Musculoskeletal

• NSAIDS

  1. Nonselective anti-inflammatory drugs used in mild cases tablets suspension on topical gel
  2. Interfered with autacoids for self healing production which induced pain and mediators including histamine and nitric oxide and eicosanoids
  3. eicosanoids from arctic acid which produces prostaglandins TXA2 and leukotrienes
• Cyclo oxygenase

  1. Cox one is involved in housekeeping and Cox two is involved in things go wrong to an inducible enzyme.
• Different prostaglandins

  1. PGD2 is invaded dilator and inhibits platelet aggregation
  2. PGE2 is a vasodilator and inhibits gastric acid and increases gastric mucus secretion
  3. PGF2 is a bronchoconstrictor
  4. TXA two is a vasoconstrictor and is involved in activating platelets
  5. LTB4 helps white blood cells go to injured sites
  6. LTC4 and LTD4 a bronchoconstrictors
• How do NSAIDs work?

  1. Inhibit or suppress Cox so therefore prostaglandins don’t get produced and reduce produce inflammatory antipyretic and analgesic effects
  2. Some are selective inhibitors of different enzymes and inhibit cox 1 to to produce side effects
  3. Do not reduce joint destruction
  4. bind irreversibly to the site of COX enzymes that accept arcadonic acid
  5. platelets unable to produce TXA2
  6. calcium levels do not rise and platelets remain inactive and require Cox 1
• Side effects of NSAIDS

  1. Disturbances gastric discomfort dyspepsia
  2. Vomiting, nausea ulceration GI bleeding and skin rashes
• renal function

  1. PGE2 and PGI2 are prostaglandins involved in blood flow and inhibiting prostaglandins means blood flow is reduced
• Selective cox 2 inhibitors

  1. Remove the unwanted side effects associated with cox 1
  2. Drug binding site contain a side pocket that accommodate for bulky size Cox to inhibitors
  3. Contraindicated with patients with ischaemic heart disease peripheral artery disease
  4. Related to Cox 1 enzyme which normally produces PGI2 and TXA2 so inhibiting Cox 1 means to prevent a blood clot formation as no TXA2 is activated and the balance shift towards TXA2
• Capsules

  1. Dosage form of powder semi-solid or liquid
  2. Enclose in a shell usually made up of gelatine or polymers hard and soft shell
  3. High bio availability rapidly dissolves and releasing contents
  4. Gelatine is the partial hydrolysis of collagen from animals, skin or bones that’s colourless or translucent and dry and elastic when exposed to moisture
  5. Cheap to produce plenty of supply easily readily soluble but religiously vegan vegetarians to consider
  6. Heavy sensation, bloating and Heartburn
• Hard shell


  • Cap is slightly higher and diameter to fit over counterpart
  • Softens and dissolves and releases API
• Soft shell


  • Tight with an oily suspension semi solid included
  • Increased bioavailability
• Hard shell


  • Useful for challenging drugs below dosage uniformity issues
  • Fewer exceptions
  • Flexibility allows better oral bioavailability
  • But can be tedious to make
  • High-speed filling equipment more costly
  • Some drugs cannot be encapsulated
• Soft shell


  • Helpful in nonpalatable solutions of suspensions
  • Can deliver low-dose lipid drugs
  • Can be in immediate, slow and sustained release
• • Optimising manufacturing process is difficult
  • The breakage of the waste of all of them
  • Great moisture content
  • Sensitive to temperature so be careful with what drugs can be formulated
• Powder


  Dosage form that includes powders for oral suspensions or reconstitution with water
• Granules


  Dosage form that includes powders for oral suspensions or reconstitution with water
• Particle size and shape


  • Surface area
  • Density
  • Flow compatibility
  • Correct uniformity
• Granulation


  1. Increasing particle size

  2. Agglomeration

  3. Breaking components

  4. Wet granulation by adding water, mixing and removing it
• Bulk powders


  Dispensed in large containers and divided into individually packaged reconstituted by the patient
• Bulk powders can be hygroscopic so moisture is absorbed
• Divided powders


  Contain sodium bicarbonate and citric acid with foil or plastic laminate packaging that protect the hygroscopic products
• RA

  1. Inflammatory chronic condition report immune origin, the proliferation of the joint destruction of the joint cartilage and bone by osteoclasts
  2. Information of cytokines and two across factors with a change in acute plasma proteins
  3. Pain and joint inflamed stiffness, swelling loss of function and weak joints
  4. OA joint swelling due to mechanical stress or abnormal joint mechanics
  5. RA genetic cartilage wears away release mediators erode Cartilage bone and ligaments
• OA and RA

  1. Ra any time relatively rapid weeks to months and OA later in life slower over years
  2. RA painful, swollen stiff generally on both sides of the body with stiffness lasting longer and OA tender or no swelling beginning on one side of the body and spreading to the other evening stiffness
• DMARDS

  1. NSAIDS give systematic relief, but not long-term progression need to improve patient’s ability to perform daily activities
  2. Long-term suppression and improvement of symptoms by reducing joint tenderness swelling progression rates of erosion
  3. Fall in acute plasma proteins and reduce therapy so DMARDS take effect
  4. Short term corticosteroids help decrease information but never use long-term
  5. Drugs that suppress with RA disease process and cytokine modulators
• Methotrexate


  A medication
• Methotrexate


  • Causes serious infections by interfering with immune responses
  • Inhibits dihydrofolate reductase by converting dihydrofolic acid into tetra
  • Decreases production of IL-1 and TNF
• Methotrexate administration

  1. Given once a week orally as it accumulates intercellular and can possess severe side effects

  2. Patients carefully counseled with treatment booklet issued info on dosages and special monitoring requirements
• Side effects of Methotrexate include nausea, blood disques and difficulty breathing so urge to seek medical attention
• Methotrexate is prescribed within three months of diagnosis with a full blood count every two weeks as it is an immunosuppressant test for Renal function
• NSAIDs and methotrexate

  1. reduces clearance in kidneys and combination of effects increase risk toxicity
  2. Serious interaction with trimethoprim so never give together as it causes neutropenia
  3. Can give folic acid weekly not taken on the same day as it antagonises the effectiveness
• Azathioprine

  1. Inhibits proliferation of BNT lymphocytes causing nausea, vomiting, diarrhoea blood marrow suppression
  2. Want to report signs of mass suppression with unusual bleeding and bruising and first sign is a sore throat so seek medical attention
• Leflunomide

  1. Inhibits dihroorate dehydorgenase involved in purine production inhibits B and T lymphocyte proliferation with liver damage possible
• Sodium aurothiomalate

  1. salts made of gold with uncle mechanism
  2. Skin reactions, mouth ulcers and flu like symptoms want to stop treatment if developed toxicity risk
  3. Inhibit prostaglandin synthesis deactivate inhibit IL-1 and two and TNF reduce t lymphocyte production inhibit neutrophil aggregation
• Anti malarials

  1. Long half-life stored in tissues but can have GI disturbances and regular examinations and cancelled to wear sunglasses for protection
  2. Inhibit Lysosomes and neutrophils by suppressing phospholipase A2 activity and inhibiting IL1 and TNF
• pencillamine

  1. Hydrolysis of penicillin may produce t lymphocyte activity
  2. GI disturbances rashes and taste disturbances
  3. For metal complexes and can cause poisoning as taste but contain zinc ions and may chelate
• Sulfasalazine

  1. Cheap effective and or really administered with few side-effects
  2. Reduce lymphocyte proliferation interfere with folate metabolism and reduce side to crime production
  3. Reduce food or antic coated preparations
• Glucorticosteriods and corticosteroids


  Maintain home acetic metabolism, natural and synthetic inflammation immuno suppressant agents regular using carbs, fats, and proteins
• Glucorticosteriods and corticosteroids


  • May have mineralocorticods That regulate salt and water balance
  • Produce annexin 1 inhibits phospholipase A2 and prevent prostaglandins forming
  • Suppresses Cox two and IL-2
• Glucorticosteriods and corticosteroids


  Adrenal suppression diabetes muscle wasting osteoporosis, psychosis Eptic ulceration
• Increased risk of oral candidiasis patient should rinse their mouth with water after using
• Sudden prolonged time afterwards to allow it to function again