Musculoskeletal Flashcards
The musculoskeletal system is composed of what
bone
CT
Voluntary muscles
Connective tissue consists of
ligaments, tendons, versa, fascia
Ligaments connect
bone to bone
Tendons connect
bone to muscle
Fascia ________ bone
encloses
Bursa is what is compared to bone
fluid-filled sack for cushioning
Functions of the Musculoskeletal System
protect organs
provide support and stability
store Ca
coordinated mvmt
Osteoblasts
bone forming
Osteocytes
mature bone cells
Osteoclasts
clean up/breakdown bones
BOne remodeling
removal of old bone by osteoclasts
deposit new bone by osteoblasts
Risk Factors associated with Musculoskeletal disorders
Autoimmune disorders
Calcium deficiency
Falls
Hyperuricemia
Metabolic disorders (diabetes)
Neoplastic disorders (tumor growths)
Obesity
Post-menopausal states (low estrogen)
Trauma and injury
Diagnostic Tests for Musculoskeletal
Radiography
MRI
Xrays
Arthrocentesis
Arthroscopy
Bone scan (CT)
Bone or muscle biopsy
Electromyography (least common)
Radiography and MRI
WARNINGS
Handle injured areas carefully
Stabilize/support above and below injured joint
Pain meds
Remove any radiopaque and metallic objects (jewelry)
Ask the client if pregnant** - may be contraindicated
Shield testes, ovaries, and pregnant abdomen
Notify patient they must lie still during the scan
HCP must wear a lead apron if in the room
Arthrocentesis
needle aspiration
diagnose joint inflammation or infection
aspirate fluid, blood, or pus
inject corticosteroid to lower inflamed
Arthrocentesis Interventions
informed consent
pain meds
Rest 8-24 hrs post-op
notify if fever/swelling occurs
Arthroscopy
**diagnose and treat acute and chronic disorders of joint w/ scope
endoscopic exam
- assess or trim cartilage abnormal, loose body removal
biopsy performed
ACL tear
Arthroscopy Interventions
NPO 8-12 hours prior
consent
pain meds
Neurovascular assessments per policy
Elastic compression 2-4 days post-op
Elevate and ice PRN 12-24 hours post-op-Help with swelling
Weight-bearing activity but should be limited to 1-4 days (per provider orders)
Notify physician of fever, swelling or increased pain >3 days post-op (infection)
Subjective Data
Past health hx = if something is new
Meds = long term corticosteroids lead to osteoporosis or arthritis, taking Ca
Surgery =
Perception = what do they consider healthy, exercise after?
Nutrition = diabetes
Exercise = willing to work on activity
Sleep-rest = healing
coping-stress tolerance
What is needed when a patient had a hip surgery?
abduction pillows
- hips don’t cross
Objective Data
General overview with focused exam
Physical examination
Inspection - spine
Palpation
Motion
Measurement
Other
Use of assistive devices
Posture and gait
Straight-leg-raising
Kyphosis
hunchback
Lordosis
swayback
Scoliosis
side to side (C or S)
Gerontologic considerations for muscles and skeletal
Decreased bone density
Decreased muscle mass and strength (less than 30%)
Decreased flexibility
Functional problems
-ADL is main goal
Soft Tissue Injuries
-from trauma mostly (sports)
sprains
strains
subluxation
dislocation
Sprain is
an injury to ligaments around a joint
wrenching or twist
Sprain Grades 1 through 3
Grade I: few fiber tears; mild tenderness and swelling - functional
Grade II: partial disruption of tissue - little more swelling and pain, tenderness
-depends on the function
Grade III: complete tear with moderate to severe swelling and pain (result in loss of function) - can not walk
Do what type of ROM 1st?
active
then if they can not do it themselves passive
Strain Grades 1-3
Grade 1: mild or slightly pulled
Grade II: moderately torn muscle
Grade III: severely torn or ruptured muscle
Strain is
excessive stretching of muscle and fascia; may involve tendon
Sprains and Strains S/S
Pain
Edema
Decreased function
Bruising
Dx Sprains and Strains
hx and physical (mechanism of injury makes a difference)
X-ray
MRI
CT
Avulsion fx
breaks away a piece of bone
- necrosis could occur due to a lack of blood supply
- hips and 5th metatarsal
Subluxation
partial dislocation
Dislocation
complete displacement or separation of the joints
Hemarthrosis
articular bleeding in joint area
What are the 6 Ps for Peripheral Neurovascular Exams
Pallor
Pulse
Poikilothermia
Pain
Paralysis
Paresthesia
Health Prevention of Sprains and Strains
Warm-up exercises and stretching
strength, balance, and endurance exercises
start gradually
What stretching should be done before static?
functional
(sit up pt to move before walking)
RICE and self-limiting
Rest: Stop activity and limit movement
Ice: 24 to 48 hours; 20 to 30 minutes at a time (barrier)
Compression: elastic bandage; apply distal to proximal- have the swelling move the blood flow back to the heart
Elevate: above the heart
Analgesia
Compression elastic should be put in what way
distal to proximal
- swelling moves blood back to the heart
How long do you keep ice on an injury
DAYS?
AT A TIME?
24-48 hours
30-30 mins
S/S of dislocation and subluxation
deformity
pain
tenderness
loss of function
swelling
Complications of dislocation and subluxation
intraarticular fx and avascular necrosis
Fractures
disruption or break in the bone continuity
- from traumatic injuries
-secondary to the disease process (pathologic)
= cancer osteoporosis
Case Study
L.G., a 23-year-old man, is brought to ED following an injury to his right arm during a rugby game. A bone in his forearm is protruding through his skin. EMS immobilized the arm at the scene. L.G. rates his pain as a 9 on a scale of 0 to 10.
-How would you classify this fracture? Explain
- Other s/s associated w/ fx in L.G.?
Open fx = protruding through the skin
- worry about infection (antibiotics), bleeding, 6Ps
- pain, emotional state, clots functionality
Open fx
skin broken; bone exposed
Closed Fx
skin intact
Linear fx
break along the bone’s long axis
Longitudinal fx
irregular in shape and chip long
Displaced
two ends separated from one another
Often comminuted or oblique
Nondisplaced
the periosteum is intact, and the bone is aligned.
Usually transverse, spiral, or greenstick
Transverse
straight acoss
Spiral
twisted across
Greenstick
chip not attached but rest of bone is
Comminuted
shattered into little pieces
Oblique
in the middle and not straight
Pathologic
due to disease
A broken bone that causes damage to
surrounding
periosteum
blood vessels in cortex/marrow
s/s of broken bone
Edema/swelling
Pain and tenderness
Muscle spasm (may need muscle relaxer)
Deformity
Contusion
Loss of function
Crepitation (grating sound or feeling)
Guarding
Possible Objective Data of Broken Bone
Apprehension
Guarding
Skin lacerations (infection), color changes
Hematoma, edema
↓ or absent pulse, ↓ skin temperature
Delayed capillary refill
Paresthesia
Absent, ↓ or ↑ sensation
Restricted or lost function
Deformities; abnormal angulation
Shortening, rotation, or crepitation
Muscle weakness
Imaging findings
6 STages of Bone Healing
1.Bleeding at fractured ends of the bone - hematoma formation.
2.Hematoma organized into fibrous network - hematoma converts to granulation tissue
3.Callus formation: new bone is built up as osteoclasts destroy dead bone
4.Ossification of the callus occurs (3 weeks to 6 months)
5. Consolidation: callus continues to develop, closing the distance between bone fragments **(up to 1 year after injury) **
6.Remodeling is accomplished as excess callus is resorbed and trabecular bone is laid down
Normal Bone Remodeling
osteoblasts form new
osteoclasts clean up old
Traction Purpose
Prevent or decrease pain and muscle spasm
Immobilize joint or part of body
Reduce fracture or dislocation
Treat a pathologic joint condition – tumors or
*counter traction (relieve pressure) pulls in opposite direction
Buck’s Traction
used for the patient with a hip, knee, or femur fracture
- 24-48 hours to relieve painful muscle spasms
w/ weights
Skeletal Traction
Long-term pull to maintain alignment
Pin or wire inserted into bone
Weights 5 to 45 pounds
Risk for infection
Complications of *immobility
Elevate end of bed
Maintain continuous countertraction
Keep weights off the floor** DO NOT TOUCH WEIGHTS!!!!!
With traction, weights should never be placed where
on the floor
Casts
Temporary
Allows patient to perform many normal activities of daily living
Typically incorporates joints above and below the fracture
Lower extremity Immobilization
Elevate extremity above heart (24-48 hours)
Do not place in a dependent position
Observe for signs of compartment syndrome and increased pressure
Prevent getting wet
External Fixation
Metal pins and rods - possible loosening (clean and teaching)
Applies traction
Compresses fx fragments
Immobilizes and holds fracture fragments in place
Mostly used for long-bones
Internal Fixation
- surgically inserted to realign and position bony fragments
-biology and bone healing by xrays
Nutritional Therapy
Essential in optimal soft tissue and bone healing
Promotes muscle strength and tone
Builds endurance
Provides energy
Diets with fx
Protein 1g/kg
Vitamins B,C, and D
Ca
Mg - relax muscles
Fluid intake 2-3L/day
HIgh fiber as constipation precaution
Peripheral Neurological
sensation
motor function
pain
Health Promotions for fx
safety
advocate for decreased injuries
moderate exercise
safe environment
Ca and Vit D
Pre-Op Management
immobilization
assistive devices
expected activity limits
needs met
pain is subjective and trust pt on schedule
start discharge planning now
Post-op Management
V/S
frequent neurovascular assessments
minimize pain and discomfort
monitor for bleeding or drainage
-asepsis
-blood salvage and reinfusion
How to prevent immobility complications?
constipation
kidney stones
cardiopulmonary deconditioning (pneumonia)
- TCDB and ICS
DVT/pulmonary emboli
- SCD, TED Hose, Anticoagulants
Non-weight bearing
NOT allowed to put any weight through the operated or injured limb to allow it to heal
TDTT weight bearing
touch down = entire foot touches the floor but not all the weight
toe touch = toes touch the floor and rest of weight on an assistive device
Partial weight bearing
a small amount on the affected extremity
Weight-bearing as tolerated
all weight they can
Full weight-bearing ambulation
normal
Cast CARE Dos
frequent neurovascular assessments
Apply ice for 1st 24 hours
elevate above the heart for 1st 48 hours
exercise above and below
Hair dryer on cool for itching thoroughly
report pain, swelling with movement
Report burning or tingling under a cast or foul odors
Cast CARE Don’ts
Do not get plaster cast wet
Discourage pulling out cast padding
Do not place foreign objects inside cast
Do not bear weight on the new cast for 48hrs
Do not cover the cast with plastic for prolonged periods of time
Psychosocial Problems with Home Care
Dependence* in performing ADLs
Family separation
Finances
Inability to work
Potential disability
Walker
Dos
Don ‘ts
Measure
Sitting and Stairs
15-30 degree elbow flex
Push off armrests of the chair and stand before grabbing walker
-stand up straight don’t hunch
- only one step ahead of you
-affected leg should go 1st**
-put the walker together and next to you when going upstairs
Cane
Dos
Don ‘ts
Measure
Sitting and Stairs
- Cane on Strong SIDE - NOT WEAK SIDE
-
15-30 DEGREES flex of elbow
like a hand in pocket - 8-12 inches ahead to walk
- Good does to heaven, bad go to hell Good side going upstairs 1st - bad side going downstairs 1st
- different types of bottoms
Crutches
Dos
Don ‘ts
Measure
Sitting and Stairs
-good going upstairs, bad going downstairs
-2 to 3 fingers width below armpits (cut off blood flow and damage nerve)
-8 to 12 inches out to walk
-15 to 30-degree elbow flex
the bar at wrist height
don’t rush
Slings
Dos
Don ‘ts
Measure
the arm needs to be 90 degrees
dress with affected arm 1st
the hand should be supported on both sides possibly stress ball
Measure from elbow to pinkie
- don’t let your arms dangle or pressure
6 Ps
Gait Belt
Dos
Don’ts
Measure
Walking
Hand under the belt when walking
mid sternum with tag inside
square base in front to stand them with counting
Ambulation
skin breakdown and protect yourself
don’t use if chemo or radiation
Hip fx are _________ in hospital settings
prevalent
Hip Fx is a fx in what part of the bone?
any in the upper 1/3 part of the femur
Hip fx S/S
external rotation (turns out an up
muscle spasms (contractions - Buck’s traction)
shortening of affected
severe pain and tenderness
Hip fractures use what type of traction
Buck’s (skin) traction
- muscle spasms
Hip Fractures Tx Options
- immediate surgery
- Buck’s traction immobilization if delay
- Pre Post-Op Care
- Ambulatory and Home Care
In hip fractures, when should you have surgery after it happens?
immediately
- longer the wait less likely of recovery
Preoperative Care
Discharge Planning
- chronic health problems
- analgesics or muscle relaxants
- comfortable positioning
- traction
Postoperative Care
Abductor pillow and no crossing of legs
V/S BP (anestesia)
I&Os (kidney function for nephrotoxic drugs)
Respirations (pneumonia)
-TCDB and IS (pneumonia)
Pain management (regimen)
6Ps
Observe dressing and bleeding
-Dr 1st dressing unless with an order
Post Hip Replacement
-For ADLs
elevated toilet seat
shower chair (remain seated while washing)
Pillow btw legs for 1st 6wks when supine
neutral straight
After a hip replacement, when should you notify the doctor?
severe pain
deformity
loss of function
bc infection
What should someone with a hip replacement get from their doctor when going in for dental work?
prophylactic antibiotics in advance
What are some major NEVER DO for Post Hip Replacements?
Flex hip greater than 90
adduct (only abduct)
internally rotate hip
cross legs or ankles
sit on chairs w/o arms
What should you use to put shoes and socks on after surgery?
adaptive device for 4-6 weeks
Average hospitalization for hip replacement
and schedule after
3-4 days post-op
then attend a subacute rehab or skilled nursing home health
-follow up appointments
What are some possible complications for post-op hip replacement?
DVT
Compartment syndrome
Pneumonia
INFECTION
pain mgmt (intervals and before PT)
bleeding risk due to anticoagulant and other sites except for an incision
fall risk - pick up trash/clutter
Brittle bones need supplements
S/S of DVT
swollen
local red
local warmth
The easiest way to educate patients on dressing changes to prevent infection
wash hands
wear gloves
You should always assess peripheral neurovascularly
bilaterally
What percentage of muscle mass is lost every day the pt is in bed?
1-5%
What are some diseases that can cause an amputation?
DM
peripheral vascular disease
osteomyelitis
Amputation
removal of a body extremity by trauma, disease, or surgery
-physically and mentally complicated
What word should be associated with amputation?
GRIEF - emotion drainage
Amputation Assessment
the appearance of soft tissue (before and after
no necrosis
preexisting illness
skin temperature
sensory function
quality of the peripheral pulse
Amputation dx studies
underlying reason
H&P
WBC (infection or gangrene)
Vascular tests
- arteriography, doppler, venography
Closed amputation
performed to create a weight-bearing residual limb or stump
-prostetics
ensure proper healing, and closure w/o infection
Emotional support
Post-op mgmt
Phantom limb sensation
brain representation does not know it does not have a limb
-causes a feeling of their limb to still be there
-ambulation for a prosthetic and home care
-teachings for pt and caregiver
Phantom-limb sensation tx
Mirror therapy
Direct Complication of Fractures
infection
incorrect union
necrosis
Indirect Complication of Fractures
compartment syndrome
venous thromboembolism (VTE)
fat embolism
rhabdomyolysis
hypovolemic shock
Infection
wound closed or open
risk increase with dirty environment
-soft tissue injuries
Open fractures should be treated with
prophylactic antibiotics
Surgical I&D
Wound cleaned with saline lavage in the operating room
Contaminants are irrigated and mechanically removed
LEAVE ANTIBIOTIC BEADS
Muscle, sub Q fat, skin, and bone fragments are surgically excised if contaminated
–Under anesthesia–
Infection Tx
skin grafting (good if the same color as skin with blood supply attached)
antibiotics = irrigation, beads, and IV
Compartment Syndrome
too much swelling (increases contents)
nowhere for it to go (lowers compartment size)
Compartment syndrome affects what blood supply
Arterial flow becomes compromised
ischemia
cell death
loss of function
How many total compartments does the human body have?
38
6 Ps of Compartment Syndrome
#1 Pain unrelieved by meds or elevation (out of proportion)
pressure
paresthesia
pallor
paralysis
pulselessness
Should the patient be told they can take off their own casts?
no, need to see a doctor to remove them
What is the best time to catch compartment syndrome?
Also, what needs to be assessed for kidney function?
early recognition via regular neurovascular assessment
- notify HCP unrelieved by meds or elevation
Urine output for kidney function
Should the compartment be elevated above the heart?
NEVER
Should you put ice on a patient with compartment syndrome? Why?
no, need vasodilation and blood supply
What should be done 1st for a patient with compartment syndrome?
Loosen bandage and splint
reduce traction wt
fasciotomy to relieve pressure
Venous Thromboembolism
High susceptibility aggravated by muscle inactivity
Prophylactic anticoagulant drugs – always
Unless low platelet count
Antiembolism stockings
SCD
ROM exercises – encourage regularly
Anticoagulant Therapy
monitor for bleeding anywhere
reinforce with pressure and dressing if bleeding
safe self-injection
keep lab appointments (low platelet count don’t give)
Fat embolism originated in the
bone marrow
- fat globule released into bloodstream
Fat embolism occurs after
fracture
What fx causes fat embolism?
crushing injury to a long bone or pelvis
S/S of fat embolism
restlessness
Hypoxemia and peticual rash on chest - O2 sat
mental status change - confused
dyspnea/tachypnea
tachycardia
hypotension
T/F: Raloxifene is contraindicated in pts with hx of venous thrombotic events.
True
Osteoarthritis PATHO
gradual loss of joint cartilage
osteophytes form at joints
not normal
Destruction of cartilage
not reversible
Osteoarthritis turns cartilage into
dull, yellow, and granular
soft and less elastic
not able to resist wear and tear
-cracks and osteophytes form
Inflammation (local) and thickening odf capsules cause
earrly stage pain and stiffness
Central cartilage is thinner; edges become thicker, and osteophytes are formed resulting in
uneven weight distribution
W/ uneven weight distribution of the bones in osteoarthritis, bones tend to do what leads to increasing pain in later stages
bones rub together
Osteoarthritis Risk Factors
over 65
females
- menopause (decrease estrogen)
obesity (more weight)
ACL injury
frequent kneeling (occupation)
smoking (vasoconstriction)
genetic? maybe
Osteoarthritis aka
Degenerative Joint Disease
Osteoarthritis is
progressive noninflammatory disorder of the synovial joints
What is the basic progression of osteoarthritis?
initial injury
attempts cartilage repair
stimulates cartilage degradation - osteophytes
outgrowth and hyperplasia
S/S Osteoarthritis
joint pain
morning stiffness
crepitation
deformity
tenderness
limited mvmt
Bilaterally compared
A nurse is assessing an Osteoarthritis pt, what would be normal findings?
joint pain and stiffness
impact on ADLs
pain mgmt
compare bilateral joints
-swelling
-limitation of mvmt
-crepitation (grating sound)
Osteoarthritis Tests
Bone scan, CT scan, MRI
X-rays
No specific lab tests or biomarkers
Synovial fluid analysis
arthroscopy - trim cartilage
NO specific markers
Is there a cure for osteoarthritis?
no
-manage pain
prevent disability
maintain functioning
What are the type of tx starting from least to most invasive for osteoarthritis?
rest and joint protection (balance, avoid prolonged, use assistive devices)
heat in the morning and cold with activity
nutrition and exercise
Drug Therapy - Tylenol, topical, OTC creams
Surgical (arthroscopic, replacement, PT assist, anticoag, edema, pain mgmt
When should you use ice or heat with osteoarthritis?
heat in the morning and cold with activity and acute inflammation
What exercise is good for OA pts?
aerobic
ROM
muscle strength
For Moderate to severe joint pain use what drug therapies for OA?
Nonsteroidal antiinflammatory drug (NSAID); start low dose, increase if needed
Ibuprofen 200 mg up to four times per day
Misoprostol to decrease GI side effects
Arthrotec (combination of misoprostol and NSAID diclofenac)
Diclofenac gel
Avoid both oral and topical NSAIDs together
Celebrex
Intraarticular **corticosteroid injections
4 or more injections without relief suggest need for additional intervention
Corticosteroids should not be given systemically
Only given 3-4 times a year
Why is Hyaluronic acid injection—knee OA not used for OA anymore?
allergic reaction stiffness
Arthroscopic surgery OA
For patients with loss of function, unmanaged pain, and decreased independence
Common for patients with knee OA
May provide no additional benefit over PT and medical treatment
Overall goals of OA
maintain or improve function - with braces
joint protection
independence in self-care
satisfactory pain mgmt
Health promotion of OA
LOSE wt
reduce hazards
athletic instruction of warming up
and physical fitness programs to increase activity
tx traumatic joint injuries
Physical therapy for exercise program such as ______ to warm up to prevent injury
Tai-Chi
Ambulatory Care for
adjusting home management goals
- no scatter rugs, railing, night light, fitting shoes, assistive devices
sex counseling
w/ pt, caregiver, family members, significant others
If they have OA, should they be exercising?
yes, but not insane marathons
CPM machine is used to
keep joints moving after a total knee arthroscopy not hip
Osteomyelitis is the
severe infection of bone, bone marrow, and surrounding soft tissue
Most common organism to cause osteomyelitis
staphylococcus aureus
Risk factors for Osteomyelitis
open wound
young boys
blunt trauma, vascular insufficiency, infections, foreign body presence
S/S of osteomyelitis
fever high
Pain unrelieved by rest and worsens with activity-restricted
night sweats
chills
restlessness
nausea
malaise
drainage(late)
increase WBC, ESR, and positive cultures
spontaneous fx
What differentiates the same symptoms but different diseases?
hx and physical
Acute osteomyelitis is an infection that occurs with
one month
Dx for osteomyelitis
bone and sift tissue biopsy
cultures
WBC count
ESR (erythrocyte sedimentation rate)
x-ray
bone scan
MRI/CT scan
Nursing Interventions for Osteomyelitis
Cultures before giving aggressive, prolonged, IV antibiotics
Irrigation and debridement
surgery - amputation
control infection in the body
pain control
wound/dressing care
What drugs are used to tx osteomyelitis?
Cephalosporins
Vancomycin
When on antibiotics for so long, what could possibly happen as a result?
C diff
If you suspect an infection, what should you give after cultures?
aggressive antibiotics
Pt Teaching for osteomyelitis
prevent infections (UTI, resp, deep pressure wounds)
**encourage IS, TCDB, and up in a chair
activity = circulation
limit stress to affected
support
lead to amputation
What type of precaution is on an osteomyelitis pt?
fracture precaution
Osteoporosis is a
chronic, progressive metabolic bone disease
-porous, brittle, prone to fx
Osteoporosis is terms of cells
increase of osteoclasts (reabsorption)
decrease osteoblasts (deposition)
Osteomyelitis results in
low bone mass
deterioration of bone
high fragility
Most common bone to have osteoporosis
hips, pelvis, wrists, vertebrae
How do you prevent osteoporosis
reg exercise
fluride
Calcium
vItamin D
Osteoporosis Risk Factors
> 65
long term corticosteroids
Females - menopause decreases estrogen
hyperthyroidism
Chronic alcoholism - more than 2 drinks a day
cirrhosis
intestinal malabsorption
low activity (sedentary)
low calcium and vit D
low body weight
white or Asian
family hx
smoking
What drug puts you at risk of osteoporosis?
long term corticosteroids
-decrease Ca absorption
S/S of Osteoporosis
back pain
spontaneous fx
gradual loss of ht
kyphosis
Peak bone mass is at what age
20
Bone loss happens at what age
35-40
Bone loss is rapid in females after
menopause
Dx of osteoporosis
H-P
bone mineral density
initial - women over 65, earlier if high risk
ultrasound
DXA
not xray or labs for dx
Nursing Interventions of Osteoporosis
nutrition
ca supplementation
exercise
prevent fx
brace if needed (Turtle shells= TLSO)
Anitresporative (estrogen, raloxifene, bisphosphonates, calcitonin, densumabs)
How much exercise should be done in a week for osteoporosis pts
3 times for 30 mins doing weight-bearing activity
Should a patient with osteoporosis increase alcohol use?
no, decrease
Adequate Ca intake a day
Premenopause
Postmenopause
Pre-1000 mg
Post- 1500
-supplemental with food in divided doses
Calcium Foods
Milk
Yogurt
Turnip greens
Cottage cheese
Ice cream
Sardines
Spinach
Weight-bearing exercise includes
Walking, hiking, weight training, stair climbing, tennis, dancing
- Build up and maintain bone mass
Increase strength, coordination, balance
Drugs Tx of Osteoporosis - goal
- decrease bone reabsorption
- promote bone formation
What drugs treat osteoporosis?
Antiresportive drugs
Antiresorptive drugs
estrogen
raloxifene
biphosponates
calcitonin
denosumab
Raloxifene (Evists)
hormone drug therapy
- tx breast CA
-decrease cardiac events
similar to estrogen and bind with receptors
**reduces bone reabsorption
Major HIgh risk for Raloxifene is it
potential DVT
fetal harm
hot flashes
Raloxifene should be ______ before surgery because
Discontinued for 72 hours
prolonged immbolization and don’t resume until fully mobile
Alendronate (Fosamax
Biphosphonate
inhibit bone reabsoption
Side effects for alendronate
anorexia
weight loss
gastritis
take with water and 30 mins before lunch while maintaining upright for 30 mins
Rare but serious reaction of alendronate
jaw osteo necrosis
Calcitonin should be given
IM at night
-nasal
Calcitonin does what for osteoprorsis
inhibits bone resorption
-get out of blood stream for hypercalcemia
What must be given along with calcitonin
calcium supplementation
Denosumab (Prolia) used for
-used in post menopausal women and men at risk for fx
Denosumab (Prolia) administered
subQ every 6 months
Denosumab (Prolia) is a management of
pts receiving corticosteroids
Teriparatide (Forteo)
form of PTH
only drug that increases bone formation and osteoclasts as well
Teriparatide (Forteo) side effects with BLACK BOX WARNINGS
Nausea
Headache
Back pain
Leg cramps
increased risk of bone cancer
Cephalosporins
most widely used antibiotics
similar to PCN
IM or IV
Toxicity is low
Cephalosporins cause
cause cell lysis
Cephalosporins are most effective against
cells undergoing active growth and division**
The higher the generation of antibiotics the more
resistance
Cephalosporins generations with the name attached
First-generation
Cefazolin (Ancef) - prophylactic
Second-generation
Cefaclor (Ceclor)
Third-generation
Cefoperazone (Cefobid)
Fourth-generation
Cefepime (Maxipime)
cephalosprins drug interactions
Probenecid (Benemid)
Alcohol**
Drugs that promote bleeding**
Calcium**
Ceftriaxone (Rocephin)**
Cephalosporins adverse reactions
allergic
bleeding
thrombophletis
First- and second-generation Cephalosporins
used for prophylactic surgery
The third and Fourth generations of Cephalosporins are used for
broad spectrum - more aggressive
agianist active infections
highly active against gram negative
penetrate CSF
Vancomycin uses
Severe active infections only
Methicillin-resistant Staphylococcus aureus or Staphylococcus epidermidis
Vancomycin uses what type of levels for toxicity measurements
peak and trough
Vancomycin adverse effects
Ototoxicity (reversible or permanent)
*Red man syndrome – raised red rash throughout body**
Just need to slow the rate down
Thrombophlebitis (common)
Thrombocytopenia (rare) – low platelet count
Aminoglycosides IV
Narrow-spectrum antibiotics/Bactericidal
aerobic gram-negative bacilli
Aminoglycosides adverse effects
**Nephrotoxicity
**Ototoxicity (total cumulative and trough levels)
Hypersensitivity reactions
**Neuromuscular blockade
Blood dyscrasias – blood disorders
Aminoglycosides drug interaction with
PCN
