (other than water), or taking other medications.

When should invasive dental procedures be planned in relation to starting bisphosphonate therapy?

Preferably before therapy begins; notify the prescriber if procedures are planned during therapy.

What lifestyle modifications are encouraged for patients on bisphosphonates?

Increase dairy (calcium) intake and perform regular weight-bearing exercise.

What is the mechanism of action of Disease-Modifying Antirheumatic Drugs (DMARDs)?

They suppress the overactive immune and inflammatory responses that drive rheumatoid arthritis.

List three commonly prescribed DMARDs.

Methotrexate, Sulfasalazine, and Hydroxychloroquine.

State three therapeutic goals achieved by DMARDs in rheumatoid arthritis.

Decrease pain and inflammation, reduce or prevent joint damage, and preserve joint structure and function.

Why must women avoid pregnancy for 24 months after stopping methotrexate?

Methotrexate is teratogenic and can cause severe fetal harm.

Which two DMARDs are considered immunosuppressants, increasing infection risk?

Methotrexate and Sulfasalazine.

Which laboratory test is routinely monitored to detect hepatotoxicity in patients on methotrexate?

Liver function tests (e.g., ALT, AST).

How long does it typically take before clinical improvement is seen after starting a DMARD?

Approximately 4–6 weeks.

Besides hand hygiene, what other infection-prevention advice should be given to patients on immunosuppressive DMARDs?

Avoid sick people and crowded places.

What enzyme is inhibited by antigout drugs like allopurinol, and what is the result?

Xanthine oxidase; inhibition blocks the production of uric acid.

Which two drugs are classified as antigout medications in this module?

Allopurinol and Colchicine.

State two common indications for allopurinol therapy.

Treatment of gouty arthritis/nephropathy and management of secondary hyperuricemia.

Why should patients on allopurinol increase their daily water intake?

Adequate hydration helps prevent kidney stone formation by diluting urinary uric acid.

How should antigout drugs be scheduled relative to meals?

They should be taken after meals to minimize gastrointestinal upset.

What serious hepatic adverse effect can occur with allopurinol, necessitating liver monitoring?

Hepatitis.

In renal impairment, what adjustment is required for the allopurinol dose?

The dose must be reduced.

A prescription reads Allopurinol 50 mg PO BID; the tablets are scored 100 mg. How many tablets should be administered per dose and is splitting acceptable?

Half a tablet per dose; splitting is safe because the tablet is scored.

A vial of methotrexate is labeled 1 g/40 mL. What is its concentration in mg/mL?

25 mg/mL.

How many millilitres of a 50 mg/mL methotrexate solution are required to deliver a 25 mg dose?

0.5 mL.

A patient needs 160 mg adalimumab on Day 1; the concentration is 100 mg/mL. What volume is required?

1.6 mL.

Calculate the safe weekly dosage range of a DMARD ordered at 0.3-0.6 mg/kg/week for a 60 kg patient.

18 mg to 36 mg per week.

What type and size of syringe is appropriate to administer 0.5 mL of intramuscular methotrexate?

A 1 mL syringe.