Chronic MS Conditions Flashcards
intervertebral disc degeneration
intervertebral disks (pads of fibrocartilage between vertebrae that resist spinal compression while permitting movement)
causes of intervertebral disc degeneration
normal wear & tear
arthritic conditions
inherited genetic disorder
intervertebral disc degeneration s/s
pain in back (spreading to buttocks & upper thighs)
numbness and tingling in leg/foot
intervertebral disc degneration dx
physical exam to assess location of spin affected
spinal x-ray
mri
intervertebral disc degeneration tx (initial, after and persisten)
aspirin & NSAIDs, rest physical therapy, back brace w/ ice&heat, massage, ultrasound, electrical stimulation tramadol before Norco/Percocet nerve block with steroid injections continued w/ complementary medicine
herniated/ruptured disc
rupture of disc causing fluid to leak out & impinge/irritate nearby nerves
decreases cushioning of vertebral joints
back pain & limited mobility
can cause sciatica
herniated/ruptured disc RF
30-50 years old excess weight regular heavy lifting/bending/twisting previous back problems smoking genetic factors
herniated/ruptured disc most common locations
C5-6, C6-7, L4-5, L5-S1
Cause of herniated/ruptured disc
loss of fluid w/in disk
increased risk for microscopc tears
decreased ability to abosrb shock
increased risk for herniation
herniated/ruptured disc s/s
if abrupt: nerve root compression, severe pain, muscle spasms
gradual: slow onset of pain, weakness, tingling
forward tilt to trunk when standing
changes in mobility, motor fx/knee & ankle reflexes
cauda equina syndrome
herniated/ruptured disc dx
mobility tests ct MRI myelography nerve conduction studies blood tests
herniated/ruptured disc tx
NSAIDS opioids (if acute) antispasmodics hot/cold packs cortisone corticosteroids anesthetics mild, low-impact exercise to help strengthen back surgery (laminectomy, discectomy, spinal fusion, artificial disc surgery, laser surgery)
four stages of disc herniation
degeneration
prolapse
extrusion
sequestration
cyclobenzaprine
antispasmodic
r/t TCAs, acts at brain stem sedately (w/ ^HR and anticholinergic)
reduces muscle spasms/motor activity (motor neuron suppression)
se: constipation, indigestion, n, dizziness, fatigue, dysrhythmia, heart block, syncope, cholestasis, paralytic ileus, edema of tongue, BMD, CVA, NMS
avoid in 65+ y/o
Contra: heart conditions/disturbances, MAOIs, hyperthyroidism
Interx: may enhance CNS depressants or anti-cholinergic agets
B
cauda equina syndrome
compression of cauda equina due to disc herniation
bowel & bladder dysfunction
anesthesia of perineum
medical emergency
spinal stenosis
narrowing of spinal column
vertebral bone degeneration with aging
spinal stenosis s/s
slow progressive symptoms
numbness weakness
cramping
general pain (may radiate down arm or leg)
spinal stenosis dx
medical hx and physical exam x-ray mri ct myelography
spinal stenosis tx
NSAIDs steroid injections nerve blocks PT lumbar brace chiropractic tx acupuncture surgery
Lordosis
spinal column is concave
due to pregnancy or obesity
kyphosis
spinal column is convex (goes out)
scoliosis
lateral curve of spin
C or S shaped
severe: rotation of spine leading to deformities & disability
scoliosis RF
9-15 years old
neuromuscular disorder
family history
scoliosis type
idiopathic
congenital (incomplete formation, seperation of vertebrae)
neuromuscular scoliosis
structural vs nonstructural scoliosis
deformities of bones in spinal column
poor posture, differences in leg length, tumors, adaption to pain
dextroscoliosis
thoracic curve
kyphoscoliosis
outward & lateral spine curvature
rotoscoliosis
vertebral column turned on its axis
levoconvex
curvature of spin to left & thoracolumbar scoliosis
r/t both thoracic and lumbar regions
sideways curvature scoliosis rating
mild: 10-20 degrees
mod: 20-40 degrees
severe: over 40 degrees
scoliosis s/s
spinal curvature to one side uneven hips/shoulders differences in leg lenghth tiredness of spine prominent shoulder blade rib bump
scoliosis complications
heart/lung problems
paralysis
scoliosis dx
adam forward bend test x-ray MRI CT bone scan
scoliosis tx
pain management (OTC or prescription NSAIDs)
PT (mild)
brace (moderate): Milwaukee [high curvatures} Boston [low/thoracic curves]
spinal fusion surgery (over 40)
osteomalacia & rickets
characterized by decreased mineralization of newlyformed bone
usually deficiency or abnormal metabolism of vitamin D
osteomalacia & rickets causes
dietary deficiency (vit D/ca) intestinal malabsorption lack of sunlight renal & liver disease following a parathyroidectomy supplement vit D/Ca
Calcium (recc/uses/normal)
800-1200 mg/day
increased for pregnancy, growing children, menopausal women
4.5-5.5
hypercalcemia
dangerous EKG changes
heart block
decreased odium permeability on cell membranes
hypocalcemia
muscle cramps tetany \+ chvostek/trousseaus torsades arrhythmias
calcium supplements
calcium acetate
calcium carbonate / chloride/citrate/gluconate/lactate
SE: only w/ IV admin hypotension/bradycardia/dysrhythmias, cardiac arrest, confusion, delirium, coma
contra: ventricular fibrillation or using ceftriaxone in neonates
don’t give with digoxin or tetracyclines or calcium channel blockers, magnesium competes w/ absorption
C
normal serum vitamin D/intake
600 mg/day
20-100 ng/ml
vitamin D uses
enable normal mineralization of gone & prevents hypocalcemia tetany
needed for bone growth/remodeling
prevents rickets in children/osteomalcia in adults
helps w/ cell growth, neuromuscular, immune fx, reduction of inflammation
vitamin D RF
female smoker age sedentary lifestyle alcohol use
calcitrol
calcium regulator
active form of vitamin D3
promotes intestinal absorption of calcium, elevates serum levels of calcium
tx rickets/hypoparathyroidism/impaired kidney fx
SE: ha, weakness, dry mouth , thirst, increased urination, muscle, bone pain
Contra: hypercalcemia, vitamin D toxicity
interx: thiazide diuretics can worsen hypercalcemia, w/ digoxin = dysrhythmias
C
osteomalacia
softening of bones due to demineralization
thin, fragile bones
deficiency of vitamin D
osteomalacia s/s
bone pain
fractures of vertebrae, hips, wrist
osteomalacia dx
labs
^ alkaline phophatase
^ parathyroid hormones
osteomalacia tx
calcium
vit D
sunlight
rickets
children’s vit D deficiency = poor mineralization in growing = skeletal deformities
inadequate sunlight or vit D
Rickets s/s
bowed legs, knock-knees pigeon breast (protrusion of sternum) thinning & soft skull late closing of fontanelles poor musculature/weakness
rickets tx
diet/sunlight
calcitriol
osteopenia
decrease in bone density (leads to fractures) eating disorders, metabolism issues chemo glucocorticoids radiation history white/asian thin body structures limited physical activity smoking drinking (cola and alcohol)
osteopenia s/s
usually asymptomatic until fracture
limited pain
hormonal changes if woman/in menopause
osteopenia dx
bone mass low
DEXA scan
osteopenia tx
increased calcium vit D
increased wight-bearing exercises
smoking cessation
reduction of drinking
DEXA
dual-energy X-ray
not a true density
T-scores calculated by comparing to range of “normal”
assesses presence/extent of osteoporosis
normal: +1 SD
low bone mass (osteopenia) BMD > 1D and < 2.5 SD
osteoporosis: BMD > 2.5 SD
osteoporosis
low bone density
low intake of nutrients or b/c of aging
1 degree osteoporosis
menopause/decreased bone formation due to aging
2 degree osteoporosis
disease process, renal hypercalciuria, drug related
osteoporosis tx
nutrition (CA/D) exercise prevent falls medications weight-bearing exercise ERT calcitonin bisphosphonates
osteoporosis vs osteomalcia
decreased bone mass, low nutrients/aging vs bone softening/lack of calcification
lack of calcium/estrogen/testosterone vs lack of vit D
bone loss and fractures vs fractures
normal parathyroid hormone vs high/normal
normal alk phos vs high alk phos
ostoeporosis tx
calcium/vitamin D
biphosphonates (most common, decreases enzyme important to bone turnover)
selective estrogen receptor modulators (SERMs) [decrease bone resorption]
calcitonin (increases bone density)
oral calcium mimic, human PTH teriparatide
Paget’s disease of bone
metabolic disorder bone resorption faster than bone formation creates new bone that is weak/brittle genetic disorder usually older age, northern european
paget’s disease of bone s/s
pain enlarged bones deformed bones fractures damaged joint cartilage DX: fracture, x-ray, blood test
paget’s disease of bone tx
bisphosphonates calcitonin calcium vitamin D exercise surgery
alendronate (nates)
bisphosphonates
blocks bone resorption and increases bone density
TX osteoporosis/paget’s
se: d/n/v, gi irritation, altered taste, pathologic fractures w/ long-term use
contra: osteomalacia, abnormalities in esophagus, renal impairment, heart failure, liver disease
interx: CA, iron, antacids w/ aluminum/magnesium
X
raloxifene
SERM
decreases bone resorption, lowers cholesterol/LDL
TX: osteoporosis in postmenopausal women
SE: hot flashes, migraine, HA, flu-like, endometrial disorder, breast pain, vaginal bleeding, fetal harm in pregnancy
BBW: ^ risk for venous thromboembolism/pulmonary embolism, stroke and MI
contra: estrogen-containing meds
Interx: decreases warfarin effect
X
osgood-schlatter disease
abnormal ossification of cartilaginous tissue
usually children in growth spurts
if playing sports w/ jumping = most at risk
overuse injury = separation of proximal patellar tendon insertion = callous formed = pronouned tubercle = painful lump below kneecap
osgood-schlatter disease tx
time & rest
usually resolves on own once bones stop growing
can stay as non-painful growth
legg-calve-perthes disease
idiopathic avascular necrosis of proximal femoral head
compromises blood supply
insidious onset (can happen after injury to hip) usually unilateral
legg-calve-perthes disease tx based on
age, stage, amount of hip damage petrie cast (hip-spica) or surgery
bone growth disorders
gigantism (^ GH = excessie growth) acromegaly (adult ^ GH = overgrowth of bony areas ie face/feet/hands) pituitary dwarfism (short long bones, max stature 4 ft)
osteoarthritis
most common form of arthritis wear & tear on joints = break down of cartilage causes bone to rub on bone mechanical disease spurs
osteoarthritis RF
men: hips/knees/spin
women: hips/knees/hands
hard labor/repetitive motion
obesity
age
idiopathic OA
localized in one-two joints
generalized is 3+
secondary OA
underlying condition
osteoarthritis s/s
mild symptoms worsen over time pain associated w/ joint degeneration (worsened by activity/relieved by rest) stiffness with prolonged inactivity tenderness swelling effusion crepitus bone spurs dx: x-ray
osteoarthritis tx
alter load in painful joint/improve function of joint protectors
avoid activities that aggravate condition
improve strength/conditioning
use a brace/splint/cane/crutch
OTC analgesics
prescription NSAIDs
topical analgesics
cortisone injections
hyaluronic acid injections
various non-pharmacologic therapies (heat/cold/assistive tech)
surgery
rheumatoid arthritis
chronic systemic authoimmune disorder
progressive arthritis, production of rheumatoid factor, extra-articular manifestation
caues unknown
usually females, age 20 - 50, genetics
antibodies bine with proteins/tissue = immune complexes = inflammation = enzymes damage joint more = pannus forms = osteoclasts cause underyling bone to demineralize
pannus
break in bone
rheumatoid arthritis s/s
joint swelling, stiffness (morning), warmth, tenderness, pain usually symmetrical (if not tx) hand/wrist/knee/ankle most common systemic: fatigue, anorexia, weight loss, weakness, low-grade fever rheumatoid nodules pleural effusion vasculitis pericarditis enlarged spleen
rheumatoid arthritis tx
NSAIDs low-dose oral corticosteroids DMARDs intraarticular steroid injection CAM
boutonniere deformity
from RA,
v-bend that is stuck
swan-neck deformity
from RA
bent downwards finger like a swan neck
DMARDs
disease modifying antirheumatic drugs
can slow/modify progression of tissue damage
begin w/ non biologic is worsens after 3 mo add 2nd DMARD then 3 if needed
hydroxychloroquine
DMARD
immunosuppressant, suppresses rheumatoid factor
TX: RA, lupus erythematosus, malaria
SE: anorexia, GI issues, alopecia, HA, mood changes, torsades, severe hypoglycemia, anemia, retinal disorder, angioedema
contra: visual changes with anti-malarials
interx: antacids decrease absorption, hepatoxic meds, alcohol, no digoxin
D
methotrexate
folic acid antagonist (blocks synthesis of folic acid = immunosuppressant)
TX: RA/SLE/UC/Psoriasis
SE: heptatoxicity, hemorragic perforation (enteritis), opportunstic infections SJS
BBW: NSAIDS, embryo-fetal toxicity
contra: anemia, thrombocytopenia
interx: NSAIDS (fatal myelosuppression), aspirin (decreases effect of metho), live vaccines (decreases antibody response)
X
avoid live virus vaccines
OA vs RA
non-inflammatory vs autoimmune inflammatory
HLA A1/B8 vs HLA DR4 DR1
degenerative vs systemic autoimmune disease
articular cartilage vs synovial tissue
weight-bearing joints vs small joints
asymmetrical, nodes, improves with rest vs symmetrical, migratory, deformities, improves with use
narrowing of joint space vs narrowing of joint space, bone erosion and fusion of joints
slightly elevated alk phosphatase vs positive rheumatoid factor w/ rheumatoid nodules ^ ESR
spondyloarthropathies
group of diseases affecting joints ankylosing spondylities reactive arthritis psoriatic arthritis enteropathic arthritis presence of enthesistis (site where ligament/tendon inserts to bone) HLA-B27 gene
spondyloarthropathies s/s
low back pain
morning stiffness of back or neck
gen fatigue
Anklyosing Spondylitis
autoimmune inflammatory disease affecting spine
bone overgrowth
usually white males <40
Ankylosing Spondylitis s/s
adults: stiffness, chronic low back pain moves to upper back, spinal joint fuse, can affect hips/chest wall/heels/iritis
children: begins in hips/knees/heels/big toe before moving to spine
ankylosing spondylitis tx
pain management
NSAIDs
DMARDs
Reiter’s Syndrome
reactive arthritis
complex syndrome: arthritis, conjunctivitis, urethritis
triggered by exposure to infection (STD: chlamydia)
Reiter’s syndrome s/s
pain swelling & inflammation of sacroiliac joint finger/toe swelling fever weight loss skin rash eye infection dysuria
Reiter’s Syndrome
tx
ABX
pain management
NSAIDs
Psoriatic Arthritis
idiopathic
associated w/ psoriasis
scaly red patches on skin, pitting/thickening/yellowing nails
adults: hip/sacroiliac joint, edema in toes/fingers
children: stiffness/swelling/pain in joint
psoriatic arthritis tx
NSAIDs
DMARDS (methotrexate)
Juvenile Idiopathic Arthritis
no specific cause but w/ genetic marker
chronic inflammatory autoimmune disease in juveniles
joint inflammation resulting in decreased mobility/swelling/pain
DX: ESR, antibody testing, rheumatoid factor, anti-ccp, x-ray, CT, MRI, U/S, synovial biopsy
juvenile idiopathic arthrits tx
NSAIDs DMARDs biologic agents intra-articular/oral corticosteroids PT OT surgery
Gout
increased serum uric acid > crystals in joint > inflammation
tophi (accumulation of crystalline deposits)
Gouty nephropathy (uric acid kidney stones)
TX: allopurinol
what has purines
high: alcohol, anchovies, sardines, mussels, herring, codfish, scallops, trout, haddock, bacon, turkey veal, venison, organ meats
moderate: beef, chicken, duck, pork, ham, crab, lobster, oysters, shrimp
allopurinol
anti-gout
decreases production of uric acid by inhibiting enzyme
SE: SJS, toxic epidermal necrolysis, hypersensitivity syndrome, GI retinopathy, thrombocytopenia, acute renal failure
interx: alcohol (inhibits renal excretion of uric acid), ampicillin & amoxicillin (^ risk of skin rashes), warfarin (enhanced anticoagulant), thiazides/ACE Inhibitors (ototoxicity), high purine foods (decreases effectiveness)
