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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
What vitamin helps with calcium absorption?
vitamin D
26
complications of calcium supplements
* hypercalcemia * renal calculi * IV precipitation * ↓ absorption with glucocorticoids (PO)
27
hypercalcemia actions
* monitor for s/sx of * tachycardia * ↑ BP * hypotonia * GI issues * lethargy * Tx * furosemide * calcium chelators
28
nursing actions for renal calculi
* monitor for flank pain * don't give to people at risk
29
nursing actions for IV precipitation of calcium
* give alone * doesn't play well with other meds
30
hypercalcemia sx
* fatigue * weakness * lethargy * anorexia * nausea * constipation * renal calculi * shortened QT segments * depressed T waves * heart block
31
osteoblasts
mature into new osteocytes
32
osteocytes
mature, permanent bone cells
33
osteoclasts
resorb old osteocytes
34
bisphosphonate action and uses
* 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
bisphosphonate SE
* 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
general teaching: bisphosphonates
* 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
SERM benefits
* 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
SERM risks
* DVT * hot flashes * **risk of endometrial ca (Tamoxifen)**
39
raloxifen
* class: SERM * route: PO * action: estrogen agonist in bone, antagonist in breast and uterus
40
tamoxifen
* class: SERM * route: PO * action: estrogen agonist in bone, antagonist in breast * **↑ risk of endometrial cancer**
41
pt education for SERMs
* 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
calcitonin salmon
* class: hormone, antihypocalcemic * route: intranasal, IM, SQ * action: ↓ bone resorption by inhibiting osteoclast activity; ↑ renal absorption of Ca
43
calcitonin salmon indications
* treats but does not prevent osteoporosis and Paget's dz * hypercalcemia r/t hyperparathyroidism and cancer
44
calcitonin salmon SE
* nausea * nasal irritation (intranasal): alternate * hypocalcemia
45
calcitonin salmon nursing actions
* monitor serum calcium and bone density * encourage high-Ca and high-vitamin D diet * therapeutic intent: ↑ bone density, normal Ca level
46
gout
* inflammatory arthrities 2/2 high serum uric acid level * swelling, redness, ↓ ROM, pain in joint
47
gout risk factors
* diet * wt * kidney dz
48
labs for those on gout meds
* UA * serum uric acid * CBC * LFT * kidney fxn
49
anti-inflammatories for gout
* NSAIDs used first * colchicine used if * NSAID response inadequate * pt cannot tolerate NSAIDs or glucocorticoids
50
colchicine
* class: antigout, anti-inflammatory * route: PO * action: intereferes with WBC inflammatory response to uric acid crystals * **only for gout arthritis**
51
colchicine SE
* GI issues * thrombocytopenia * rhabdomyolysis * *agranulocytosis* * *aplastic anemia*
52
colchicine contraindications
* severe dysfunction in * kidneys * heart * liver * GI system * caution: PG, lactation, older adults, ↓ renal fxn
53
colchicine interactions
grapefruit juice: ↑ colchicine levels → toxicity
54
antihyperuricemics
* ↓ 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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