Download 10.2.1 Drugs used in myasthenia gravis

10: MUSCULOSKELETAL and
JOINT DISEASES
10.1
Drugs used in rheumatic diseases and gout
10.1.1 NSAIDs
All NSAIDs and Cox-2 inhibitors carry a cardiovascular risk. Modified release preparations should be restricted for patients with early
morning stiffness or compliance problems as they encourage regular higher doses and do not afford dosage flexibility.
Patients with OA may only require intermittent treatment and may benefit from regular paracetamol.
ibuprofen
naproxen
diclofenac sodium
Patients at high risk of serious gastro-intestinal adverse events:
NSAID (see 10.1.1)
+ omeprazole caps
Patients at high risk of serious
gastro-intestinal adverse events
intolerant of NSAIDs
celecoxib
etoricoxib
Patients at high risk but also requiring low dose aspirin for cardiovascular protection:
NSAID (see 10.1.1)
+ omeprazole caps
10.1.2 Systemic corticosteroids
Oral:
prednisolone plain
Please refer to osteoporosis
guidance for advice on bone
protection
Intravenous injection:
methylprednisolone sodium
succinate (Solu-Medrone®)
Intramuscular depot injection:
methylprednisolone acetate (Depo-Medrone®)
triamcinolone acetonide (Kenalog®)
Local corticosteroid injections
Soft tissue injection:
hydrocortisone acetate
Intra-articular injection (only to be administered by appropriately
trained staff):
methylprednisolone acetate (Depo-Medrone®)
triamcinolone acetonide (Adcortyl® Intra-articular/intradermal or Kenalog® Intra-articular/intramuscular)
10.1.3 Disease-modifying
antirheumatic drugs
Initiated in consultation with a specialist
methotrexate 2.5mg (prescribe in small quantities – 4 weeks supply and in 2.5mg strength tablets. Practice to give patient a
NPSA patient information / dosage record booklet or similar with 1st prescription)
sulfasalazine e/c
leflunomide
specialist only initiation
sodium aurothiomalate
penicillamine
azathioprine
hydroxychloroquine
certolizumab▼
adalimumab▼
etanercept▼
infliximab
rituximab
tocilizumab▼
10.1.4 Drugs for treatment of gout
(a) acute attacks of gout
diclofenac sodium
naproxen
colchicine (500mcg THREE times a day, Note at doses described in the BNF, toxicity usually occurs before the therapeutic effect)
etoricoxib (reserved for special cases of acute gout where the patient has not responded to courses of both diclofenac or
naproxen)
(b)
prophylaxis of gout
allopurinol
10.2
Drugs used in neuromuscular disorders
10.2.1 Drugs used in myasthenia gravis
pyridostigmine bromide
neostigmine
10.2.2 Skeletal muscle relaxants
baclofen
dantrolene sodium
diazepam – short term use for muscle spasm only
10.2.3 Drugs used in acute exacerbations of multiple sclerosis
methylprednisolone sodium
succinate injection
dexamethasone tablets
10.3.2 Rubefacients and other topical antirheumatics
Diethylamine salicylate 10% cream (Algesal)
Oral NSAIDs should be prescribed
in preference to topical gels
Piroxicam 0.5% gel
Ibuprogen 5% gel