Term
| What are the two main goals in treating musculoskeletal disorders? |
|
Definition
| Relieve pain and maintain function |
|
|
Term
| What don't you put heat on an acute injury? |
|
Definition
| Because it will cause the injury to swell more |
|
|
Term
| How long after an acute injury until it's OK to use heat? |
|
Definition
|
|
Term
| Localized pain can often be treated with topical therapy |
|
Definition
|
|
Term
| what is lidoderm indicated for? |
|
Definition
| post herpatic neuralgia, not useful as a deep pain relived |
|
|
Term
| What is the drug of choice for musculoskeletal pain without inflammation? |
|
Definition
|
|
Term
| What drug should be used for musculoskeletal pain with inflammation? |
|
Definition
|
|
Term
| what is an acute musculoskeletal injury? |
|
Definition
|
|
Term
| What does RICE stand for? |
|
Definition
| Rest, Ice, compression, Elevation |
|
|
Term
| What connects bone to bone? |
|
Definition
|
|
Term
| what drug is no more effective than APAP for musculoskeletal pain but can cause GI side effects therefore shouldn't be used in musculoskeletal injurty? |
|
Definition
|
|
Term
| NSAIDs are preffered of APAP in musculoskeletal disorders when what is present? |
|
Definition
|
|
Term
| This should not be applied during the acute musculoskeletal injury phase |
|
Definition
|
|
Term
| What is the drug of choice for mild to mderate pain in musculoskeletal injury when inflammation is not present? |
|
Definition
|
|
Term
| What connects muscle to bone? |
|
Definition
|
|
Term
| what is the partial or complex tear of a ligament? |
|
Definition
|
|
Term
| The cornerstone for nonpharmacologic therapy in acute musculoskeletal injury in the first 48-72hr is known as what? |
|
Definition
|
|
Term
| What cream contains the same irritatns found in hot peppers? |
|
Definition
|
|
Term
| A strain involves damage to what? |
|
Definition
|
|
Term
| Counterirritates that produce redness on application are |
|
Definition
|
|
Term
| Ehlers-danlos syndrome (EDS) mostly affects what two portions of the body? |
|
Definition
|
|
Term
| Studies suggest that illicit HGH abuse has become common among what demographic? |
|
Definition
| Young american male weightlifters |
|
|
Term
| Long term supraphysilogic HGH levels may increase the risk for certain types of what? |
|
Definition
|
|
Term
| What syndrome can affect the heart, blood vessels, lungs, eyes, bones, ligaments. people with this synd may be unusually tall and thing w/ long amrs and legs |
|
Definition
Marfan syndrome
Ed Welch syndrome |
|
|
Term
| Longterm supraphysilogic levels of HGH may have adverse effects on what 3 systems? |
|
Definition
Respiratory
Metabolic
Cardiovascular |
|
|
Term
| Acromgalic patients have mortality rates ______ times that of the general population |
|
Definition
|
|
Term
| Many non-weightlifters older than 40 get HGH prescriptions from _______ clinics, compounding pharmacies and other illegal sources |
|
Definition
|
|
Term
| what disorder causes bones to break easily even for no obvious reason |
|
Definition
|
|
Term
|
Definition
| National Organization of Rare Diseases |
|
|
Term
|
Definition
| pharmaceutical agent that has been developed specifically to treat a rare medical condition, the condition itself being referred to as an orphan disease. The assignment of orphan status to a disease and to any drugs developed to treat it is a matter of public policy in many countries, and has resulted in medical breakthroughs that may not have otherwise been achieved due to the economics of drug research and development. |
|
|
Term
| What drug therapy might be useful in Marfan's life expectancy (especially cardiac) |
|
Definition
|
|
Term
| What condition causes skin hyperelasticity and joint hyper mobility? |
|
Definition
|
|
Term
| what is an inherited disorder of elastic fibers in skin, eye and vasculature? |
|
Definition
Pseudoxanthoma elasticum
(very wrinkly and nasty) |
|
|
Term
| What does hyper HGH cause before ephypiseal plate closure? |
|
Definition
|
|
Term
| What does hyper HGH cause after ephypiseal plate closure? |
|
Definition
|
|
Term
| What might you use to suppress HGH? |
|
Definition
Dopamine agonists, somatostatin analogs and GH receptor antagoists
(Cabergoline, ocreotide, lantreotide, pegvisomant) |
|
|
Term
| What syndrome is a complete lack of growth hormone? |
|
Definition
|
|
Term
| What might you do to treat dwarfism? |
|
Definition
| cortisol, thyroid, GH, sex steroids |
|
|
Term
|
Definition
| Slow growth rate, no adolescent growth spurt, no HGH deficency |
|
|
Term
| What disease is caused by a lack or alteration of Chromosome 15? |
|
Definition
|
|
Term
| What is indicative of prader-willi? |
|
Definition
Inability to suck (born awesome?)
constant appetite, xs weight gain |
|
|
Term
| When would you not give GH in prader willie? |
|
Definition
very obese
sleep apnea
resp infxn |
|
|
Term
| What is considered to be "idiopathic short stature"? |
|
Definition
| <4'1" at 10yo or more than 2sd below ave height |
|
|
Term
| what muscle relaxant is a contrlled substance in the state of wv? |
|
Definition
|
|
Term
| what joints are most commonly affected by osteoarthritis? |
|
Definition
| Weight bearing joints (Hips and Knees) |
|
|
Term
| What happens to the joint space in osteoarthritis? |
|
Definition
| Joint space becomes smaller/bone on bone this destroys cartilage |
|
|
Term
| What are risk factors for OA? |
|
Definition
| Age, damage or injury (RA and Gout), obesity |
|
|
Term
| What are the signs and symptoms of OA? |
|
Definition
| loss of mobility, pain, stiffness |
|
|
Term
| What lab test might be useful in OA diagnosis? |
|
Definition
| X-ray, no real definative diagnostic test |
|
|
Term
| What are the goals of therapy for OA? |
|
Definition
| treat pain, improve QOL, improve movement |
|
|
Term
| When do you get a knee replacement? |
|
Definition
| When you can't stand the pain |
|
|
Term
| What are some nonpharmacologic approches to OA managmenet? |
|
Definition
Lifestyle mod- aerobic AND strength training
Weightloss
Heat before activity
Cold after activity |
|
|
Term
| First line pharmacologic therapy for OA? |
|
Definition
| Acetaminophen when no inflammation is present |
|
|
Term
|
Definition
|
|
Term
| When do you go from APAP to NSAID? |
|
Definition
| When you exceed 4gm APAP, then it's not safer than NSAID so use the NSAID |
|
|
Term
| How long must you be on, at or near the 4gm tylenol dose to determine it needs to be changed? |
|
Definition
|
|
Term
| The major side effects of acetaminophen |
|
Definition
| Liver, worsens renal fxn, inc BP |
|
|
Term
| What is the antidote for tylenol toxicity? |
|
Definition
|
|
Term
| When might you lower the max dose of tylenol? |
|
Definition
| When someone is a declared heavy drinker |
|
|
Term
| What do you give a pt after tylenol? What should you look at along with that therapy? |
|
Definition
NSAID
Concerns- GI assesment and CV system assement |
|
|
Term
| What might you give a pt with GI problems when on NSAID? |
|
Definition
|
|
Term
| What form of COX does all NSAIDs block? |
|
Definition
|
|
Term
|
Definition
| GI mucosa, kidney (renal SE), platelets (bleeding) |
|
|
Term
| Describe the process of NSAIDs effect on renal perfusion |
|
Definition
| NSAID causes unopposed constriction at the afferent arteriole resulting in decreased blood flow to the glomerulus thus decreasing glomerular filtartion pressure and perfusion |
|
|
Term
|
Definition
| Primarily in response to inflammation, that is why COX2 specific is useful. ALSO FOUND IN KIDNEY so they are not safer in renal dysfxn |
|
|
Term
| What is a side effect of NSAID involving fluid levels? |
|
Definition
|
|
Term
| What is the benefit of COX2 inhibitors? |
|
Definition
|
|
Term
|
Definition
| Non are any better than the other |
|
|
Term
| What are the risk factors that might predict higher GI side effects of NSAID? |
|
Definition
GI bleed in combination
Age (>60)
Hemophilia
Dose related- higher dose worse
Steroid use
Smoking |
|
|
Term
| Who is more likely to get the renal side effects of NSAIDS? (risk factors) |
|
Definition
Prexisting renal insuficency
Consumant ACE/ARB
Heart failure (LVDF)
Dehydration |
|
|
Term
| Why might an NSAID trigger a drug interaction in computor? (2 most common) |
|
Definition
Offsetting hypertensive effects
Addative effects w/ anticoags (risk of bleeding (pradxa, warfarin etc)) |
|
|
Term
| True or false COX2 inhibition is more effective in pain relief than COX1 |
|
Definition
|
|
Term
| What is the advantage of COX2 inhibition? |
|
Definition
|
|
Term
| How can you offset the cardiovascular risk of COX2 inhibitors? |
|
Definition
| ASA, but this nulifies GI preservation |
|
|
Term
| Does it pay off to take COX2 inhibitors if a person in on ASA? |
|
Definition
| NO! The cardiovascular risk is there, with ASA you already have the GI issues, just put them on a COX1 |
|
|
Term
| What's the site of action for motrin/NSAIDS? |
|
Definition
|
|
Term
| Where does ASA work? What's the problem with it? |
|
Definition
| COX1 on the platelet. Competes w/ COX1 NSAIDS |
|
|
Term
| How should a person take ASA and NSAID when taken together? |
|
Definition
| ASA 1st! NSAID 1/2hr-1hr later otherwise ASA loses it's cardio protection. This works because ASA is irreversible |
|
|
Term
| What is the proposed mechanism of cardiovascular harm in COX2 inhibitors? (What tips the balance of thromboxane A2?) |
|
Definition
| Prostacycline (the anti of thromboxane A2) which is an antiplatelet and vasodilator. Prostacycline prodxn is COX2 dependant. Thus Prostcyclin is inhibited and there's proportionally more thromboxane A2 |
|
|
Term
| What might you use in a OA PT who's failed APAP and has GI problems? |
|
Definition
| Stuck w/ an NSAID, add PPI |
|
|
Term
| Why might you not use ASA for pain control? |
|
Definition
| No better pain relief but alot more GI |
|
|
Term
| glucosamine/controitin NIH trials show what? |
|
Definition
| No difference from placebo- probably shouldn't recomend unless already taken and "responded well" |
|
|
Term
| Does placebo show any improvemnt in OA? |
|
Definition
|
|
Term
| What are your pharmacologic options for treating OA? |
|
Definition
| Tylenol, tramadol, NSAID, COX2, topical analgesic, dietary supplementation |
|
|
Term
| Glucosamine and condroitin dose |
|
Definition
| 500mg TID/1500mg qd of glucosamine and 400-800mg TID Condroitin |
|
|
Term
| APAP failed, high NSAID and still have pain(OA). What are the other options? |
|
Definition
| Intraarticular corticosteroid Tramadol (esp asa allergies) Topical- esp hands (capsasin) Avoid narcotics |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| What is kyphoidscoliosis? |
|
Definition
| Humback w/ a curved spine |
|
|
Term
| What happens when you administer sex hormones to a young person? |
|
Definition
| Will cause closure of the epiphysial plates |
|
|
Term
| how do you tell if there is inflammation (3 things) |
|
Definition
| reddness, warmth and swelling |
|
|
Term
| how do you tell if you can help someone or if the need to be reffered? |
|
Definition
| if acute symptoms last longer than 7-10 days, or if sx worsen or if they subside and return. If there's deformity in the joint, dislocation, broken, back pain w/ radiating/burning pain or difficulty urinating |
|
|
Term
| When advising elderly in putting heat or cold on skin what is important to remeber? |
|
Definition
| Not to put in direct contact w/ skin use a cloth or something |
|
|
Term
| how do you wrap an ace bandage? |
|
Definition
| Start distal and wrap medial |
|
|
Term
| What is the age cut off for reye's syndrome? |
|
Definition
| 16. No one 16 and under should get ASA |
|
|
Term
| What is something you should be cautioned of with Mg salicylate? |
|
Definition
| Renal impairment may cause Mg buildup |
|
|
Term
| What is the difference between topical and transdermal? |
|
Definition
Topical- skin deep
Transdermal- systemic via dermal absorption |
|
|
Term
| why do you not want to put a heating pad or heat etc on a topical drug? |
|
Definition
| Speeds absorption, changes pharmacology by changing rate |
|
|
Term
| what is important points about capsasin cream? |
|
Definition
| Wear gloves when applying, wash hands thoroughly, don't touch eyes mouth or nose after applying |
|
|
Term
|
Definition
| Inflmation of the synovial fluid in the joints |
|
|
Term
|
Definition
hands and feet (distal joints)
Most often in the morning
persists more than 1hr |
|
|
Term
|
Definition
|
|
Term
| Is RA systemic or localized? |
|
Definition
|
|
Term
| What age group does RA normally present? |
|
Definition
| Younger/non-geriatric when first signs appear (35-50) |
|
|
Term
| What are characteristics of OA? |
|
Definition
| Wt bearing joints, uni or bilateral, asymetrical, local inflamation, no systemic complications, age >65 |
|
|
Term
| RA immunogenic process. Tcells presented w/ antigen do what? |
|
Definition
| Stimulate B and Tlymphocytes |
|
|
Term
| What do B-lymphocytes do in RA? |
|
Definition
| make antibodies (RF and antiCCP) that cause inflammtion |
|
|
Term
| What do T-lymphoctes produce in RA? |
|
Definition
| cytokines and macrophages |
|
|
Term
| What do macrophages do in RA? |
|
Definition
| Cause inflammation by way of cytokines |
|
|
Term
| What are the cytokines involeved in RA? |
|
Definition
IL-6, IL-17, IL-1, TNF alpha
All are pro-inflammatory cytotoxins (ones that cause damage) |
|
|
Term
| What are the 4 main risk factors for RA? |
|
Definition
Female (3x more likely)
Age
Family history
smoking |
|
|
Term
| What decresase the risk of RA? |
|
Definition
|
|
Term
| What can RA cause in the blood vessels? |
|
Definition
| Vasculitis, inflammation w/in the vessel due to cytokines. Causes inability to constrict or dilate and breaks down vessel walls |
|
|
Term
| What respiratory problem can RA cause? |
|
Definition
| Pulmonary fibrosis, pulmonary effusions from RA |
|
|
Term
| What ocular disorder can RA cause? |
|
Definition
|
|
Term
| What are the seven criteria to diagnose RA? (Not all RF pt will have the last 3) |
|
Definition
Joint stiffness longer than 1hr
3 or more joint areas affected
Arthritis of the hands
Symmetric joint involvment
Presence of HA nodules
Elevated RA RF
Radiographic changes |
|
|
Term
| Which 4 criteria of the 7 for diagnosis in RA MUST be present? (ALL RA pt will have these) |
|
Definition
Morning stiffness >1hr
3 or more joint areas
Arthritis of hands
Symetrical |
|
|
Term
| How long must the 4 primary criteia for RA be present for a diagnosis of RA? |
|
Definition
|
|
Term
| What are the three main types of deformities in LONG STANDING RA? |
|
Definition
Swan neck
Bootenier
Ulnardeviation |
|
|
Term
| What are the treatment goals of RA? |
|
Definition
Relieve pain
improve quality of life
maintain structure |
|
|
Term
| What is first line for RA? |
|
Definition
| Methotrexate! Unless contraindicated |
|
|
Term
| What are contraindications to Methotrexate? |
|
Definition
CrCl
Pregnacy
Chronic liver disease
Immuno suppresion |
|
|
Term
| What can you add to initial treatment of RA (Methotrexate) to help with symptomatic control? |
|
Definition
|
|
Term
| Will NSAIDs help reverse RA? |
|
Definition
| No, it will only help control sx, pain in joints etc |
|
|
Term
| Important side effects of NSAIDs |
|
Definition
GI intolerance (use PPI)
Fluid retntion
HTN |
|
|
Term
| What are some comlications of steroids use in RA? |
|
Definition
| Osteoporosis, peptic ulcer disease, wt gain, buffalo hump, moon faced, inc risk of infxn, hyperglycemia |
|
|
Term
| What is the non-biologic DMARD of choice? |
|
Definition
|
|
Term
| Where does MTX action occure in RA? |
|
Definition
| Dihydofolate reductase inhibitor which inhibits the formation of cytokines |
|
|
Term
| When should pt begin MTX uppon diganosis? |
|
Definition
|
|
Term
| What should be administered w/ MTX and why? |
|
Definition
| Folic acid, because folate reductase is being inhibited thus reducing folic acid prodxn |
|
|
Term
| What are adverse rxn of MTX? |
|
Definition
| pulmonary fibrosis, hepatotoxicity |
|
|
Term
| What two non-biologic DMARDs are used second line (but seperately either/or) to MTX? |
|
Definition
| Hydroxychloroquine and Sulfasalixine |
|
|
Term
| Where is Steroids site of action in RA? |
|
Definition
| tcells and inflammation both |
|
|
Term
| how often should hepatic monitoring be done with MTX? |
|
Definition
|
|
Term
| What is an important thing to monitor with Sulfasalizine? |
|
Definition
|
|
Term
| Should sulfasalizine be used longtem? |
|
Definition
|
|
Term
| What is a benefit of Hydroxqychloroquine? |
|
Definition
| No renal tox, hepatotox or bone marrow supression. Not a great drug for RA though |
|
|
Term
| How long must a person be on hydroxychlorquine before you can determin it a failed therapy? |
|
Definition
|
|
Term
| What should hydroxychloroquine be taken with? |
|
Definition
|
|
Term
| What drugs are non-biologic DMARDs? |
|
Definition
| MTX, hydroxychloroquine, sulfasalazine, leflunamide |
|
|
Term
| What drugs are biologic DMARDs? |
|
Definition
| Etanercept, infliximab, adalimumab, golimumab, cetolizumab, anakinra, abatacept, rituximab,anti- IL-6 |
|
|
Term
| What drugs are TNA alpha agonsits? |
|
Definition
| Etanercept, infliximab, adalimumab, golimumab, cetolizumab |
|
|
Term
| What drug is a IL-1 inhibitor? |
|
Definition
|
|
Term
| What drug is a Co-stimulation modulator? |
|
Definition
|
|
Term
| What drug is an Anti-CD20? |
|
Definition
|
|
Term
| What does leflunomide do? |
|
Definition
| Inhibits T-lymphocytes. This shuts down the entire inflammatory process |
|
|
Term
| Leflunamide interaction/problems |
|
Definition
Cholestyramine- removes drug from body
Also don't use in hepatic disease or alcholics |
|
|
Term
| What is the order of drugs used to treat RA? |
|
Definition
| MTX then Sulfasalzine/hydroxqycholoquine/leflunamide. IF pt wants/has money they can go straight from MTX to biologic DMARDs though |
|
|
Term
| How do TNF antagonists work? |
|
Definition
| Binds to soluble or membrane bound or bother TNF alpha preventing it from being able to bind to TNF alpha receptors. |
|
|
Term
| What conditions should etanercept not be used with? |
|
Definition
Heart failure (fluid ret)
MS (demyelanting neuropathy) |
|
|
Term
| What does preventing TNF alpha from binding to the TNF alpha receptor site do? |
|
Definition
| Eliminates abnormal B-lymphocyte activity |
|
|
Term
| Which biologic DMARDs act at soluble and bound TNF? |
|
Definition
| Cetolizumab, Golimumab, Adalimumab, Infliximab, Etanercept (ALL TNF alphas!) |
|
|
Term
| Which biologic DMARD needs to be given w/ MTX and why? |
|
Definition
| Infliximab, because it's partly murine AB (chimeric) so there's mouse components. Needs to be immunosupressed |
|
|
Term
| What therapy might you consider coadministering with all TNF alph inhibitors to lessen inj site rxns? |
|
Definition
| H1/H2 receptor antagonists and corticosteroids to reduce problems |
|
|
Term
| TNF alpha antaogists will be the first ones to use/add on after MTX has failed |
|
Definition
|
|
Term
| What type of drug is Anakinra and whom is it indicated in? |
|
Definition
| IL-1 antagonist, used in pt who've failed non-biologic and a TNF alpha antagonist. Don't use w/ TNF antagonist because of increased infxn risk |
|
|
Term
| What type of drug is abatacept? |
|
Definition
| Costimulation modulator- which prevents tcell from signaling the lymphoctese and stop response from antigen. |
|
|
Term
| When might a patient be put on abatacept in RA? |
|
Definition
| Moderate to sever disease (RA) after pt fails MTX/non-biologic and TNF alpha Can be administered w/ TNF alpha though |
|
|
Term
| What RA drugs are relatively safe in pregnancy? |
|
Definition
|
|
Term
| What drug is an anti-CD20? |
|
Definition
|
|
Term
| What should be coadministered with Rituximab? |
|
Definition
| Methotrexate, it's chimeric so it has murine components |
|
|
Term
|
Definition
| Causes B-lymphocyte depletion |
|
|
Term
| What two drugs might you administer w/ MTX and why? |
|
Definition
| Rituximab and Infliximab because they are chimeric |
|
|
Term
| Rituximab can cause inj site rxns. What might you coadminister to prevent this? |
|
Definition
| Corticosteroids and H1/H2 antagonists |
|
|
Term
| When might you use Rituximab? |
|
Definition
| Failed MTX/nonbiologic and TNF alpha |
|
|
Term
| What type of drug tocilizusamba? |
|
Definition
| anti-IL-6 antibody. Binds at IL-6 preventing binding to receptor |
|
|
Term
| When might you use tocilizumab and what can it cause an increase in? |
|
Definition
When MTX/non-biologic and TNF fail
Might increase LFTs (hepatic monitoring q6mo) |
|
|
Term
| What drug is absolutely contraindicated in pregnancy for RA? |
|
Definition
|
|
Term
| How long must someone DC MTX before trying to become pregnant? |
|
Definition
|
|
Term
| How long must someone DC leflunamide before attempting to become pregnant? |
|
Definition
|
|
Term
| What category are NSAIDs in the 1st and 2nd trimest? How about the 3rd? |
|
Definition
|
|
Term
| Cocroft and gault equation for CrCl |
|
Definition
((140-age)x wt(kg))/ (SrCr(mg/dl)x72)
multiply by 0.85 in women |
|
|
Term
| Osteoporosis is a scilent disease |
|
Definition
|
|
Term
| Risk factors for osteoporosis? |
|
Definition
Age (men-70(unless other RF) , women-postmenopausal(surg included))
Family Hx
Smoking
Alcohol use
Female
Diet (low Ca and Vit D)
Small frame
Caucasian
Previous fracture
Low BMI
Low bone mineral density
Chronic glucocoriticoid |
|
|
Term
| Why is Vit D vital to osteoprosis? |
|
Definition
| Because Ca can't be absorbed with out it! Also people have much lower vitamin D levels than once though. |
|
|
Term
| What level of glucocorticoid use is considered to be of risk? |
|
Definition
High oral- 5mg prednisone
Inhaled oral (not as important as oral, monitor, pseudo RF) |
|
|
Term
| What medications/medical condidtions that can increase risk of osteoporosis |
|
Definition
|
|
Term
| How does osteoporisis occure? |
|
Definition
| one of two imbalances: Building slows down and break down is maint at same level OR Building is the same but increased in breakdown |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| What process does most of our drugs target in osteoporosis? |
|
Definition
|
|
Term
| At what age is the bone in the body most dense? |
|
Definition
| 25-35, this is what age group is used to determine a bone density/ Tscore |
|
|
Term
| What is the only time your Tscore and Zscore the same? |
|
Definition
| person of same gender w/o OP about 30yr old |
|
|
Term
| What is the presentation of OP? |
|
Definition
Pain, usually at the site of a fracture/microfracture
W/o fracture is asymptomatic |
|
|
Term
| What is the Tscore for diagnosis of OP? |
|
Definition
|
|
Term
|
Definition
| Identified cause (Glucocorticoids, medication, medical conditions etc, RF present) this is most of your pts |
|
|
Term
|
Definition
| Idiopathic, no known cause |
|
|
Term
| What is considered normal in T scores? |
|
Definition
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|
Term
| What is the Tscore range considered "Osteopenia"? |
|
Definition
|
|
Term
|
Definition
Fracture assement for risk ages 40-90 gives 10yr probability of fracture
Useful as a screening tool |
|
|
Term
| What is the recommended Ca intake? Men age 65>, Women 51> and postmenopausal, Women >65 |
|
Definition
1500mg
1000 when on estrogen, 1500mg no on est
1500 |
|
|
Term
| What is the vitamin D daily req for pt age less than 50 and greater than 50 |
|
Definition
|
|
Term
| Why can't pt take 1500mg Ca at once? |
|
Definition
|
|
Term
| How much elemental Ca can the body absorb at one time? |
|
Definition
|
|
Term
| Os-cal products have how much elemtal Ca? |
|
Definition
| 500mg except "ultra"=600mg |
|
|
Term
| Cacarbonate only has about 40% elemental by mg weight |
|
Definition
|
|
Term
| Caltrate has how much elemental Ca? |
|
Definition
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|
Term
| Citrical has roughly how much elemental Ca |
|
Definition
|
|
Term
| What is important to counsel pt about with Ca carbonate? |
|
Definition
| GERD/PPI notice that PPI decreases the absorption of Ca carbonate |
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|
Term
| How do you improve absorption of Ca carbonate? |
|
Definition
| Eatfood, that increases GI secretion of acid |
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|
Term
| What is another option for OP pt on PPI to get Ca other than Calcium carbonate |
|
Definition
| Calcium Citrate, no acidic absorption needed! |
|
|
Term
| What are some Ca supplemented foods? |
|
Definition
| Orange juice, butter, brocolli, etc |
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|
Term
| What is the importance of fall risk in OP pt? |
|
Definition
|
|
Term
| What is a risk for fall in alot of elderly pt's home? |
|
Definition
| RUGS! (really? did we really go there in class? ugh) |
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|
Term
| What is first line treatment for OP? |
|
Definition
|
|
Term
| What drugs are bisphosphonates? |
|
Definition
| Alendronate, ibandronate, risdronate, zoledronic acid |
|
|
Term
| What is dosing for Alendronate (fosamax)? |
|
Definition
|
|
Term
| What is the dosing for Ibandronate (Boniva)? |
|
Definition
150mg PO 1 monthly
3mg/3ml inj |
|
|
Term
| What is the dosing for Risedronate (Actonel) |
|
Definition
5mg qd
35mg qw
75mg two consecutive days monthly
150mg once monthly |
|
|
Term
| Zolendronic acid (Zometa) dosing |
|
Definition
| 5mg/100ml IV infusion once yearly |
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|
Term
| What drugs are estrogen receptor modulators? |
|
Definition
|
|
Term
| What is raloxifene indicated for? |
|
Definition
| Postmenopausal osteoporosis |
|
|
Term
| What is the dosing of Raloxifene (Evistia) |
|
Definition
|
|
Term
| What is a calcitonin supplement? |
|
Definition
| Calcidonin salmon/micalcin |
|
|
Term
| Micalcin/calcidonin-salmon dosing |
|
Definition
|
|
Term
| What is important to note about Micalcin dosing? |
|
Definition
| Alternate nostrils daily for nasal spray |
|
|
Term
| What is the dosing for Teriparatide (Forteo) |
|
Definition
| 20mcg SQ daily in the thight or abdominal wall |
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|
Term
| What OP drugs might you use in men? |
|
Definition
Alendronate/risedronate first line
Teritide second line
Micalcin third line |
|
|
Term
| What are the important counseling points for bisphosphonates? |
|
Definition
| GI is most common SE. Can't take food to help with this though! (Decreases absorption) If you eat w/ it you might as well pitch it. Take on empty stomach, first thign in the morning with a full glass of water, no additional medications |
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Term
|
Definition
|
|
Term
| what is the most common side effect of raloxifen? |
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Definition
|
|
Term
| what drug class is reloxifene in? |
|
Definition
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|
Term
| What might happen if you use calcitonin in the same nostil consecutive days? |
|
Definition
| Increased nasal side effects (nose bleed, dry nostil, congestion) |
|
|
Term
| What is the concern with longterm use of bisphosphonates? |
|
Definition
| Necrosis of the jaw (rare). Usually seen in IV drugs more than orals |
|
|
Term
| Nonpharmacologic things you can do for osteoporosis? |
|
Definition
| Exercise (Wt bearing), Aerobic exercise will not strengthen bone mineral density. Increse Ca in diet, fall prevention, quit smoking, Ca/Vit D supplementation |
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|
Term
| What is first line treatment of OP in both men and women? |
|
Definition
| Bisphosphonate (only 2 for men) |
|
|
Term
| What is second line treatment for OP in both men and women? |
|
Definition
|
|
Term
| What is third line treatment for OP in women? |
|
Definition
|
|
Term
| What is fourth line for OP in women? |
|
Definition
|
|
Term
| What is a nice side effect of Calcitonin? |
|
Definition
| Decreases pain in the spine, better to go w/ bisphosphonate and treat the pain but if DQ from bis this is good |
|
|
Term
| What are some contraindications in bisphosphonate therapy? |
|
Definition
| Can't stand or sit up for 30min |
|
|
Term
| what is a big side effect of Ca to remeber? |
|
Definition
|
|
Term
| What will an X-ray show for osteopenia/OP? |
|
Definition
| A black spot where it's supposed to be white |
|
|
Term
|
Definition
| Painful, arthritic type of pain |
|
|
Term
| What drugs might cause gout? |
|
Definition
| Thiazide type diuretics and Niacin |
|
|
Term
| What are some risk factors for gout? |
|
Definition
|
|
Term
|
Definition
| Type of arthtiris caused be uric acid crystal build up |
|
|
Term
|
Definition
|
|
Term
|
Definition
Severe pain
Swelling
Warmth |
|
|
Term
| What might a tophi indicate in gout? |
|
Definition
|
|
Term
| What does gout to do WBC count? |
|
Definition
|
|
Term
| How do you determine if a pt is an over producer or an under excreter? |
|
Definition
24hr urine collection
>800mg uric acid = over producer
<600mg uric acid = underextreter |
|
|
Term
| What are the disired outcomes in gout? |
|
Definition
Rapid/effective pain relief
Maint joint fxn
prevent disease complications
provide coset effective therapy
improve QOL |
|
|
Term
| Non-pharmacologic therapy for gout pts |
|
Definition
Immobilization
Ice
Hydration |
|
|
Term
| What is the pharmcologic therapy options for gout? |
|
Definition
NSAID
Colchicine (Colcrys!)
Corticosteroids
Antihyperuricemics |
|
|
Term
| What are some NSAIDs used for gout? |
|
Definition
| Fenoprofen, Flurbiprofen, Ibuprofen, Indomethacin, Ketoprofen, Meclofenamate, Naproxen, Piroxicam, Sulindac, Celecoxib, Meloxicam |
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|
Term
|
Definition
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|
Term
|
Definition
| 100mg QID D1 then 50mg QID thereafter |
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|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| 750mg initially then 250mg q8h |
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|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| Colcrys (Colchicine) dosing |
|
Definition
| 1.2mg at onset and 0.6mg 1hr later |
|
|
Term
| Corticosteroid injections for gout |
|
Definition
Methylprednisolone, prednisone, triamcinolone
10-40-60-60 |
|
|
Term
| What three drugs are considered antihyperuricemics? |
|
Definition
| Allopurinol, Febuxostat, Probenecid |
|
|
Term
| What is the dosing for allopurinol |
|
Definition
CrCl > 90ml/min = 300mg qd
CrCl 60-90ml/min = 200mg qd
CrCl 30-60ml/min = 100mg qd
CrCl >30ml/min = 50mg qd |
|
|
Term
| How would you adjust dosing of Allopurinol? |
|
Definition
| Adjust based on uric acid levels with a max of 800mg/day |
|
|
Term
| Febuxostat dosing for gout |
|
Definition
|
|
Term
| Febuxostat dosing for gout |
|
Definition
|
|
Term
| What drug works well for underexceters? |
|
Definition
| Probenicid. Blocks tubular reabsorption |
|
|
Term
| What is important to note in respect to renal fxn and probenecid? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| What is the treatment for acute gout in pt with normal renal fxn and no ulcer risk? |
|
Definition
1st line- NSAID
2nd line- Colchicine
Consider corticosteroid |
|
|
Term
| What is the treatment for acute gout in pt w/ normal renal fxn and at risk for GI ulcer? |
|
Definition
|
|
Term
| What is the treatment for gout in pt with renal insuficency and a risk for GI ulcer? |
|
Definition
|
|
Term
| When might you consider prophylactic treatment for gout? |
|
Definition
| 2 or more atacks/yr OR tophi present OR joint errosion |
|
|
Term
| What is the treatment for chronic gout with renal insufficency OR uric acid stones? |
|
Definition
|
|
Term
| What is the treatment for chronic gout in pt with no renal fxn problems and no uric acid stones? |
|
Definition
| 1st line- Allopurinol 2nd line- Probencid |
|
|
Term
| What form of hyperuricemia is allopurinol treating for? |
|
Definition
|
|
Term
| What's the MOA of Allopurinol? |
|
Definition
| inhibits xanthine oxidase which blocks oxidation of hypoxanthine to xanthine to uric acid |
|
|
Term
| What drug might you consider for a pt w/ HTN and gout? |
|
Definition
|
|
Term
| What drug might you consider for pt w/ gout and dyslipidemia |
|
Definition
|
|
Term
| What two drugs for treating other disorders have hypouricemic effects? |
|
Definition
|
|
Term
| What is notable about uloric/febuxostat? |
|
Definition
| No dosage adjustment for mild to mod renal dysfxn |
|
|
Term
| What should be used along with Febuxostat/uloric? for how long? |
|
Definition
|
|
Term
| Why should a pt be on colchicine or NSAID for 3-6mo during initation of Uloric? |
|
Definition
| because of potency/rapid uric acid rdxn which causes other problems |
|
|
Term
| How does febuxostat/uloric work? |
|
Definition
| xanthine oxidase inhibitor. Inhibits the pathway leading to uric acid prodxn. Totally unrelated to allopurinol, but same MOA |
|
|
Term
| What two drugs are at risk for potentiation from concament dosing with Allopurinol? |
|
Definition
|
|
Term
| What two drugs are at risk for potentiation from concament dosing with Allopurinol? |
|
Definition
|
|
Term
| Azathioprine and Mercaptopurine metabolism is inhibited by concomitant administration with what? What is the "fix" for this problem? |
|
Definition
Allopurinol
Reduce dose by 75% |
|
|
Term
| What is tumor lysis syndrome? |
|
Definition
| Rapid cell destruction associated with chemo that results in higher uric acid content from breakdown of nucleotides/purines |
|
|
Term
| What is a very severe reaction that can occure with Allopurinol? |
|
Definition
|
|
Term
| When can rxn on Allopurinol occure? |
|
Definition
| Any time but normally the first 3mo |
|
|
Term
| What should pt on probenecid be monitored for? |
|
Definition
| Fever, nausea, rash. Also significant urine decrease (more than 50% in 24h) |
|
|
Term
| What should you monitor for in allopurinol pt? |
|
Definition
|
|
Term
| What are the diuretics that can increase likeliehood of gout? |
|
Definition
| acetazolamide, bumetanide, chlorthalidone, ethacrynic acid, furosemide, indapamide, metolazone, thiazides, triamterene |
|
|
Term
| What immunosuppresants might increase the likelihood of gout occuring? |
|
Definition
|
|
Term
| What lipid altering drug might cause increased probability of gout? |
|
Definition
|
|
Term
| Name three other drugs that can cause gout |
|
Definition
| ethambutol, levodopa, pyrazinamide |
|
|
Term
| What should pt increase when taking anti-hyperuricemics (especially probenicid(renal))? |
|
Definition
|
|
Term
| What might you use to treat tumor lysis syndrome? |
|
Definition
|
|
Term
| What lab might you monitor uloric/fuboxestat for? |
|
Definition
|
|
Term
| Why do you never use IV colchicine? |
|
Definition
| Horrible toxicity/side effects |
|
|
Term
| What are the systemic toxicity problems for colchicine? |
|
Definition
| Myopathy, bone marrow suppression and neutropenia |
|
|
Term
| Why isn't colchicine normally used 1st line? |
|
Definition
| Toxicity/serious side effects |
|
|
Term
| What are some common side effects of colchicine? |
|
Definition
| Nause and vomiting 80% of the time |
|
|
Term
| When is it best to start gout treatment? |
|
Definition
|
|
Term
| What are some side effects of corticosteroids? |
|
Definition
| Increased appetite, hyperglycemia, stimulation/wired |
|
|
Term
| What do you do for asymptomatic gout? |
|
Definition
|
|
Term
| Can low dose ASA cause gout? |
|
Definition
|
|
Term
| What are some long term effects of gout? |
|
Definition
| joint destruction, tophi, nephrolithiasis |
|
|
Term
| What is a really new formulation of antihyperuricemic drug? |
|
Definition
|
|
Term
| What is the role of krystexxa in gout? |
|
Definition
|
|
Term
| How is krystexxa administered and why is this significant |
|
Definition
| IV, because most IV gout drugs historically have anaphylactic rxns |
|
|
Term
| What is the black box warning for Krystexxa? |
|
Definition
|
|
Term
| What is the starting dose for allopurinol? |
|
Definition
| 100mg qd titrating up according to response (serum uric acid level at goal or no more gout symptoms) |
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