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Pharm 2 > Exam #3 Chronic MSK Disorders > Flashcards

Exam #3 Chronic MSK Disorders Flashcards

1
Q

Osteopenia Defintion

A
  • Decrease in bone density
  • Can lead to fractures
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2
Q

Osteopenia Causes

A
  • Chronic eating disorders or issues with metabolism
  • Chemotherapy
  • Glucocorticoids
  • Radiation exposure
  • Family history of low bone density
  • White / Asian
  • Thin
  • Limited physical activity, smoking, drinking cola based beverages, high alcohol intake
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3
Q

Osteopenia S/S

A
  • Causes no signs / symptoms
  • Only detected during diagnostic test
  • ^ DEXA scan
  • Recommended for women 65+
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4
Q

Osteopenia Treatment

A
  • Diet Therapy of
  • Calcium & Vit D
  • Weight bearing exercises
  • Smoking cessation
  • Reduction of cola based and alcoholic beverages
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5
Q

Osteoporosis Definition

A
  • Low bone density due to low intake of nutrients for bone growth or increase in bone resorption when aging
  • Primary: Menopause, Decreased bone formation from aging
  • Secondary: Disease process, effect of drug
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6
Q

Osteoporosis Diagnosis and Treatment

A
  • Diagnosis using DEXA scan
  • Serum bone G1a level
    Treatment:
  • Calcium & Vit D
  • Exercise
  • Prevent falls
  • Medications
  • Decrease ETOH and caffeine
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7
Q

Calcium Supplements
Citrate, Carbonate, Acetate

A

MOA: Maintenance of MSK, neurologic and cardiovascular function
Contradictions: Hypercalcemia, renal calculi, kidney disease
Interactions: Glucorticoids, thiazide, calcium
Education:
- May cause cardiac arrest in high doses
- 4 hrs between thyroid hormone
- 1 hr between tetracylcine and calcium
- Digoxin and parenteral calcium can lead to severe bradycardia

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8
Q

Selective Estrogen Receptor Modulator
: Tamoxifen, Raloxifene

A

MOA: Decreases bone reabsoprtion, slowing bone loss and perseveres bone mineral density
Uses: Postmenopausal osteoporosis
Complications:
- DVT ( Stop every 2 hrs in long periods of travel )
- Hot flashes
Education:
- Bone density scans every 12-18 months
- Monitor for DVT
- With / without food

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9
Q

Biophosphonates
: Alendronate

A

MOA: Decrease bone resorption by inhibiting the activity of osteoclasts in osteoporosis
Complications;
- Esophagitis
- GI
- MSK pain
- Visual disturbances
- Kidney toxicity w IV
- Osteonecrosis of jaw
Interaction: Decreased absorption with calcium, iron, mag, antacids, OJ, caffeine

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10
Q

Calcitonin

A

MOA: Lowers blood calcium levels by suppressing osteoclast activity in the bones and increasing the amount of calcium excreted in the urine
Complications: Nausea, nasal dryness, hypocalcemia
Contradiciton: Hypersensitivity to the medication or fish protein
Interactions: Lithium, glucocorticoids

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11
Q

Osteomyelitis Definition

A
  • Bone infection: Occurs after penetrating wound from blood infection, skin breakdown
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12
Q

Osteomyelitis Causes & S/S

A

Causes: Bacteria, fungi, parasites, worms, viruses
S/S: Bone pain, drainage, swelling, redness, warmth, tenderness, lymph node swelling, fever w chills, tachycardia

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13
Q

Osteomyelitis Diagnosis & Treatment

A

Diagnosis: Xray, bone scan, MRI, WBC count, blood cultures, bone biopsy
Treatment: Antibiotics, surgery for severe, drainage tubes

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14
Q

Bone Tumors

A
  • Develop when cells within a bone divide uncontrollably forming a lump or mass of abnormal tissue
    Risk: Abnormal growth of tissue
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15
Q

Bone Tumors Targeted Age Group

A
  • Occurs in children and young adults up to 30!
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16
Q

Bone tumor vast majority….

A
  • Affected by growth hormones
  • Stop growing when child stops growing
17
Q

Benign Bone Tumors

A
  • Pain
  • Local Swelling
  • Fever
18
Q

Malignant Bone Tumors

A
  • Deep bone pain
  • Skin over mass warm, erythematous
19
Q

Osteoarthritis

A
  • Develops as wear and tear on joints break down cartilage in joint, causing bone to rub on bone. Pain worsened by activity and relieved by rest.
20
Q

Osteoarthritis Risk Factors

A
  • Older age
  • 60% Women
  • Men: Hips, knees, spine
  • Women: Hips, knees, hands
  • Hard labor
  • Heavy lifting
  • Bending
  • Repetitive motion
  • Obesity
21
Q

Osteoarthritis Medical Conditions that put you at risk?

A
  • Malformed joints
  • Defective cartilage
  • Diabetes
  • Hypothyroidism
  • Gout
  • Paget Disease
22
Q

Osteoarthritis Causes

A
  • Changes slowly start to develop to joints;
  • Synovium
  • Subchondral bone
  • Cartilage
    Typically involves:
  • Weight bearing joints of hips and knees
  • Digits of hands and big toe
  • Cervical and lumbar spine
23
Q

Osteoarthritis S/S

A
  • Mild –> Worsens
  • Worsened by activity, improves with rest
  • Tenderness to touch
  • Effusion: Swelling related to excess fluid
  • Crepitus: Crackling or grating of joints
  • Bone spurs
  • Decreased range of motion
24
Q

Osteoarthritis Complications

A
  • Increased risk for falling:
  • Joint pain
  • Stiffness
  • Unsteady gait
25
Q

Osteoarthritis Treatments

A
  • OTC Analgesics
  • NSAIDS, Opioids
  • Topical Analgesics
  • Cortisone injections
  • Hyaluronic acid injections
  • Heat / cold therapy
  • Weight reduction
26
Q

Osteoarthritis Surgery

A
  • Arthroscopy
  • Joint resurfacing
  • Joint fusion
  • Arthroplasty
27
Q

Rheumatoid Arthritis

A
  • Chronic autoimmune disorder causing inflammation of tissue, primarily in joints
  • Exact cause is not known
  • Inflammatory process in the synovium
  • Women more likely
28
Q

RA S/S

A
  • Joint swelling, stiffness, warmth, tenderness, pain in the morning
  • Joint deformation
  • Bilateral
  • “Boggy” or sponge like feeling when palpated
  • Fatigue
  • Rheumatoid nodules
  • Pleural effusion
  • Vasculitis
  • Pericarditis
  • Enlarged spleen
  • Common in : Fingers, wrists, knees, ankles, toes
29
Q

RA Diagnostic Tests

A
  • More than 70% of RA patients test positive for Rheumatoid Factor
  • ESR is elevated
  • Examination of synovial fluid
  • Increased protein
  • Increased WBC
30
Q

RA Seven S’s

A
  • Sunrise Stiffness
  • Soft feeling in joints
  • Swelling in joint ( warm )
  • Symmetrical
  • Synovium ( affected and inflamed )
  • Systemic ( fever, fatigue, anemia, heart, lungs )
  • Stages ( pannus- fibrous )
31
Q

RA Treatment

A
  • NSAIDS for reduction of pain and inflammation
  • Low does oral corticosteroids
  • DMARD’s: slows progession of RA, supress immune system
  • Rest / exercise
  • PT
  • Heat / cold
32
Q

Disease Modifying Antirheumatic Drugs
DMARD’s 1

A

: Major Non- Biologic
- Immunomodulator: Methotrexate, Leflunomide
- Antimalarial Agent: Hydroxychloroquine
- AntiInflammatory: Sulfasalazine
- Tetracylcline antibiotic: Minocycline

33
Q

Disease Modifying Antirheumatic Drugs
DMARD’s 2

A

: Minor biologic DMARD’s
- Tumor necrosis factor antaganists
- Etanercept
- Infliximab
- B Lym Agent: Rituximab

34
Q

Disease Modifying Antirheumatic Drugs
DMARD’s 3

A

: Minor non-biologic and non-biologic DMARD’s
- Good salts: Auronofin
- Penicllamine
- Immunusuppressant
- Cyclosporine

35
Q

RA Meds
Glucocorticoids

A
  • Prednisone
  • Prednisolone
36
Q

RA Meds
NSAIDS

A
  • Diclofenac
  • Indomethacin
  • Meloxicam
  • Naproxen
  • Celecoxib
37
Q

DMARD’s
Non-biologic
Methotrexate *

A

MOA: Slow joint degeneration and progression of rheumatoid arthritis, Suppress immune system

Complications: Increased risk for infection, hepatic toxicity, bone marrow suppression, GI ulcerations

Contradictions: Liver failure, ETOH, blood dyscrasias

Interactions: NSAIDS, Salicylates, Sulfonamides, PCN, tetracyclines

Nursing Actions:
- Monitor liver / kidney function
- Dose w folic acid, reduces GI and hepatic toxicity
- Inspect mouth, gums, hands and throat for ulcerations, bleeding, color changes

Education:
- S/S of infection
- Observe for anorexia, abd fullness, jaundice
- Use soft toothbrush when providing oral care

38
Q

DMARD’s
Biologic
Etanercept, Infliximab, Adalimumab

A

MOA: Slow joint degeneration and progression of rheumatoid arthritis, Suppress immune system

Complications: SubQ site irritation, IV reactions, Risk of infection, severe skin reactions; Steven Johnson Syndrome

Contradictions:
- Malignancies
- Active infection
- Hematologic disorder
- Heart failure
- MS
- Liver dysfunction

Interactions:
- Live vaccine increases risk of infection
- Immonosuppressants increase risk of serious infection

Nursing Action:
- Monitor injection site
- Test for Hep B and TB
- Monitor for Heart Failure
- Etanercept given SQ 1x / wk

Pharm 2 (10 decks)

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