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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
Created by: mojoshare



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