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2021 Pharm 2 > Joint and Bone > Flashcards

Joint and Bone Flashcards

1
Q

rheumatoid arthritis

A
  • RA
  • autoimmune disorder
  • attacks joint tissues
    • usually symmetrical bilaterally
    • may start in a couple of joints
    • most common: wrist, hand, elbow, shoulders, knees, ankles
  • usually begins @ 30-60 yo
  • more debilitating than osteoarthritis (OA)
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2
Q

med classes for RA Tx

A
  • DMARDs (disease-modifying antirheumatic drugs)
  • glucocorticoids
  • NSAIDs
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3
Q

DMARD

A

disease-modifying antirheumatic drug

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4
Q

DMARDs

A
  • slow progression of dz
  • may take 3-6 wks for response, several months for therapeutic outcome
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5
Q

DMARD I

A
  • methotrexate
  • hydroxychloroquine
  • sulfasalazine
  • minocycline
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6
Q

DMARD II

A
  • etanercept
  • infliximab
  • adalimumab
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7
Q

DMARD III

A
  • auranofin
  • penicillamine
  • azathioprine
  • cyclosporine
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8
Q

glucocorticoids for RA

A
  • may be given PO or intra-articular
  • drugs: prednisone, prenisolone
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9
Q

goal of RA Tx

A
  • ↓ swelling and stiffness in joints
  • ↑ ROM
  • maintain joint fxn
  • pain relief
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10
Q

NSAIDs for RA

A
  • ASA
  • ibuprofen
  • diclofenac
  • indomethacin
  • meloxicam
  • naproxen
  • celecoxib
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11
Q

cyclosporine toxicity

A
  • risk ↑ when taken with erythromycin
  • concurrent therapy contraindicated
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12
Q

mouth sores

A
  • methotrexate, auranofin
  • sign of toxicity
  • monitor, teach pt to report
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13
Q

retinal damage

A
  • SE of hydroxychloroquine
  • eye test before and q6mth
  • report changes in vision
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14
Q

SJS

A
  • Stevens-Johnson Syndrome
  • rxn to many cancer, autoimmune, other medications
  • rare, life-threatening systemic skin dz
  • stop medication immediately
  • possibly identical to toxic epidermal necrolysis
  • progression
    • flu-like sx
    • blisters of mucous membranes
    • cutaneous rash, often widespread and severe
    • skin dies and sheds → dehydration, infection, death
  • Tx
    • elimate cause
    • control s/sx
    • prevent infection
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15
Q

osteoporosis

A
  • loss of bone mass throughout the skeleton
  • common in
    • older adults
    • younger pts with chronic conditions
      • autoimmune
      • chronic GI
      • wt loss surgery
      • cancer
      • chronic nervous disorders
  • first sx often fx
  • lifestyle risk factors: smoking, caffeine, sedentary
  • prevention
    • wt-bearing exercise
    • no smoking
    • Ca foods: dairy, sardines, salmon, dark greens
    • vitamin D foods: fatty fish, beef, cheese, fortified foods
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16
Q

meds for osteoporosis

A
  • calcium supplements
  • bisphosphonates
  • SERM
  • calcitonin
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17
Q

calcium supplements

A
  • PO
    • calcium citrate
    • calcium carbonate (Tums)
    • calcium acetate (PhosLo)
  • IV: for severe hypocalcemia
    • calcium chloride
    • calcium gluconate
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18
Q

bisphosphonates

A
  • PO
    • alendronate
    • ibandronate
    • risendronate
  • IV: zoledronic
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19
Q

SERM

A

selective estrogen receptor mediator

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20
Q

selective estrogen receptor modulators for osteoporosis

A
  • route: PO
  • raloxifene
  • tamoxifen
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21
Q

normal serum calcium

A

9.0-10.5 mg/dL

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22
Q

calcium supplements

A
  • mainly for osteoporosis prevention in women with
    • hypocalcemia
    • poor diet
    • risk for osteoporosis
    • pregnancy
  • does not rebuild bone
23
Q

IV calcium use

A

severe hypocalcemia

24
Q

therapeutic action of calcium supplements

A

maintain MSK, neuro, and CV fxn

25
Q

What vitamin helps with calcium absorption?

A

vitamin D

26
Q

complications of calcium supplements

A
  • hypercalcemia
  • renal calculi
  • IV precipitation
  • ↓ absorption with glucocorticoids (PO)
27
Q

hypercalcemia actions

A
  • monitor for s/sx of
    • tachycardia
    • ↑ BP
    • hypotonia
    • GI issues
    • lethargy
  • Tx
    • furosemide
    • calcium chelators
28
Q

nursing actions for renal calculi

A
  • monitor for flank pain
  • don’t give to people at risk
29
Q

nursing actions for IV precipitation of calcium

A
  • give alone
  • doesn’t play well with other meds
30
Q

hypercalcemia sx

A
  • fatigue
  • weakness
  • lethargy
  • anorexia
  • nausea
  • constipation
  • renal calculi
  • shortened QT segments
  • depressed T waves
  • heart block
31
Q

osteoblasts

A

mature into new osteocytes

32
Q

osteocytes

A

mature, permanent bone cells

33
Q

osteoclasts

A

resorb old osteocytes

34
Q

bisphosphonate action and uses

A
  • action: ↓ number and action of osteoclasts → ↓ bone resorption
  • uses
    • prophylaxis and Tx of osteoporosis r/t
      • menopause
      • aging
      • long-term glucocorticoids
    • Tx in Paget’s dz and hypercalcemia r/t cancer
35
Q

bisphosphonate SE

A
  • esophagitis, esophageal ulcerations
    • take with full glass of water
    • sit upright for 30 min
    • report mouth pain, dysphagia
    • do not eat for 1 hr
  • visual disturbances, eye pain: stop taking, notify provider
  • osteonecrosis of jaw
    • have regular dental care
    • report jaw pain
    • notify dentist about med
  • GI disturbances
    • notify provider if intolerable
36
Q

general teaching: bisphosphonates

A
  • take first thing in morning on empty stomach with full glass of water
  • after: upright for 30 min, don’t eat for 1 hr
  • daily wt-bearing exercise
  • forgotten dose: skip and take next day
  • need monitoring for bone density and Ca level
37
Q

SERM benefits

A
  • works as
    • estrogen in bone, lipid metabolism, and blood
    • anti-estrogen in breast and endometrium
  • prevents and treast osteoporosis and spinal fx
  • protects against breast ca
38
Q

SERM risks

A
  • DVT
  • hot flashes
  • risk of endometrial ca (Tamoxifen)
39
Q

raloxifen

A
  • class: SERM
  • route: PO
  • action: estrogen agonist in bone, antagonist in breast and uterus
40
Q

tamoxifen

A
  • class: SERM
  • route: PO
  • action: estrogen agonist in bone, antagonist in breast
  • ↑ risk of endometrial cancer
41
Q

pt education for SERMs

A
  • don’t take with HRT
  • wt-bearing exercise
  • monitor bone density, serum calcium, LFTs
  • stop taking 3 days before surgery
  • therapeutic intent: ↑ bone density, no fx
42
Q

calcitonin salmon

A
  • class: hormone, antihypocalcemic
  • route: intranasal, IM, SQ
  • action: ↓ bone resorption by inhibiting osteoclast activity; ↑ renal absorption of Ca
43
Q

calcitonin salmon indications

A
  • treats but does not prevent osteoporosis and Paget’s dz
  • hypercalcemia r/t hyperparathyroidism and cancer
44
Q

calcitonin salmon SE

A
  • nausea
  • nasal irritation (intranasal): alternate
  • hypocalcemia
45
Q

calcitonin salmon nursing actions

A
  • monitor serum calcium and bone density
  • encourage high-Ca and high-vitamin D diet
  • therapeutic intent: ↑ bone density, normal Ca level
46
Q

gout

A
  • inflammatory arthrities 2/2 high serum uric acid level
  • swelling, redness, ↓ ROM, pain in joint
47
Q

gout risk factors

A
  • diet
  • wt
  • kidney dz
48
Q

labs for those on gout meds

A
  • UA
  • serum uric acid
  • CBC
  • LFT
  • kidney fxn
49
Q

anti-inflammatories for gout

A
  • NSAIDs used first
  • colchicine used if
    • NSAID response inadequate
    • pt cannot tolerate NSAIDs or glucocorticoids
50
Q

colchicine

A
  • class: antigout, anti-inflammatory
  • route: PO
  • action: intereferes with WBC inflammatory response to uric acid crystals
  • only for gout arthritis
51
Q

colchicine SE

A
  • GI issues
  • thrombocytopenia
  • rhabdomyolysis
  • agranulocytosis
  • aplastic anemia
52
Q

colchicine contraindications

A
  • severe dysfunction in
    • kidneys
    • heart
    • liver
    • GI system
  • caution: PG, lactation, older adults, ↓ renal fxn
53
Q

colchicine interactions

A

grapefruit juice: ↑ colchicine levels → toxicity

54
Q

antihyperuricemics

A
  • ↓ production
    • allopurinol: IV, diluted, over 30-60 min
    • febuxostat
  • ↓ reabsorption in kidneys: probenecid
  • SE
    • kidney injury: 2-3 L water/day
    • severe rxn
    • GI distress
    • livery injury
  • goal of Tx: ↓ serum uric acid

2021 Pharm 2 (18 decks)

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