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Revision Questions: Musculoskeletal (Preview)

Sample Questions

  1. Celecoxib should not be taken by patients allergic to ........................
  2. Glucosamine should not be taken by patients allergic to .......................
  3. True or false: COX-2 inhibitors are associated with a lower GI upset risk than non-selective agents.
  4. True or false: Rectal NSAID formulations reduce the GI ulceration risk where as enteric coated NSAID tablets have no effect on GI ulceration.
  5. A patient takes meloxicam 15 mg daily, pantoprazole 40 mg daily and methotrexate 22.5 mg weekly on the same day. Do you have any concerns?

Sample Answers

  1. Sulfonamides.
  2. Shellfish.
  3. True.
  4. False. Neither enteric coated or rectal NSAID formulations reduce the risk of GI ulceration.
  5. Important findings and recommendations:
    • Coadministration of meloxicam and methotrexate may increase the risk of methotrexate toxicity via a reduction of renal function and methotrexate excretion (especially when the dose is >20 mg/week). Also, meloxicam may contribute to fluid retention, cardiovascular complications, and gastrointestinal irritation when used on a long-term basis. Recommend replacement of meloxicam with paracetamol 500mg 2 qid for pain relief.
    • Pantoprazole may be drug-induced therapy associated with meloxicam. Coadministration of pantoprazole and methotrexate increases the risk of methotrexate toxicity. Review the need for pantoprazole after ceasing meloxicam. Cease pantoprazole if no longer needed.
    • Review the need for high-dose methotrexate treatment. Reduce dose if possible to minimise risk of adverse effects.

The full version has many more questions with answers included.

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