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Pharmacology Test 4
Pharmacology Test 4 Mod, 7,9,12,11
| Cancer (CA) facts | Leading cause of morbitity (diseased state) and mortality (death) in US. Leading cause of mortality by disease <15yo. High survival: prostate, testicular, thyroid. Low survival: pancreatic & liver. |
| Etiology | CA risk factors. Carcinogens- CA causing agents. Chemical factors listed separate (also carcinogens): tobacco smoke, asbestos, benzene, x-rays. EtOH, diet, sedentary lifestyle, Sun exposure, Lack of personal care/awareness, lack of screening. |
| Reducing risks: | No tobacco exposure (includes 2nd hand smoke). Decrease EtOH. Low fat, hi fiber diet. Decr sun exposure, sun block. Health awareness: self breast/skin/stool exams. CA screening. |
| CA screening | Mammograms. PSA (prostate specific antigen) & prostate exam. Fecal occult blood and sigmoidoscopy. Pap smear. |
| CA treatment | Comfort/control/cure. Surgery, radiation, chemo. Must treat microscopic disease to cure. |
| WBC major divisions | Agranular: LYMPHOCYTES (1/3) & monocytes. Granular: basophils, NEUTROPHILS (2/3), eosinophils |
| Define: metastasis | Spread of CA to distant sites. |
| Define: tumor or neoplasm | Abnormal enlargement, swelling or mass. |
| Define: malignant | A disease that grows rapidly worse, becomes resistant to treatment, and normally results in death (carcinomas and sarcomas). |
| Define: leukemia | Cancer from blood-forming cells in the bone marrow. A blood cell CA. |
| Define: lympoma | Cancer that arises from lymphatic tissue. |
| Glioma | CA in the CNS. |
| Apoptosis | Programmed cell death. Cells divide only a certain number of times. Cells can no longer divide and replace themselves. Pharm notes say: self destruction. |
| Growth fraction and doubling time | Two factors related to the growth of the tumor or cancer that determines the effectiveness of the treatment. High growth fraction increases the response to the chemo—the faster growing tumors result in better response to chemo. |
| Define: CA | A group of diseases characterized by uncontrolled growth and spread of abnormal cells. |
| Define: oncology | The study of cancer. |
| Define: anaplastic | Lacks structural differentiation. (Not in notes: undifferentiated cells are embryonic-type precursor cells that are capable of forming different types of tissues). Synonyms: dedifferentiated, undifferentiated. |
| Define: primary tumor | Initial cancer. Metastasizes to form secondary tumor or "met". |
| Define: secondary tumor | Metastasis of primary tumor to new site. Definition from notes: New, histological separate malignant neoplasm in a person with a primary tumor. |
| Define: unknown primary | Anaplastic (dedifferentiated) secondary tumor. Can't tell what primary CA was. |
| Define: carcinogenesis | Ability to cause CA. |
| Define: oncogenes | "Oncology genes" - genes predisposing individual to CA. |
| Define: cancer suppressor genes | Genes that inhibit CA. They may "turn off" and inhibit malignant growth. |
| Define: adjuvant chemotherapy | Enhancing treatment used to complement chemotherapy. Example: radiation therapy may be used to enhance the effects of chemotherapy. |
| Define: anemia | Low hemoglobin (Hgb) or hematocrit (Hct). |
| Define: Leukopenia | Low WBC count. |
| Define: nadir | In chemo treatment, the lowest WBC count reached before rebounding. |
| Define: neutropenia | Low neutrophil count. |
| Metastatic process | Spread of cells to new site. Cells from primary tumor break away and travel through body. Immune systems catched 999/1000 of these. But the ones that survive become "mets". |
| Early warning signs of CA: C-A-U-T-I-O-N | Change in bowel habits. A lesion that does not heal. Unusual bleeding or discharge. Thickening or lump in breast or elsewhere. Indigestion or dysphagia (difficults swallowing). Obvious changes in wart/mole. Nagging or persistent cough/hoarseness. |
| CA pathophysiology | Carcinogenesis (CA birth): suppressed by CA suppressor genes [-] OR cell growth of CA cells begin [+]. See CA cell characteristics on another card. |
| CA cell characteristics: immortality, divide without anchoring, loss of contact inhibition. | Immortalitiy (lack of apoptosis). May divide without anchoring (such as in liquid). Loss of contact inhibition (neighboring cells do not stop growth). |
| CA cell characteristics: decr growth factors, no rest phase of cell cycle. | Diminished growth factor requirement (do not require growth factors needed by normal cells, higher affinity (attraction) for body's resources than normal cells. Lack of resting stage of cell cycle, (nonstop cell division). |
| Example of a cancer: The patient has a colon cancer with mets to liver and lungs | Initial tumor = CA in the colon. Biopsy of liver and lung tissue shows the same colon CA tissue in the biopsy samples. Liver and lung neoplasms are secondary tumors, colon is primary. All tumors, regardless of where they are in the body, are colon CA. |
| CA drug classifications | Alkylating agents (works on DNA of cells, nitrosoureas, antimetabolites, antitumor abx, plant (Vinca) alkaloid/natural products, hormones & hormone blockers, taxanes, topoisomerase inhibitors. |
| General concepts of CA drugs (SE) | Many inhibit or affect mitosis (cell division). Many cause low cell counts: neutropenia, thrombocytopenia, anemia or all pancytopenia. N/V/D, mucocytosis, infertility, alopecia. NC: treat n/v/d, CBC |
| Alkylating agent drugs | cyclophosphamide (Cytoxin), BRCA, ovarian CA, lymphoma. SE hemorrhagic cystitis, alopecia. NC: give in 7-10d, peak 1-2d, will potentiate anticoagulants / insulin, immune boosters may antagonize these drugs. |
| Antimetabolites | methotrexate (MTX), fluorouracil, 5-FU, action interf w/ folate metabolism. use: choriocarcinoma, bone CA, lung CA, RA (MTX), psoriasis. SE; pulm fibrosis. NC: give in 5d. Permission from onco prior to vaccines. Monitor PFT. MTX becomes toxic w NSAIDS. |
| Antitumor abx | doxyrubicin (Red Devil vesicant), bleomycin. Action: distorts DNA. Use: solid tumors, BRCA, ovarian and bladder CA. SE: heart dmg. NI: baseline cardiac function, can decr digoxin levels, urine pink/red |
| Digoxin level | 0.5-2 |
| Plant alkaloids | paclitaxel, vincristine. Action: inhibits mitosis. Use: lymphoma, leukemia, sarcomas, Wilm's tumor, BRCA, neuroblastoma. SE: nerv system tox, neuropathic pain, severe constip, min immunosupression. NC: IV only. vincristine - give w/ phenytoin (Dilantin) |
| Hormones and hormone antagonist | adjuvants: megesterol (Megace), appetite stimulant, pred. tamoxifen (PO <=5y) - true chemo Act: ag/antag estrogen. Use: prostate and ovarian CA, leukemia, Hodkin's SE: hot flash, fluid retention, vag bld, DVT. |
| Biological response modifiers | interferon stim immune system. use: ovarian, colorectal, leukemia, melanoma. SE: flu like, hepatorenal toxicity. NC: given daily. |
| Topoisomerase inhibitors | etoposide, act: DNA damaging effects. use: testicular CA, small cell lung ca. SE: constipation, neuropathy. NC: inc bleeding if taken with NSAIDS or anticoagulants |
| Tyrosine kinase inhibitors | gefitinib. inhibit tumor angiogenesis. Use: non-small cell lung CA refactory to other treatements. SE: HTN, puritis, mucocytosis, abn eyelashes. NC: erythromycin, ketoconazole may make med toxic. |
| Proteasome inhibitors | bortezomib (Velcade), inhibits protein that feeds cell. Use: multiple myeloma (3rd line), mantle cell lymphoma. SE: fatigue, dizziness, HoTN. NC: FSBS in d.m. |
| Multikinase inhibitors (MKI) | sorafenib (Nexavar), inhibits angiogenesis. Use: advanced, refractory, renal cell carcinoma, GI tumors. SE: stomatitis, taste disturbances, cracking palm/soles. NC: take on empty stomach |
| Angiogenesis inhibitors | bevacizumab (Avastin), toxic to newly formed vessels. used for colorectal CA, non small cell lung CA, and nonsquamous cell carcinoma. SE: dizzy, HA, anorexia, diarrhea. NC: monitor perfusion |
| Monoclonal antibodies | rituximab (Rituxan) alerts immune system to attack CA cells (like vaccination). Use: leukemia, relapsed non-Hodkins lymphoma (NHL). SE: flu like. NI: infusion reactions |
| More CA adjuvants | sulcralfate (Carafate), dronabinol (Marinol), (epoeitin) (Epogen), filgrastin (Neupogen) |
| epoetin | (Epogen). Use: treats anemia (biological response modifier). SE: HTN, injection site reaction (SC), SOB, diarrhea, rash. NC: chilled, must warm. |
| sucralfate | (Carafate) coats GI tract as protectant, used to soothe GI tract. SE: constipation, rash, pruritis. NC: mucyocytosis, don't give w/ other meds |
| dronabinol | (Marinol) Act: antinausea/pain and appetite stimulant. SE: decreased LOC drowsiness, hallucinations, addictive |
| filgrastin | (Neupogen) Act: incr neutrophils. SE: bone pain, HA, tachy, burning at inj site. NC: chilled, must warm. Not admin w/in 24h of chemo. not given to leukemia pt with neutropenia |
| Adverse affects of psychiatric drug side effects. | Acute - dystonia, akathisia, pseudoparkinsonism. Chronic tardive dyskinesia |
| Antipsychotic | Synonym=neuroleptic. Dev 1950's. Used to treat psychosis. |
| Psychosis | Loss of contact with reality. Usually hallucinating. Incoherent. delusional, catatonia. |
| Anxiolytic | Anxiety drug. "nerve pills". Most commonly benzos. May be others, such as hydroxyzine. |
| Atypical antipsychotics | 2nd generation. Usually dopamine blockers. Less EPS. |
| Extrapyramidal symptoms (EPS) | akathisia, dystonia, pseudoparkinsonism, tardive dykinesia. EPS side effects are most noticable with 1st generation antipsychotics like haloperidol (Haldol). (Dopamine antagonists). |
| Barbiturates | Class of drugs that depress CNS. Used for sedation and anesthesia. GABA agonist. More dangerous than EtOH or Benzos. Used for seizures, sedation, anxiety,& as hypnotics. S.E. bradypnea, coma, death. Addictive. [Prototype: phenobarbital. Not in notes] |
| Blood dyscrasia | Blood dyscrasia=blood disorder (general term). In practice it is often used to mean bone marrow suppression or granulocyte (syn=neutrophil) supression or agranulocytosis. |
| Dopamine | Common inhibitory neurotransmitter. Main function is to inhibit prolactin from adenohypophysis |
| Dystonia | EPS of tighten muscles in a frozen, statue like state. May have repetitive motion or abnormal postures. |
| Insomnia | Can't sleep or stay asleep. Caused by anxiety, XS caffeine, EtOH, stress, and depression. |
| Neuroleptic | Neuroleptic=antipsychotic. |
| Neuroleptic malignant syndrome (NMS) | (Neuroleptic = antipsychotic, Malignant=life threatening). Tranlation: antipsychotic life threatening syndrome. Rare syndrome of side effects. Muscle rigidity, AMS, tachycardia, seizures, high fever, respiratory failure, coma, death. |
| Neurotransmitters | Chemical substances used to transmit impulsed in the nervous system (across a synapse). GABA and dopamine are inhibitory. Acetylcholine (occurs at neuromuscular junction), serotonin, epinephrine, and norepinephrine are excitatory. |
| Parkinsonism, similar to pseuparkinsonism | Tremor, hypokinesia, rigidity, and postural instability. Parkinsonism is a disease. Pseudoparkinsonism is a drug side effect. |
| Phenothiazines | Class of antipsychotic drugs that act as dopamine antagonists. Often tranquilizing effect. EPS side effects. |
| Tardive diskinesia | Drug side effect. Tardive (later stage of development). Diskinesia (movement disorder). Means later onset movement disorder. Repetitive involuntary movements which may have belated onset. |
| Typical antipsychotics | Typical=1st generation psychotics. EPS side effects. Many are phenothiazines. |
| Sedation | Reduction of irritability or agitation with sedating drug. |
| Withdrawal | Symptoms secondary to abrupt reduction or cessation of addicting substance |
| Akathisia | Sensation of inner restlessness. Can't sit still or stop moving. An acute movement disorder that is a side effect of drugs. |
| Schizophrenia | XS dopamine. Use dopamine blockers to treat. [Not in study guide: psychotic illness that is lifelong. Starts in early adulthood. Periods of psychosis. 1% of population]. |
| Typical antipsychotics (D blockers) | Chlorpromazine (Thorazine), fluphenazine (Prolixin). Haloperidol (Haldol). |
| Typical antipsychotics = 1st generation SE. Fluphenazine (Prolixin). Chlorpromazine (Thorazine). Haloperidol (Haldol). | Blocks D receptors. Route PO/IM (SC fluphenazine only). SE: drowsiness, insomnia, vertigo (sensation of movement). EPS symptoms. Hypotension, photophobia, N/V, urinary retension. (granulocytosis - fluphenazine only) |
| Haloperidol (Haldol)uses. | Alters affect of D. Used for Tourette's, severe behavior in children, and schizophrenia. Like all Gen I: EPS. |
| Atypical antipsychotics (Gen II) | Colzapine (Clozaril). Risperidone (Risperdal). Olanzepine (Zyprexa), Quetiapine (Seroquel), Aripiprazole (Abilify). "newer" anthipsychotics. Less problems with EPS. |
| Gen II antipsychotic SE to know. Clozapine (Clozaril given as example) | Block D and serotonin receptors. SE: drowsiness, sedation, seizures, dizziness, syncope, HA, tachycardia, n/v, fever, NMS. Potentially fatal agranulocytosis, esp in demented pt. (CLOZapine must be watched CLOZELY! - monitor CBC) |
| Agranulcytosis | Not enough granulocytes (not enough neutrophils) often due to bone marrow problems. Synonyms: neutropenia, granulocytopenia. |
| Anxiolytic drug usages | Treat anxiety and insomnina. |
| Anxiolytic drugs studied | Benzos (-zepam and -zolam) alprazolam (Xanax), diazepam (Valium), and lorazepam (Ativan). Also studied buspirone (Buspar), a nonbenzo. |
| Lorazepam (Ativan) example drug for benzo side effects | GABA (an inhibitory neurogransmitter) agonist. SE: drowsiness, dizziness, confusion, n/v, hallucinations. |
| GABA agonists | Benzo, barb, EtOH. All can be used to treat seizures. All can be addictive. |
| Antidepresents / mood stabilizers | Tricyclic antidepressents (TCA), selective serotonin reuptake inhibitors (SSRI), atypicals, monoamine oxidase inhibitors (MAO inhibitors -dangerous drugs with lots of drug interactions and side effects). |
| Depression facts | Most common psych disorder. W>M. 60% of suicides related to depression. |
| Bipolar disorder | Cycles of mania alternating with depression. Old name = manic-depressive. |
| Tricyclic antidepressants (TCAs) | Amitriptyline (Elavil) - Inc. serotonin and norepinephrine. Route PO/IM. SE: same as anticholinergic SE + orthostatic hypotension and light headedness. |
| Selective serotonin reuptake inhibitors (SSRI) -oxetine -oxamine | Action block dopamine. Common drugs: fluoxetine (Prozac), paroxetine (Paxil), fluvoxamine (Luvox), sertraline (Zoloft), citalopram (Celexa), escitalopram (Lexapro) |
| SSRI side effects | Sexual dysfunction, anticholinergic effects, seizures. Route: PO. |
| Atypical antidepressants | Buproprion (Welbutrin), trazadone (Desyrel), mirtazapine (Remeron), venlafaxine (Effexor). |
| Atypical antidepressant - example: buproprion | Acts on 3 neurotransmitters: serotinin, dopamine, norepinephrine. SE: anticholinergic and seizures. |
| Monoamine oxidase inhibitors (MAO Inhibitors or MAOI) | Isocarboxazid (Marplan) and phenelzine (Nardil) Action: block NZ causing norepi, serotinin, epi, and dopamine to increase. SE: CNS agitation, restlessness, insomina, orthostatic hypotension, anticholinergic effects. Potentially fatal hypertensive crisis. |
| Mood stabilizers | Lithium (Eskalith) is only example given. Incr serotonin. S.E. dizziness, fatigue, drowsiness, slurred speech, hypotension, restlessness. Dysrhythmias and circulatory collapse. |
| Catatonia | coma-like daze — unable to speak, move or respond — or you may talk and behave in a bizarre, hyperactive way. |
| Atypical antipsychotic mnemonic: ORCAS 3Tons | The atypical antipsychotics: Olonazpine, risperdal, Clozapine, Aripiprazole, Seroquel (quetiapine). 3T means 3 neurotransmitters. (An orca is a killer whale). |
| SSRI mnemonic: a pair of oxes got the flu and were sitting on a sertra matress | Pair oxes: paroxetin, flu: fluoxetine, sit: citalopram, serta: sertraline. |
| EPS mnemonic: tDAP | Tardive dyskinesia, Dystonia, Akathisia, Pseudoparkinsonism |
| NMS mnemonic: FARMERS CD | Fever, Adrenaline (incr HR and BP), Rigidity, Mental status changes, Excitation (more adrenaline), Respiratory failure, Seizures, Coma, Death |
| Name the parts of the GI tract mouth to anus | mouth, esophagous, stomach, duodenum, jejunum, ileum, cecum, ascending colon, transverse colon, descending colon, sigmoid colon, rectum, anus |
| Partially digested food (name) | chyme |
| Pepsin | NZ for protein digestion |
| Intrinsic factor | produced by gastric lining. required for Vitamin B12 absorption Pernicious anemia = too little intrinsic factor |
| Accessory digestive organs and function | Pancreas (exocrine) - lipase, amylase Liver/Gallbladder - bile These dump into common duct into duodenum |
| Dyspepsia | "stomach ache", indigestion upper abdominal discomfort |
| Greasy, bulky, foamy, +/- floating, stinking stools | Cystic fibrosis. Pancreatitis |
| Light gray or clay colored stools | bilirubin problem |
| Steatorrhea | definition: greasy stools. Impairment of fat digestion (pancreatic cause or cystic fibrosis) |
| Peptic ulcer disease | ulcerative erosion of esophagus, stomach, or duodenum. Common bacterial cause: Helicobacter pylori (H. pylori). May contribute: XS HCl, stress, familial tendency. Dull knawing pain and burning in epigastrum or back. |
| Malabsorptive diseases | Problems absorbing minerals (Fe & Ca), vitamins (A & B12), and nutrients (carb, fat, protein), lipids (pancreatic insufficiency and cystic fibrosis) |
| pernicious anemia | inadequate intrinsic factor and decreased B12 absorption |
| GERD | GastroEsophageal Reflux Disease: reflux of stomach secretions into esophagus. Impairment of lower esoph sphincter. Risk factors: obesity and smoking. |
| Stool tests | Gross inspection: color, consistency, +/- blood. Hemoccult. Occult means not grossly visible. |
| H. pylori test | breath test |
| Abdominal ultrasound (US) | Gallstones, gallbladder, pancreas, and chronic colonic diverticulitis |
| DNA testing for GI diseases | colon cancer (CA), inflammatory bowel disease (IBD), gastric cancer (CA), lactose intolerance |
| Upper GI study | Barium under fluoroscopy (fluro) to access swallowing, peristalysis, or anatomical problems such as sphincter problems with GI tract |
| Lower GI study | Rectal barium: to look for polyps, tumors, or other |
| Abdominal computed tomography (CT scan) | Cross sectional imaging of abdomen for inflammation or problems with GI tract, abdominal wall |
| Magnetic resonance imaging (MRI) | evaluating abdominal soft tissues as well as blood vessels, abscesses, fistulas, neoplasms & other sources of bleeding |
| Positron emission tomography (PET scan) | detect presence of tumors or anatomic abnormalities |
| Scintigraphy | Study by injection of radioactive isotopes to study anatomy, neoplasm, abscess, bleeding site |
| Upper GI endoscopy | EGD esophogastroduodenoscopy, direct visualization through camera on flexible scope |
| Lower GI endoscopy | Colonoscopy direct visualization through camera on flexible scope. CA screening |
| Gastric secretion analysis | Diagnosing pernicious anemia, severe chronic atrophic gastritis or gastric cancer, peptic ulcer secrete some acid, duodenal ulcers usually secrete excess acid. |
| Drug classes to treat GERD and PUD | H2 blockers, antacids, proton pump inhibitors (PPI), GI protectants, digestive NZ dysfunctions |
| H2 blockers | cimetidine, ranitidine, famotidine, nizantidine. Act: decr acid, blocks histamine2. SE: dizziness, rash, diarrhea, muscle pain, agranulocytosis, bradycardia. NC: toxic - hepatorenal tox, hallucinations |
| Antacids | Mg(OH)2 (MOM), CaCO3 (Tums), Al(OH)3 (Amphojel) bases ingested to neutralize stomach acid. SE: Al+3 / Ca+2 constipation, Mg+2 diarrhea. NC: Mg caution w renal insuf. Monitor Ca (dysrythmias) Interact with other drugs. Take 1 hour apart from other meds |
| PPI | omeprazole (Prilosec). esomeprazole Nexium), lansoprozole (Prevacid), pantoprazole (Protonix). Act: Block parietal cell proton pump. Use: GERD, PUD. SE abd pain, rash, FSBS changes. NC: give on empty stomach |
| GI protectants | sucralfate (Carafate) protective stomach lining, SE: N/V/C. NC: qHS empty stomach. |
| Stomach ulcers | 90% caused by Helicobacter pylori (H. pylori) |
| prostaglandin analogs | misoprostil (Cytotec): prostaglandins not first choice drugs protective to stomach (this is why NSAIDS cause stomach damage) SE: N/V/D/C. Can't use in pregnancy (induces labor) |
| Anti-infective/gastric pump inhibitor | Prepackaged marketing gimick treatment for H. pylori. amoxicillin + lansoprazole in blister packs. #600 for $40 worth of drugs. |
| Client education for antiulcer medications | Smoking antagonizes H2 blockers. H2/PPI may cause drowsiness - practice safety. Avoid NSAIDS if you have GERD. |
| Digestive NZ | amylase, pancreolipase, pancreatin. Act: fat/protein digestive enzymes. Act: use for client with pancreatic disease. usu enteric coated (acid destroys NZ. Derived from slaughtered animals. |
| Laxatives | bulk forming, osmotic, stimulant, emollient, cathartic (aggressive w/ cramps), pergatives (harsh cathartics). Act: make you stool. |
| Stimulant laxatives | bisacodyl (Dulcolax), sennoside (ExLax, Senokot). Act: cause peristalsis. SE: dizziness, edema, SOB, CRAMPING!, n/v/d, discolored urine, lyte abn. NC: contraindicated for acute abdomen, precipitate labor, don't take castor oil (malaborptive problems). |
| Bulk forming laxatives | lactulose, magnesium citrate, MgSO4, PEG (GoLytely, Miralax), psyllium (Metamucil) take with lots liquids. SE: bronchospasm, cramps, esoph obstruction, n/v/d. Lactulose binds K+, Mg citrate is most commonly used. |
| Emollients, stool softeners, lubricants | docusate (Colace, Surfak), mineral oil. Act: pulls water into stool, increase lyte secretion into colon. SE: mild cramps, throat irritation, rash. Contraindicated for acute abdomen. |
| Constipation: nonpharmacologic measures | Hi fiber, lots of water, exercise, routine bowel habits |
| Diarrhea | More liquid or more frequent stools than normal. Comlications: lyte disturbance, dehydration, HoTN, perianal irritation. Causes: infections, functional bowel disorders, intestinal disease, food intolerance/sensitivities, medication reaction. |
| Antidiarrheals | loperamide (Imodium), bismuth (Pepto Bismol), diphenoxylate/atropine (Lomotil) SE: drowsiness, dizziness, nervousness, N/V/C ileus, obstruction |
| Antiemetic types | phenothiazines, nonphenothiazines, anthicholinergic/antihistamine, partial serotonin antagonist (5HT3), substance P/neurokinin I receptor antagonist |
| Phenothiazine antiemetics | derviatives antipsychotics, prochlorperazine (Compazine), chlorpromazine (Thorazine), promethazine (Phenergan). Act: alters effects of dopamine in CNS. SE: NMS, EPS, sedation, anticholinergic, HoTN, tachy, urine discolor, photosensitivity, agranulocytosis |
| Nonphenothiazine antiemetics | metoclopramide ( blocks D receptors in chemoreceptor trigger zone, SE -same as phenothiazines + anx/depression, HoTN/HTN, C/D |
| Antiemetic: anticholinergic antihistamines | meclizine (Antivert Nondrowsy Dramamine). Act: antihistamine/anticholergic, CNS depressent, decreases inner ear labyrinth activity and vestibulocerebellar pathways. Use: n/v vertigo. SE: drowsiness, blurred vision, dry mouth. |
| Antiemetic: 5HT3 antagonists | ondansetron (Zofran), granisetron (Kytril). Act: antagonizes Serotonin subtype (5HT3). Use: N/V SE: HA, dizziness, drowsiness C/D, abdominal pain, dry mouth, incr LFT, EPS |
| Antiemetics: substance P / neurokinin-1 antagonists | aprepitant (Emend) Act: blocks N/V at CNS level. Use: chemo patients. SE: N/V/C/D, anorexia, HA, fatigue NI: give with dexamethasone |
| Osteoblast / osteoclast | Osteo - bone. Blast - primitive cell. Clast - breakdown or fragment. So, -- osteoblast - primitive bone (makes bone). Osteclast - bone breakdown (breaks down bone) |
| Osteocyte | Bone cell. Maintains bone homeostasis. |
| Ca+2; PO4-3. Major minerals of bone matrix. | Ca+2 - crystallized to add rigidity and compressive strength "calcified". PO4-3 - regulates Vitamin D and promotes mineralization. |
| Calcification | Bone formation/mineralization of bone. Minerals are deposited and crystallized. Bone remodeling Bone formation <---> bone reabsorption. Both are ongoing processes. Takes 3-4 months. -blasts (formation). -clasts (resorb). |
| Phases of bone remodeling | Phase I - activation (stimulous) osteoclasts are formed. Phase II - resorption - osteoclasts digest bone and leave resorption cavity. Phase III - formation - osteoblasts form new bone. |
| Synovial membrane | Surrounds a joint. Filled with synovial fluid. |
| Synovial fluid | Straw colored viscous lubricating fluid of joints. Covers ends of bones. Hyaluronic acid in fluid gives biomechanical properties. |
| Skeletal muscle | Voluntary muscles of the body. Contract to do work, move skeletal components. The somatic nervous system. |
| Fascia | Connective tissue covering muscles/tendons, bones. 3 part connective tissue framework. Protect muscle fibers, attach muscle to bone, and structure for nerve fibers, blood vessels, and lymphatic channels. |
| Aging of bones (Agility) | Loss of bone tissue, less dense, weaker, more brittle. Bone remodeling takes longer. Mineralization is slow. Bone loss: W>M. Greater in early menopause. |
| Aging (aglility) of joints | Cartilage more rigid, fragile, and decreased range of motion (ROM). |
| Osteoporosis | Loss of bone density. W>M. May lead to pathologic fractures. Decreased interverterbral disk spaces. (secondary to decrease disk height). |
| Osteoporosis risk factors | Female. Post menopausal, genetics. Early menopause. White, fine boned, small framed, Asian, low Ca+2 diet, EtOH, smoking, sedentary lifestyle, long term corticosteroids, caffeine XS. |
| Pathophysiology of osteoarthritis (OA) or simply "arthritis" | Loss of cartilage, cartilage thins, may leave overlying bone unprotected. Cysts may develop. As articular cartilage erodes, alters bone contours and joint anatomy. May develop spurs. |
| Osteoarthritis (OA) risk factors | >40yo. W>M. Occurs in those who put exceptional stress on joints. Ex: basketball/football/soccer players. |
| Rheumatoid arthritis (RA) | An autoimmune arthritis. Body damages itself by attack of immune system against body. Signs: inflammation, fever, leukocytosis, malaise, anorexia, hyperfibrinogenemia |
| RA pathophysiology | 3 processes. 1 - neutrophils in synovial fluid degrade articular cartilage. 2 - cytokines, TNFalpha, interleukins attack cartilage. 3 - synovium digests cartilage releasing inflammatory molecules. |
| RA risk factors | autoimmune - cause unknown. |
| Gout | Error in uric acid metabolism causing uric acid joint deposits and gouty arthritis. Most common location: great toe MTP joint |
| Gout pathophysiology | Uric acid is the end product of purine catabolism and is excreted by kidneys. Hyperuricemia may be increased production or decreased renal clearance or both. |
| Gout risk factors | EtOH, prolonged fasting, D.M., osteosclerosis, chemo drugs, obesity. |
| Imaging: osteoporosis - dual Xray absorptiometry test\ | Compare Xray bone density to young adults. This is the GOLD STANDARD for detecting/monitoring osteoprosis. Common sites: spine, hips, forearms. |
| Imaging: osteoarthritis | Xray, MRI, CT, Bone scan, arthroscopy, etc. anything that can image a joint can be used. |
| Imaging: rheumatoid arthritis | not diagnosed by imaging. |
| Diagnosis: rheumatoid arthritis | Rheumatoid factor (80% positive), fibrin flecks in synovial fluid. |
| Imaging: gouty arthritis | Not diagnosed by imaging |
| Diagnosis: gouty arthritis | Uric acid crystals seen under microscope exam of synovial fluid (obtained by joint aspiration). Uric acid >6 is suggestive, but not diagnostic of gout. |
| Bisphosphonates - prototype - MOA | Prototype: alendronate (Fosamax). Drugs used for osteoporosis or hypercalcemia. Makes client lay down bone tissue.(stimulates osteoblasts) |
| alendronate (Fosamax) | bisphosphonate. Take daily. Causes severe GERD. Must not lie down for 30m after taking. Take on empty stomach with water. |
| Bisphosphonates - drugs to know | alendronate (Fosamax). risedronate (Actonel). ibandronate (Boniva) [all end in -dronate] |
| Gout treatment | colchicine (Colcrys). probenecid (Benemid). allopurinol (Zyloprim). SE (all): gastroenteritis. colchicine - neurophathy (use with caution in elderly). probenecid -headache, rash, kidney stone. allopurinol - fever/rash |
| gout treatment - MOA | colchicine - inhibits inflammation, pain, swelling. probenecid - blocks uric acid resorption from kidney (increased excretion). allopurinol - blocks NZ in uric acid pathway (decreases production), allowing precursor of uric acid to be excreted. |
| muscle relaxants - drugs | carisoprol (Soma), chlorphenesin (Maolate), chlorzoxaxone (Parafon Forte), cyclobenzoprine (Flexeril), metaxalone (Skelaxin), methocarbamol (Robaxin), orphenadrine (Norflex), ophenadrine + caffeine (Norgesic) |
| muscle relaxants - SE NC | Most common: CNS effects, dizziness, light headedness, blurred vision, N/C, orthostatic HoTN. Less common - some color urine grn/org/brn. methocarbamol -skin peeling & unctrl eye mvmt. NC: take w food, don't drive, avoid EtOH, falls risk. Follow LFT's |
| corticosteroid injection | betamethasone (Celestone), triamcinolone (Kenalog). SE: after injection may crystallize and incr pain (cortisone flare), skin whitening at injection site. NC: RICE - access cap refill, color, mvmt, make sure not too tight. May use heat >48h |
| Calcium supplements | CaCO3 - common - take w food, ex: Tums Maalox Mylanta. calcium citrate - common w/wo food - less effective for pts w lots gastric acid ex: Citrical Calcitrate. calcium gluconate ex: Kalcinate, Cal-nate. calcium lactate Redactate. calcium phospate Pasture |
| Calcium supplement side effects | Dyspepsia, N/V/C, metallic taste, decr appetite, belching, HA |
| Cause of Hypocalcemia | insuf diet, insuf VitD, hypoparathyroidism. SS: tingling/numbness extremities, muscle spasms, seizures, irritability |
| Causes of hypercalcemia | Hyperparathryroidism, CA of bone, thiazides, prolonged immobilization. SS: flabby muscles, kid stones |
| Conditions caused by hypocalcemia & vit D deficiency | Rickets children - impaired bone growth. Osteomalacia (soft bones). Osteoporosis - calcium loss - weak bones - fractures. |
| Medications for osteoporosos / bone reabsorption drug classification | Selective estrogen receptor modulators. Polypeptide hormone. Bisphosphonates. Estrogen replacement. |
| Osteoporosis - Selective estrogen receptor modulators. | raloxifen (Evista) SE: hot flashes, arthralgias |
| Osteoporosis - polypeptide hormone | calcitonin (Miacalcim) - reduces bone loss & increases density. Contraindicated w DVT. SE:runny nose, nasal congestion, flusing, nausea. SC/IM/Nasal |
| Osteoporosis - bisphosphonates | alendronate (Fosamax), ibandronate (Boniva), risedronate (Actonel) SE: esphogeal ulcers, N/V/D, HA, arthralgia |
| Osteoporosis - estrogen replacement | estradiol (Menostar) - transdermal. teriparatide (Forteo). SE: PMS symptoms, breast tender, moody, nausea, bloating. |
| Osteoprosis - NC | don't d/c meds abruptly, fall prevention / safe environment, teach of hi calcium / Vit D diet, exercise. |
| Antigout drugs - names and general side effects | colchcine (Colcrys). allopurinol (Zyloprim). probenecid (Benemid). SE: N/V/D, anorexia, abdominal pain, HA |
| Antigout drugs - colchicine | Act: inhibits inflammation. Take in combination with other drugs. SE: general SE + bleeding, muscle weakness, reversible azoospermia. |
| Antigout drugs - allopurinol | Act: uric acid inhibitor. SE: general SE + rash, hives, metallic taste, BONE MARROW SUPPRESION |
| Antigout drugs - probenecid | Act: increases uric acid urinary elimination. Should drink 8 glasses of water daily to prevent stone formation. SE: general + dizziness |
| Gout - NC | Low purine diet. Pt may eat fruit, need to maintain health weight. Avoid bad foods - meat, seafood, beans, broccoli, asparagus, mushrooms, green peas, & EtOH. |
| Fibromyalgia | chronic joint pain. Problems sleeping, HA, depression, anxiety, irritable bowel, RLS, dysmennorhea. |
| Fibromyalgia drugs | duloxetine (Cymbalta) - treats depression/anxiety/neuropathic pain. pregabalin (Lyrica) - treats neuropathic pain. Milmacipran (Savella) - SSNRI |
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