Musculoskeletal diseases 4 Flashcards by Hannah Garrison

Drugs that are MOST likely to induce systemic lupus erythematosus include: (select 2)
a. cyclophosphamide
b. hydralazine
c. isoniazid
d. hydrocortisone

b. hydralazine
c. isoniazid

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The most common causes of drug-induced SLE are

hydralazine & isoniazid
over 80 drugs have been identified as causes of drug-induced systemic lupus

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Systemic lupus erythematosus is an

autoimmune disease that affects nearly every organ system

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Most of the consequences of SLE are due to

anti-body induced vasculitis and tissue destruction

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The most common problems of SLE are

polyarthritis & dermatitis (only 33-50% of these patients develop the classic butterfly rash)

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The following 4 things can exacerbate SLE symptoms

stress
pregnancy
infection
surgery
drugs

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Medical treatments for SLE include

corticosteroids, NSAIDs, immunosuppressants, and antimalarials

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Cricoarytenoid arthritis can present as

hoarseness, stridor, and airway obstruction

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Patients with SLE may develop ______________ leading to a risk of _______ & ___________

antiphospholipid antibodies; hypercoagulability and thrombosis

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Antimalarials that are used to treat SLE include

hyroxychloroquine & quinacrine

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Immunosuppressants that may be used to treat SLE include

cyclophosphamide, azathioprine, methotrexate, and mycophenolate mofetil

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______________ (a drug used to treat SLE) inhibits plasma cholinesterase and increases the duration of succinylcholine

Cyclophosphamide

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What is the mneumonic “pissed chimp” for?

drugs that can cause drug induced lupus and other reasons for lupus

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Describe Pissed CHIMP

P= pregnancy
I= infection
S= surgery
S= stress
E= enalapril
d= d-penicillamine
C= captopril
H= hydralazine
I= isoniazid
M= methyldopa
P= Procainamide

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Airway concerns with SLE include

cricoartyenoiditis

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Nervous system concerns with SLE include

stroke
peripheral neuropathy
psychosis/dementia

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Renal concerns with SLE include

nephritis with proteinuria

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Hematologic concerns with SLE include

antiphospholipid antibodies
hypercoagulability
anemia
thrombocytopenia
leukopenia

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Cardiac concerns with SLE include

Pericarditis (tamponade is uncommon)
Raynaud’s
HTN
Conduction defects
endocarditis

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Pulmonary concerns with SLE include

restrictive ventilatory defect
pulmonary HTN
interstitial lung disease
recurrent pulmonary emboli
pleural effusion

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Marfan syndrome is a

connective tissue disorder

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Marfan syndrome is associated with

aortic insufficiency, aortic dissection, pectus excavatum, kyphoscoliosis, and hyperflexible joints (careful with positioning)

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Ehlers-Danlos syndrome is an

inherited disorder of procollagen and collagen

Common problems associated with Ehlers-Danlos syndrome includes

arterial aneurysm and increased bleeding tendency (avoid regional anesthesia & IM injections)

What should be avoided with Ehlers-Danlos syndrome?

IM injections and regional anesthesia

Osteogenesis imperfecta is a

connective tissue disorder (brittle bones)

Risks with osteogenesis imperfecta include

fractures that can occur during patient positioning and NIBP cuff inflation

For patients with marfan syndrome there is a risk for

spontaneous pneumothorax

For patients with Marfan syndrome, _________ increases the risk of cardiovascular complications

pregnancy

When we think of Marfan syndrome we should think of

aortic insufficiency and AAA

When we think of Ehlers-Danlos syndrome we should think of

spontaneous bleeding into joints and AAA

When we think of osteogenesis imperfecta we should think of

weak bones

Is the risk of MH increased with osteogenesis imperfecta?

A unique finding in patients with osteogenesis imperfecta is

blue sclera- the sclera is actually susceptible to fracture

Airway management with patients with osteogenesis imperfecta can result in

c-spine fracture and reduced cervical ROM

_________ is increased in >50% of patients with osteogenesis imperfecta

Serum thyroxine (increased BMR and VO2--> hyperthermia)

Multiple sclerosis is a

demyelinating disease of the CNS

Classic teaching with multiple sclerosis suggest that while _________ anesthesia is safe, __________ anesthesia may exacerbate symptoms.

epidural; spinal

Select considerations for patients with MS include

bulbar muscle dysfunction (aspiration risk), chronic steroid therapy, and sensitivity to increased body temperature (risk of demyelination)

Myotonic dystrophy is characterized by a

prolonged contracture after a voluntary contraction

Factors that increase the risk of sustained muscular contractions for patients with myotonic dystrophy

succinylcholine (risk of sustained contractors- not MH), anticholinesterases, and hypothermia

Scleroderma causes

excessive fibrosis in the skin and organs, particularly in the microvasculature

Scleroderma is characterized by _____________ syndrome.

CREST syndrome

CREST includes

calcinosis Raynaud's phenomenon esophageal hypomotility sclerodactyly telangiectasia

Paget's disease is associated with

excess osteoblastic and osteoclastic activity that causes abnormally thick, but weak, bone deposits

This is a concern with Paget's disease

risk of fractures during positioning

This is a concern with Paget's disease

risk of fractures during positioning

This is a concern with Paget's disease

risk of fractures during positioning

Myotonic dystrophy is the result of

dysfunctional calcium sequestration by the sarcoplasmic reticulum

Patients with myotonic dystrophy are also at risk for

aspiration respiratory muscle weakness cardiomyopathy and dysrhythmias sensitivity to anesthetic agents

MS patients may experience __ and _______ deficiencies as well as _______ instability.

sensory and motor deficiencies as well as autonomic instability

With MS, ________________ can cause life-threatening hyperkalemia.

succinylcholine

Airway issues with scleroderma include that

skin fibrosis can limit mouth opening and mandibular mobility

Eye issues with scleroderma include that

dryness predisposes to corneal abrasion

Lung issues with scleroderma include

pulmonary fibrosis and pulmonary hypertension

Heart issues with scleroderma include

dysrhythmias and CHF