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EXAM 5 - MED SURG
OA, Osteoporosis, Gout
| Question | Answer |
|---|---|
| Osteoporosis Risk Factors | Low calcium and vitamin D intake, Age (women after menopause), lifestyle factors such as smoking, excessive alcohol intake, sedentary life, immobility, Caucasian and Asian women, family history, underweight/malabsorption disorder, Long-term use of corticosteroids, anticonvulsants, levothyroxine, or PPIs. |
| Osteoporosis Testing | Bone Density Test- Dual-Energy X-Ray Absorptiometry (DEXA), this process takes X-Ray images, measuring calcium, and other minerals in the bones. |
| Patient Education for Non-Pharmacologic Management of Osteoporosis | Food sources of Vitamin D such as cod liver oil, oysters, mackerel, most fish, egg yolk, fortified milk, some ready-to-eat cereals, and margarine |
| Pharmacological Management of Osteoporosis | Vitamin D, Calcium, Bisphosphonates, Calcitonin, Denosumab |
| Bisphosphonates | End in “DRONATE” - Alendronate (Binosto), Etidronate (Didronel), Ibandronate (Boniva), Pamidronate (Aredia), Risedronate (Actonel), Zoledronic Acid (Reclast, Zometa). |
| They are bone resorption inhibitors, inhibiting normal and abnormal bone reabsorption to increase bone mineral density. | Side Effects include Nausea, Diarrhea, Dyspepsia, Acid Reflex, Abdominal Pain |
| Should not be used in evidence of osteopenia, Monitor serum Calcium Levels before, during and after therapy (should be 9-11 mg/dL) | Take with full glass of water, on an empty stomach. Separate iron, antacids, and multiple vitamins by at least 30 mins. Encourage intake of calcium and vitamin D, perform weight-bearing exercises to preserve bone mass |
| Calcitonin Salmon (Miacalcin) | Hormone/Hypocalcemia Agent, that lowers serum calcium levels in the blood by inhibiting bone reabsorption (because we don’t want calcium in the blood we want it in the BONES). Prevents further bone loss in the presence of adequate calcium and vitamin D, inhibits osteoclasts (cells that cause bone breakdown), treats, and prevents postmenopausal osteoporosis. |
| Side Effects include GI upset, nasal irritation, and dryness (intranasal route) | Single injection decreases calcium levels in approximately 2 hours and lasts approximately 6-8 hours. |
| Denosumab (Prolia, Xgeva) | Antiresorptive Drug. Used to treat osteoporosis in postmenopausal women at high risk of fracture. Administered SubQ at 7-month intervals Prevents skeletal-related events in bone metastases from solid tumors. Decreases bone resorption and increases bone mass and strength |
| Side Effects Include | Fatigue, Weakness, Back Pain, Extremity Pain, Hypocalcemia, Hypophosphatemia, Nausea, Diarrhea, Peripheral Edema, Hypertension, Headache, Skin Rash, and Dermatitis |
| Risk Factors for Osteoarthritis (OA) | Obesity, older age, females, heavy labor occupations, genetics |
| Patient Education for Non-Pharmacologic Management of Osteoarthritis | Occupational Therapy, Physical Therapy, Exercise, Walking Aids (Canes), Orthotic Devices (Splints, Knee Braces), weight loss. - Pulsed electromagnetic fields. Transcutaneous electrical nerve stimulation (TENS) and music therapy. Acupuncture, acupressure, copper bracelets or magnets |
| Pharmacological Interventions for Osteoarthritis | Analgesics (NSAIDs and Acetaminophen). Other medications that may be considered are nonopioids, such as tramadol, opioids in severe cases, and intra-articular corticosteroids. Also, Capsaicin and Methyl salicylate, Methotrexate, Colchicine, Diclofenac, Oxicam Derivatives (Meloxicam (Mobic) |
| Capsaicin and Methyl salicylate | Topical diclofenac sodium gel has been FDA approved for the use of osteoarthritic joint pain in the hands and knees |
| Methotrexate & Colchicine | typically prescribed for treating RA and gout, respectively, may also be considered for some patients with OA who are refractory to other treatments. The pathophysiologic antecedents of these diseases are like those in OA, and it is believed that may explain the effectiveness of these medications in some select patients with OA |
| Visco supplementation | the injection of gel-like substances (hyaluronates) into a joint (intra-articular), is thought to supplement the viscous properties of synovial fluid. These Viscos supplements aim to prevent the loss of cartilage and repair chondral defects but lack strong evidence that support their use |
| Diclofenac | Reversibly inhibits COX-1 and COX-2 to produce an anti-inflammatory response. 99% bound to albumin. Transdermal patch has half-life of 12 hours. Oral preparation is 1-2 hours. Used to relieve inflammatory symptoms of RA, OA, and ankylosing spondylitis |
| Oxicam Derivatives | Meloxicam (Mobic) - Another type of NSAID, A COX-1 & COX-2 inhibitor. Produces anti-inflammatory, analgesic, and antipyretic effects. |
| Side Effects include dyspnea, hemoptysis, bronchospasm, pharyngitis, and rhinitis, bleeding, platelet inhibition, decreased hemoglobin, and hematocrit, along with bone marrow depression and edema, Nausea, dyspepsia, diarrhea, vomiting, headaches, dizziness, drowsiness, and insomnia. BLACK BOX WARNING increased risk for cardiovascular events and GI bleeding. | Patient education includes Take with food to decrease GI upset, do not drive until effects are known, Report sore throat, dyspnea, edema, and tarry stools |
| Long term options for treatment of Osteoarthritis | Total joint arthroplasty, also known as total joint replacement, involves the replacement of all components of an articulating joint. |
| Allopurinol (Aloprim, Zyloprim, Lopurin), & Febuxostat | Uric acid inhibitor/Xanthine oxidase inhibitors Interrupt the breakdown of purines before uric acid is formed. Inhibit xanthinoxidase because uric acid formation is blocked. Prevents gout attacks but does not help with acute attacks. |
| Side Effects Include nausea, vomiting, abdominal pain, diarrhea, and skin rashes (may indicate SJS - stop med). BLACK BOX WARNING Taking this med with aspirin increase uric acid levels TAKE ACETAMINOPHEN INSTEAD | Patient Education includes take with full glass of water, increase fluid intake to 2-3 L/day (may produce urine output of 2 L/day), avoid organ meats, and it does take several months to work. Uric acid deposits can cause kidney stones (fluids help prevent this) |
| Colchicine (Mitigare, Colcrys) | Antigout agent. Lowers the deposition of uric acid and interferes with leukocyte infiltration, thus reducing inflammation. Does not alter serum or urine levels of uric acid. Used for both acute and chronic management |
| For acute management - administer when attack begins. Dosage increased until pain is relieved, or diarrhea develops - then stop med. For Chronic Management - Causes GI upset in most patients | Relieves acute attacks and prevents future but DOES NOT decrease inflammation. Side effects include vomiting, abdominal pain, and diarrhea BLACK BOX WARNING OF RISK OF BONE MARROW SUPPRESSION |
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