Musculoskeletal Flashcards
What is rheumatoid arthritis?
inflammation around the joint, especially in the synovial fluid
What is osteoporosis
loss of bone density
What are causes of osteoporosis
overuse /long-term use of corticosteroids
natural or surgical menopause, leading to decrease in the production of estrogen
gradual loss of bone mass
overuse of caffeine, alcohol, and tobacco
What is the building of bone called?
osteoblastic activity (blasts build)
What is the reabsorption of bones?
Osteoclastic activity? (clasts consume bone)
Whend oes BMD peak?
ages 25 to 30
What are the three main types of drugs to treat rheumatoid arthritis?
NSAIDs, glucocorticoids, and disease-modifying antirheumatic drugs (DMARDs)
What are drugs that decrease joint inflammation and joint dammage?
DMARDs. They also delay the progression of RA
What do nonbiologic DMARD drugs do?
they exert their immunosuppressive effect by interfering with normal B and T lymphocyte activity
What are the prototypes for nonbiologic DMARDs?
methotrexate
What are the prototypes of biologic DMARDs?
etanercept (enbrel)
Humera
How do biologic DMARDs work?
They inactivate tumor necrosis factor drugs resulting in reduced inflammation and immunosuppression by bein antagonists in the receptors in the synovial joint
What are the four main types of drugs to prevent or treat osteoporosis?
selective estrogen receptor modulators (SERMs), bisphosphonates, calcitonin, and calcium supplements
What does SERMs treat?
postmenopausal osteoporosis
cancer
estrogen-dependent/ receptor-positive cancer
What is the prototype for SERMs?
raloifene aka EvistaW
What is the classification for SERMs?
bone resorption inhibitor
How do SERMs work?
they activate estrogen receptor in some tissue and block receptors in other tissue
What are bisphosphonates used for?
precention and treatment of postmenopausal osteoporosis in women
age-related osteoporosis in men
glucocorticoid-related osteoporosis
What is the prototype drug for bisphosphonates?
alendronate (Fosamax)
How do bisphosphonates work?
Expected pharmacologic action is to decrease bone resorption by inhibiting activity
What are some ADRs for bisphosphonates?
GI disturbances
esophagitis, n/v
ab pain
eye pain and vision changes in some
joint pain
bisphosphonates interventions
monitor for decreased bone resorption and changes in vision and esophagitis
client administration for bisphosphonates
30 minutes before any oral intake with full glass of water
sitting or standing position afterward
no calcium supplement or antacid with this drug
contraindication for bisphosphonates
those who cannot sit or stand after the medication
esophageal structures or disorders or those who can’t swallow
interactions with bisphosphonates
Calcium supplements and dairy products will decrease absorption.
What are therapeutic uses of calitonin?
treating established postmenopausal osteoporosis and hypercalcemia secondaery to hyperparathyroidism
What is the prototype of calcitonin?
calcitonin-salmon (Miacalcin, Calcimmar)
How does calcitonin work?
decreases bone resorption by increasing excretion of calcium
What and when secretes calcitonin?
when CA is high, then the thyroid secretes calcitonin
What does calcitonin do?
decreases osteoclast activity
kidney increase calcium excretion
hypocalcemia
What class are calcium supplements?
mineral and electrolyte supplements
What are the two prototypes of calcium supplements?
Calcium citrate (citrate)
calcium carbonate (Tums)
Calcium supplements are effective in doing what?
Neutralizing gastric acids
What are some symptoms of hypercalcemia?
nausea, vomiting, constipation,
polyuria depression
kidney stones
what are some interventions for calcium?
monitor for gastric and instestinal motility
n/v and constipation
oliguria, flank pain and blood in urine
Client teaching for calcium supplements
fiber supplement/stool softener
intake plenty of water
flank pain/blood in urine
take one to two hours after glucocorticoids, thyroid supplements, and tetracycline and quinolone antibiotics
When should calcium-based antacids be taken?
chew it one after after meals and at bedtime
They are highly water soluble.
why are calcium supplements contraindicated for people with high phosphate levels?
phosphate has a reverse relationship with calcium
What drug can calcium supplements interact with to increase the risk of toxicity?
digoxin
What foods decrease the absorption of calcium?
cereals
rhubarb
spinach