Musculoskeletal diseases 4 Flashcards
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
The most common causes of drug-induced SLE are
hydralazine & isoniazid
over 80 drugs have been identified as causes of drug-induced systemic lupus
Systemic lupus erythematosus is an
autoimmune disease that affects nearly every organ system
Most of the consequences of SLE are due to
anti-body induced vasculitis and tissue destruction
The most common problems of SLE are
polyarthritis & dermatitis (only 33-50% of these patients develop the classic butterfly rash)
The following 4 things can exacerbate SLE symptoms
stress
pregnancy
infection
surgery
drugs
Medical treatments for SLE include
corticosteroids, NSAIDs, immunosuppressants, and antimalarials
Cricoarytenoid arthritis can present as
hoarseness, stridor, and airway obstruction
Patients with SLE may develop ______________ leading to a risk of _______ & ___________
antiphospholipid antibodies; hypercoagulability and thrombosis
Antimalarials that are used to treat SLE include
hyroxychloroquine & quinacrine
Immunosuppressants that may be used to treat SLE include
cyclophosphamide, azathioprine, methotrexate, and mycophenolate mofetil
______________ (a drug used to treat SLE) inhibits plasma cholinesterase and increases the duration of succinylcholine
Cyclophosphamide
What is the mneumonic “pissed chimp” for?
drugs that can cause drug induced lupus and other reasons for lupus
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
Airway concerns with SLE include
cricoartyenoiditis
Nervous system concerns with SLE include
stroke
peripheral neuropathy
psychosis/dementia
Renal concerns with SLE include
nephritis with proteinuria
Hematologic concerns with SLE include
antiphospholipid antibodies
hypercoagulability
anemia
thrombocytopenia
leukopenia
Cardiac concerns with SLE include
Pericarditis (tamponade is uncommon)
Raynaud’s
HTN
Conduction defects
endocarditis
Pulmonary concerns with SLE include
restrictive ventilatory defect
pulmonary HTN
interstitial lung disease
recurrent pulmonary emboli
pleural effusion
Marfan syndrome is a
connective tissue disorder
Marfan syndrome is associated with
aortic insufficiency, aortic dissection, pectus excavatum, kyphoscoliosis, and hyperflexible joints (careful with positioning)
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?
No
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
