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Musculoskeletal Pharmacology Flashcards

1
Q

Osteoarthritis

A

Progressive disease that can result in chronic pain, restricted range of motion, muscle weakness especially when a weight bearing joint is affected .

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2
Q

What contributes to primary OA?

A

Primary OA is either idiopathic or related to age and hormone changes

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3
Q

What contributes to secondary OA?

A

Secondary OA is formed by trauma, infection, or loss of synovial fluid in the affected joint

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4
Q

Modifiable risk contributing to OA?

A
  1. Obesity ( either prior to diagnosis to OA or after
  2. Occupation with heavy weight lifting related to repetitive movements
  3. smoking
  4. Vitamin D Deficiency
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5
Q

What are the non-modifiable risk factors leading to OA?

A
  1. Age
  2. Race
  3. Gender
  4. Genetics
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6
Q

What Gender is more common for OA

A

women

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7
Q

What race is more prone to OA

A

White and Native American

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8
Q

What is the non-pharmalogical treatment for OA of the hand?

A
  1. Exercise
  2. Self management
  3. Thumb brace (CMC orthosis)
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9
Q

What is the non-pharmalogical treatment for OA of the knee?

A
  1. Exercise
  2. Self Management
  3. Weight loss
  4. Tai Chi
  5. TF knee brace
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10
Q

What is the non-pharmalogical treatment for OA of the hip?

A
  1. Exercise
  2. Self management
  3. Weight loss
  4. Tai Chi
  5. Cane
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11
Q

What is the pharmacological treatment for OA of the hand?

A

Oral NSAIDS

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12
Q

What is the pharmacological treatment for OA of the knee?

A
  1. NAIDS
  2. Topical NSAIDS
  3. Intra-articular glucocorticoid injections
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13
Q

What is the pharmacological treatment for OA of the hip?

A
  1. NSAIDS
  2. Intra-articular glucocorticoid injections
  3. US guided intra-articular glucocorticoid injections
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14
Q

First line treatment for OA?

A

Oral NSAIDS

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15
Q

What are the risks associated with oral NSAID use?

A

GI bleeding and cardiac events

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16
Q

Name the oral NSAIDs used in OA that can cause GI bleeding?

A
  1. aspirin
  2. Naproxen
  3. Ibprofen
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17
Q

Name the oral NSAID used to in OA that can cause cardiac events?

A

Celecoxib

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18
Q

What patient population with OA can you not give oral NSAIDS to?

A
  1. Cardiac

2. Renal

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19
Q

What drug would you use to treat a patient with OA and renal disease?

A

Tramadol

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20
Q

A nurse practitioner is prescribing a topical NSAID for OA of the knee, what is the topical agent called?

A

Diclofenac (Voltaren)

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21
Q

The nurse practitioner knows that the black box warning for Diclofenac is..

A

Increased risk for cardiac events

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22
Q

What is a topical agent used for OA made out of peppers?

A

Capsaican (Salonpas)

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23
Q

Refractory agents used for OA

A
  1. Cymbalta

2. Glucorticosteriod injections

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24
Q

What is Gout?

A

An inflammatory condition that results from monosodium urate crystals precipitating in the synovial fluid between joints due to hyperuricemia

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25
Q

What is the most common affected joint in a patient with Gout?

A

Big toe (metatarsophlangeal joint)

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26
Q

What other joints can gout affect?

A
  1. ankles
  2. knees
  3. fingers
  4. wrists
  5. elbows
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27
Q

Risk factors for Gout?

A
  1. obesity
  2. Hypertension
  3. Thiazide and loop diuretics
  4. Alcohol
  5. meats
  6. aged cheeses
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28
Q

Teaching for patient with Gout

A
  1. limit alcohol intake
  2. limit purin intake
  3. limit high fructose corn syrup
  4. weight loss
  5. Switch to alternative diuretics
  6. Losartan as an anti-hypertensive drug
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29
Q

Indications for urate lowering therapy

A
  1. one or more sq tophi
  2. radiographic damage due to gout
  3. gout inflammatory activity
    - Frequent gout flare ups greater or equal to 2 flares a year
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30
Q

This class of medication increases excretion of uric acid by blocking reabsorption in the kidney

A

Uricosurics

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31
Q

Drugs classified as uricosurics

A
  1. Probenecid (Probalan)

2. sulfinpyrazone (Anturane)

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32
Q

This class of drugs inhibits formation of uric acid

A
  1. Allopurinol (lopurin, zyloprim)

2. febxostat (uloric)

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33
Q

This class of drugs converts uric acid into a less toxic form

A
  1. Pegloticase (Krystexxa)
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34
Q

Black box warning for Febuxostat (Uloric)

A

Risk for cardiac events

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35
Q

How is pegloticase (krystexxa) administered?

36
Q

Adverse reactions when giving pegloticase?

A
  1. Anaphylaxisis
37
Q

To prevent adverse reactions from occurring when adminstering pegloticase (krystexxa) the provider should prescribe

A
  1. Steroids

2. Antihistamines

38
Q

This drug class inhibits phagocytosis of urate crystals

39
Q

Refractory agent used for gout

A

Colchicine

40
Q

This medication has a CYP3A4 substrate and is classified as an anti-inflammatory that prevents the activation of neutrophils

A

Colchicine

41
Q

Which drug can you not give to help a gout patient with pain and why?

A

Aspirin; Can inhibit excessive uric acid from being excreted from the tubule

42
Q

What is the considered and preferred the first line medication for treating gout?

A

Allopurinol

43
Q

Can allopurinol be given to patients with CKD?

A

yes they can receive this treatment up until stage 3 of CKD

44
Q

Drug used for patients with CKD greater than 3

A

Probenicid

45
Q

Provider considerations when starting a patient on medication for gout

A
  1. Start with a low dose and titrate up to target

2. Use anti-inflammatory prophylaxis for 3-6 months and longer if persistent active anti-inflammatory disease

46
Q

As providers treating patients with gout, the providers would like to see the serum uric acid level where?

47
Q

What will the provider prescribe if a patient is having a gout flare?

A
  1. Colchicine
  2. NSAIDS
  3. Glucocorticoids
48
Q

What medication will a provider prescribe for gout when the patient is NPO?

A

glucocorticoids

49
Q

When should a provider check a uric acid level after prescribing medication

A

3-6 months

50
Q

Food and Beverages that can increase serum urate levels

A
  1. Red meat
  2. Organ meat: kidney, liver
    3.Seafood: sardines and shellfish
  3. High fructose corn syrup: soda and sport drinks
  4. Alcohol: wine, beer, spirits
    6, Aged cheese
51
Q

Rheumatoid Arthritis

A

Chronic autoimmune inflammatory disease characterized by symmetric poly arthritis and joint changes, including erythema, effusion, and tenderness

52
Q

Rheumatoid Arthritis affects what?

A

synovial tissue changes in the freely moveable joints

53
Q

Key principles the provider uses when diagnosing and treating a patient with RA?

A
  1. Focus on common clinical goal, not exceptional cases
  2. Cost effectiveness
  3. Assessment questionnaires for patients
  4. If a patient has a low RA disease activity or is in clinical remission, switching from one therapy to another should be considered
54
Q

Preferred drugs in treating RA

A

Disease modifying anti-rheumatic drugs

55
Q

First line therapy for RA: Older class of DMARDS

A
  1. Methotrexate
  2. Sulfasalazine
  3. Hydroxycholoriquine
  4. Leflunomide
56
Q

This drug breaks down folic acid which target proliferating cells and proliferating tissue

A

Methotrexate

57
Q

Severe adverse reactions to methotrexate

A
  1. Hepatotoxicity

2. Bone marrow suppression

58
Q

What should a provider watch for when prescribing DMARDS?

59
Q

This DMARD has a narrow therapeutic level and if it becomes to high it becomes toxic and to low it does not work

A

Methotrexate

60
Q

Due to the MOA of methotrexate what should the provider consider prescribing along with the medication?

A

Folic Acid

61
Q

Which DMARD is given to patients who can not tolerate methotrexate or NSAIDS

A

Sulfasalazine

62
Q

What the adverse reaction the patient and provider should look out for when prescribed sulfasalazine

63
Q

Name a Target Stimulating Disease Modifying Anti-Arthritic drug

A

Tofacitinib (Xeljanz)

64
Q

What class of drugs are used as second line therapy to treat RA after DMARDS and NSAIDS?

65
Q

This drug is a JK inhibitor and helps inhibit activation of the immune response

A

Tofacitinib (Xeljanz)

66
Q

Adverse effects of Xeljanz

A
  1. TB
  2. Fungal infections
  3. lymphomas
  4. Thrombosis
67
Q

Considerations a provider may think about when prescribing DMARDS

A

renal adjustment for patients

68
Q

When prescribing a DMARD what should the provider monitor?

A
  1. CBC with Dif
  2. Urine analysis; creatine, BUN
  3. Serum bilirubin; liver enzymes
  4. ESR
  5. platelet study’s
  6. eye examinations
69
Q

Progressive systemic disease characterized by a decrease in bone mass and microarchtectural deterioration of bone tissue, resulting in bone fragility and increased susceptibility to fractures

A

Osteoporosis

70
Q

Daily dose of calcium for men

71
Q

Daily dose of calcium for women

A

1.2 grams women 50 years and older

72
Q

Patient teaching about taking calcium supplements

A
  1. Take throughout the day with vitamin D because the dose is so large not all of it will get absorbed if you take it at once
  2. Alcohol, smoking, and caffeine interfere with bone growth and reabsorption so watch your intake
  3. Everyone should get a screening for osteoporosis over 65 or after menopause
  4. Medications like steroids decrease bone density
73
Q

Risk Factors for osteoporosis

A
  1. Female (older age asian or white)
  2. Family history, petite stature or low body weight
  3. Menopause or Amenorrhea
  4. Sedentary lifestyle, low calcium intake
  5. Excessive alcohol, smoking and caffeine intake
  6. low testosterone in men
74
Q

Diagnostic tool for osteoporosis

75
Q

First line therapy for treating osteoporosis

A

Bisphosphonates

76
Q

This medication class decrease action of osteoblasts increasing bone density

A

bisphosphonates

77
Q

Bisphosphonates

A
  1. Alendronate
  2. Risdronate
  3. Ibandnate
  4. Zoledronic acid
78
Q

Adverse effect of bisphosphonates

A

bone necrosis

79
Q

Who can be prescribed a bisphosphonate?

A
  1. a patient who has to be able to sit or stand up for 30 minutes are taking this medication
80
Q

If patients can not tolerate oral bisphosphonates they can receive the IV version once a year and it is called?

A

Zoledronic acid (Reclast)

81
Q

Agents used to prevent or treat osteoporosis besides bisphosphonates

A
  1. Selective Estrogen Receptor modulator: Raloxidine (Evista)
  2. Rank Ligand Inhibitor: Densoumab (Prolia)
  3. Calcitonin
  4. Hormone modulators: Teriparatide
82
Q

First line prevention for osteoporosis

A
  1. Raloxidine
  2. Alendronate
  3. Ibandronate
  4. Zoledronic acid
  5. Risdronate with calcium and vitamin D
83
Q

First line treatment of osteoporosis

A
  1. Raloxidine
  2. Alendronate
  3. Ibandronate
  4. Zoledronic acid
  5. Calcitonin
84
Q

Second line treatment for osteoporosis

A

add a hormone modifier to original medical treatment

85
Q

Patient Education on Bisphosphonates

A
  1. Should be taken with 8 oz of water before meals and the patient should remain upright for 30 minutes after administration

Advanced Pharmacology (5 decks)

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