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Pathopharm 326 > osteo, fractures, & gout > Flashcards

osteo, fractures, & gout Flashcards

1
Q

T scores

A

-1 or greater → normal → normal bone mineral density

between -1 and -2.5 → low bone mass → osteopenia

less than or equal -2.5 → “porous bone” → osteoporosis

less than or equal -2.5 with a hx of a fragility fx → severe osteoporosis

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2
Q

how do we measure bone mineral density

A

DEXA scan

results reported with T-score

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3
Q

osteoporosis risk factors

A 
aging
female
caucasian &  asian
hx fracture as an adult
family hx
low body weight (<127 lbs)
smoking
alcohol
corticosteroids & immune suppressive drugs
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4
Q

other risk factors for osteoporosis

A 
thin and small frame
lack of weight bearing exercises
lack of Ca and vit d
eating disorders, gastric bypass surgery
lack of estrogen/testosterone
excess caffeine
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5
Q

FRAX

A

prediction tool for assessing individual risk of fx
used to provide treatment guidelines
can use dexa scan or other methods

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6
Q

3 common fxs caused by osteoporosis

A

hip
wrist
vertebrae: compression fx

50% of all women greater than 50 years old will have a fx in one of these in their lifetime

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7
Q

hip fracture complications

A

death after a fall (d/t complications r/t immobility)
lifetime risk: 18% women, 6% men
women experience 3/4 of all hip fxs
mortality rate 12-37%
osteoporotic hip fxs are specifically linked to an ↑ risk of mortality

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8
Q

clinical presentation of hip fx

A 
sudden onset of hip pain before or after fall
inability to walk
severe groin pain
tenderness
affected leg is externally rotated
affected extremity is shortened
typically no bruising
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9
Q

complications of hip fx

A

infection: UTI’s, PNA

venous thromboembolism

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10
Q

osteoporosis primary prevention

A

calcium (1200-2000mg daily post-menopausal)
vit d (800-1000IU daily)
exercise at least 30 min/3x week

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11
Q

osteoporosis treatment

A

promote bone formation

decrease bone resorption

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12
Q

bisphosphonates

A

1st line treatment for prevention and treatment of osteoporosis

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13
Q

alendronate

moa

A

binds permanently to surfaces of bones
inhibits osteoclasts

↓ fxs by 50% for men & women

bishphosphonate

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14
Q

bisphosphonate

SE

A

GI most common: N/D, discomfort

risk of esophageal ulceration: don’t lie down after taking

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15
Q

bisphosphonate
alendronate
nursing implications

A
  • take with water
  • don’t lie down for 30 min after taking
  • no food, drink, calcium or vitamins for 2 hrs (only 1% bioavailable
  • drug holiday - after 5 years take a break to ↓ risk of jaw necrosis & esophageal cancer
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16
Q

raloxifene

A

selective estrogen receptor modulator (SERMs)

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17
Q

raloxifene

moa

A

mimics estrogen
inhibits bone resorption (not as well as bisphosphonates)

it is NOT hormone replacement therapy
only used in post-menopausal women to prevent & treat osteoporosis

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18
Q

SERMs

SE and nursing implications

A

hot flashes, leg cramps

important to take adequate calcium & vit d
d/c at least 72 hrs before and during prolonged immobilization
no tobacco or alcohol
teratogenic
black box - stroke

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19
Q

calcitonin-salmon

class & moa

A

hormone: bone resorption inhibitor (parathyroid agent)

inhibits bone removal by osteoclasts

not a 1st line drug, not used long-term

20
Q

calcitonin-salmon
uses & effects
routes

A

treatment only
↓spinal fxs by 30% only (have to take 5 yrs to see benefit)

slows down bone loss
increases spinal bone density

may have an analgesic effect in pt that have acute, painful vertebral fxs

SQ, IM, nasal - can cause nasal irritation

21
Q

causes of fractures

A

traumatic

fatigue - bone subjected to repeated, prolonged stress

pathologic - weakened bone, may break spontaneously, highest risk pop. is the elderly

22
Q

describing a fracture

A
  • name of bone
  • location on bone
  • orientation of fx
  • alignment of fx (displaced v aligned)
  • condition of overlying tissue (closed v. open)
23
Q

fracture orientation

A
  • transverse (90 degree to length of bone)
  • spiral
  • longitudinal (along length)
  • oblique (diagonal)
  • comminuted (> 1 fx line & more than 2 fragments)
  • impacted (jumping from heights, crushing)
  • greenstick (bends, doesn’t completely break, common in children)
  • stress
  • avulsion (fx of patella)
24
Q

clinical manifestations of fractures

A

P.E.D.

Paid
Edema
Deformity

25
Q

delayed healing

A
  1. delayed union
    bone pain & tenderness ↑ 3 months - 1 yr after fx
    risk factors - smoking, malnutrition
  2. malunion
    improper alignment - maybe began wt bearing too soon
  3. nonunion
    no healing 4-6 months post-fx
    causes: poor blood supply, repetitive stress
26
Q

compartment syndrome

A

increased pressure within limited anatomic space

manifestations: extreme pain, often very rapid onset, assess 5 P’s (paresthesia, paralysis, pulselessness, pain, pallor)

27
Q

fat embolism

A

fat molecule in lung following long bone fx, major trauma
typically occurs 24-48 hrs after injury

triad of manifestations:
hypoxemia
altered LOC
petechiae - often last sx

no treatment - provide supportive care

28
Q

osteomyelitis

A

acute or chronic pyogenic (pus producing) infection of the bone

Staph aureus usual cause

Peds- long bones
adults - vertebrae, hips

29
Q

risk factors for osteomyelitis

A 
recent trauma
diabetes - ↓ immune response
hemodialysis
IV drug use
splenectomy
PVD

DM & PVD → ↑ risk for chronic osteomyelitis

30
Q

2 routes of contamination that cause osteomyelitis

A

direct - open wound, gunshot, puncture, etc.

hematogenous (direct) - from bloodstream (most common)
usually occurs in long bones
children < 16 y.o. at highest risk

31
Q

clinical manifestations of osteomyelitis

A 
Local
local tenderness, warmth, redness
wound drainage
restricted movement
spontaneous fx

Systemic
spiking fevers
positive blood cultures
↑ WBCs

32
Q

Tx of osteomyelitis

A

Broad spectrum
nafcillin
cefazolin
vanco

bacteria specific once C&S comes back

often IV therapy 4-6 weeks then transfer to PO

33
Q

sources of purine

A

alcohol - specifically beer
organ meat (liver)
red meat
seafood, shellfish, sardines, scallops

34
Q

waste product of purine metabolism

A

uric acid

35
Q

gout predisposing factors

A 
male
genetics
diet
obesity
diuretic therapy and kidney insufficiency
36
Q

gouty arthritis patho

A

elevated uric acid levels → uric acid accumulates in body fluids → formation of uric crystals → deposition in or around joints → inflammation → gouty arthritis

often big toe affected

37
Q

gouty arthritis manifestations

A

Pain

  • intense
  • great toe
  • early morning → peaks 24-48 hrs → 5-10 days for flare up to resolve

Inflammation

  • edema
  • tenderness
  • redness

Fever
Malaise

38
Q

Complications of gout

A

urate kidney stones

39
Q

pharmacotherapy for gout

A

ACUTE

  • NSAIDS
  • steroids - only if pt can’t tolerate NSAIDs or is not responding to them
  • colchicine - acute and prophylactic

PROPHYLACTIC

  • allopurinol
  • colchicine
  • probenecid
40
Q

allopurinol

A

inhibits production of uric acid (xanthine oxidase inhibitor which ↓ uric acid synthesis)

prophylactic only

AE: rash, typically well tolerated

41
Q

nursing implications with allopurinol

A

if gi upset, take with food or milk

monitor serum/urine uric acid
monitor serum glucose (may cause hypoglycemia)
monitor PT/INR of pts on warfarin

improve 2-6 weeks

42
Q

colchicine

A

anti-inflammatory, anti-gout

mostly unknown, inhibits leukocyte infiltration (disrupts cell division)

gout flares & prophylaxis

43
Q

colchicine

SE & nursing implications

A

GI effects → stop drug immediately (1st sign of toxicity)

PO
contra: renal disease

Teach pt to avoid: they all inhibit breakdown of drug

  • ETOH
  • grapefruit
  • B12 vitamins

substrate of CYP450 system
check for other drugs that could interact

44
Q

probenecid

A

uricosuric agent

inhibits reabsorption of uric acid in the kidneys, promoting excretion

treats hyperuricemia with gout

used alone or in combo with allopurinol when not effective alone

45
Q

probenecid

SE & nursing implications

A

GI upset - take with food, drink plenty of fluids
dizziness, HA
kidney/liver impairment - report hematuria, changes in urine output, wt gain/urine retention, jaundice, clay color stools
lots of drug interactions

Pathopharm 326 (16 decks)

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