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PHM 114
Chapter 6
| Question | Answer |
|---|---|
| Osteoclasts | break down bone tissue and release calcium into the blood stream |
| Osteoblasts | Take calcium from the blood to build body tissue |
| When does bone density for the most part stop growing? | In your 30's. Then your bone density starts to decrease especially for woman |
| Osteoporosis | A reduction in bone density that results in weakened bones and fractures. Condition causes fractures in the hips, spine, and wrist that cause pain and debilitation |
| Risk factors for Osteoporosis: | Being female.Being Caucasian.Family history of osteoporosis.Small body frame.Smoking.Heavy caffeine intake.Poor nutrition |
| Bone Mineral Density- BMD | Screening test for osteoporosis. Uses x ray and ultrasound technology. Result of an BMD screening is a T-Score which is an estimate of risk. Not diagnosis |
| What part of the body is measured during a BMD? | Heel bone. Because it is a good estimate of hip and spine bone density. |
| What are the risk in hormone replacement therapy- HRT? | Heart disease.Cancer.Stroke. Which outweighs the benefits. Not a favorable choice for osteoporosis anymore |
| What is HRT used for now? | Perimenopausal symptoms such as hot flashes but is taken at lowest dose for shortest time possible |
| How much calcium should healthy adults get daily to maintain bone strength? | 1000 mg |
| How much calcium should osteoporosis patients over 65 and women after menopause get? | 1500 mg |
| How many mg of calcium is absorbed at a time? | 500-600 mg |
| What should patients taking prescription drugs for osteoporosis also take? | Calcium and Vitamin D |
| What is Calcium and Vitamin D also useful in treating? | Osteopenia which is bone weakening |
| What does Vitamin D do? | Improves calcium absorption from the GI tract |
| Osteoblasts cannot build more bone without what? | Calcium |
| What are the side effects of calcium supplements? | Nausea.Vomiting.Constipation.Take with food to alleviate |
| What form of calcium might be easier on the stomach? | Cirtrate form of Calcium but it doesn't offer as much elemental calcium as do other salts |
| What are the side effects of Vitamin D supplements? | Nausea.Vomiting.Edema(swelling) |
| A patient should call there physician if what side effects occur with taking Vitamin D? | Fever.Chills.Flu like symptoms.Lightheadedness.Pneumonia |
| What condition can occur from taking Vitamin D? | Hypervitaminosis D - Occurs because vitamin D is fat-soluable and excessive amounts can accumulate |
| What are the cautions and considerations to taking Calcium? | Too much can lead to kidney stones. If you have a history of kidney stones you shouldn't take it. |
| What shouldn't be taken with Calcium? | Quinolone antibiotics.Tetracyclines.Iron supplements. Calcium binds to these drugs and keeps them from being absorbed |
| What are the cautions and considerations to taking Vitamin D? | Can lead to hypercalcemia and kidney problems. Don't take more than recommended. Patients with prior kidney problems should speak to doctor before taking |
| Biophosphonates | Class of drugs that inhibit osteoclasts from removing calcium from bone tissue.Prevent bone breakdown so that stronger bones are maintained. Overtime fractures can be prevented |
| What do Biophosphonates treat? | Osteoporosis and Page's disease which is a bone remodeling disorder. Also in bone and spinal injury cases to promote bone regrowth |
| How should Biophosphonates be taken? | Orally once a day,once a week,or once a month |
| How often if infused intravenously should Biophosphonates be taken? | Every month.Three months.Or annually |
| What are the side effects for Biophosphonates? | Headache.Nausea.Vomiting.Diarrhea.Constipation.Abdominal pain.Indigestion |
| What can decrease some of the effects for Biophosphonates? | Taking oral dosage forms with a full glass of water and remaining upright afterward |
| You should seek medical advice if what side effects occur for Biophosphonates? | Insomnia.Anemia |
| What severe yet uncommon side effect can occur with Biophosphonates? | Osteonecrosis which is bone tissue death of the jaw |
| With an IV dosage form for Biophosphonate what side effect occurs? | Fever. So acetaminophen is given |
| What are the cautions and considerations for Biophosphonates? | Oral dosage forms should be taken on an empty stomach first thing in the morning with water. After taking wait at least 30 minutes before eating. Remain upright for 30 minutes.Refrigerate and use within 24 hrs |
| Selective Estrogen Receptor Modulator- SERM | work as estrogen receptors by mimicking the beneficial effects of estrogen on bone mineral density. They do not increase the risk of breast or uterine cancer the way regular estrogen can. Improves cholesterol |
| What are the SERMs currently available? | Raloxifene(Evista).tamoxifen(Nolvadex).Toremifene(Fareston) |
| What are the side effects for Raloxifene? | Hot flashes.Headache.Diarrhea.Joint pain.Leg cramps.Flu like symptoms |
| What is the most serious side effect with Raloxifene? | Deep vein thrombosis or blood clots - If patient experiences pain,swelling,or bruising in one leg or difficulty breathing, they should seek medical care STAT |
| Human Parathyroid Hormone | Teriparatide(Forteo) supplements the body's production of parathyroid hormone, which regulates calcium phosphate balance and stimulates new bone growth. |
| What is the Human Parathyroid Hormone used for? | Patients with severe osteoporpsis as short term therapy. Has been associated with osteosarcoma, So patients with Paget's disease should not take. Drug is injected |
| Arthritis | Most common joint disorder |
| What are the 3 different types of arthritis? | Osteoarthritis.Rheumatoid arthritis.Gouty arthritis |
| Osteoarthritis | Most common. Caused by the wear and tear on joints that comes with age. After 40 or 50. Cartilage that coats ends of bones inside joints erodes resulting in rubbing |
| What joints are effected first with Osteoarthritis? | Knees,Shoulders,Hips. Finger and hands as well because of the daily stress |
| Rheumatoid arthritis | Involves abnormal process in which the immune system destroys the synovial membrane and produces inflammation within the joint. Small joints affected first.Symmetry is present. Not curable |
| What are the symptoms and signs of RA? | Morning pain and stiffness that last longer than an hour and are not relieved by activity. |
| What are the 2 labratory test used for RA? | Erythrocyte Sedimentation Rate(ESR) and Rheumatoid Factor(RF) |
| Gouty arthritis | Excessive uric acid accumulates in the blood. Next, urate crystals form in the synovial fluid and irritate joints |
| Where does joint pain and swelling first occur in gouty arthritis? | The big toe. Possibly elbows and heels |
| What condition can gouty arthritis eventually cause? | Kidney damage |
| What are the drugs that predispose someone to gout? | Diuretic,Salicylates,Nicotinic acid,Ethanol,Cytotoxic agents such as those used for cancer |
| Certain foods rich in what, are also implicated in gout? | Amino acid purine- red meat |
| Common drugs for OA | Reduce pain and inflammation but does not remove the underlying causes. If severe enough surgery and joint replacement are preformed |
| Acetaminophen | Drug choice for OA because it treats pain but doesnt have as many side effects. Many patients dont take this because it has to be taken multiple times a day |
| Nonsteroidal Anti-Inflammatory Drugs- NSAIDs | Blocks pain by inhibiting cyclooxygenase I(COX-1) and II(COX-2)NSAIDs are good analgesics when inflammation is the primary cause of pain or acetaminophen no longer works |
| What is cyclooxygenase? | An enzyme that converts arachidonic acid to prostaglandins |
| what are prostaglandins? | Produced in response to various stimuli. Promote inflammation and connect to pain receptors to trigger the pain response |
| What does prostaglandins do? | Protect against erosion from gastric acid in the stomach and intestins. This effect is eliminated when NSAIDs block its production |
| How do NSAIDs affect the GI lining? | It has a deleterious effect on it when taken in high doses over a long time |
| What else besides OA do NSAIDs treat? | Dysmenorrhea(painful menstrul cycle) and fever |
| With athritis what type of therapy is needed with NSAIDs? | Long term to control chronic pain |
| What are the side effects of NSAIDs? | Headache.Diarrhea.Nausea.Constipation.Dizziness.Drowsiness. The GI side effects include indigestion.heartburn.abdominal pain.heartburn.blood in stool.black and tarry stools which are signs of GI bleeding. Take with food or milk |
| What are the cautions and considerations of NSAIDs? | Cause renal(kidney) problems and fluid accumulation.Drink plenty of water.Some tablets such as etodolac should no be chewed or crushed.Avoid duplication of therapy with OTC products such as advil. Dont take aspirin. Use acetaminophen instead |
| What drugs interact with NSAIDs? | Diuretics.Methotrexate.Warfarin.Cyclosporine |
| Cycloocygenase-II Inhibitors | Celecoxib is the only COX-2 inhibitory available. It inhibits cyclooxygenase II, and enzyme that promotes production of prostaglandins that cause pain and inflammation but not those that protect the GI lining |
| What are the side effects of Celecoxib? | Headache.Abdominol Pain.Heartburn.Nausea. Take with food. URI can occur. |
| What are the cautions and considerations of Celecoxib? | Other COX-2 Inhibitors were removed from market because of adverse effects involving heart problems and death in some cases. Some patients wont take med. Should have monitored heart function |
| Drugs for RA | Goal for these drugs are to maintain mobility and delay disability for as long as possible |
| Disease-Modifying Antirheumatic Drugs- DMARDs | Used to improve functional status by slowing disease progression. Many work by inhibiting immune system to slow down destruction of joint tissue |
| What are the duel actions of Azathioprine and Cyclosporine? | Immunosuppressants after transplant and DMARDs for RA |
| What are the injectable biological response modifiers for DMARDs? | Etanercept.Infliximab.Adalimumab.Anakinra. They are made through recombinant DNA technology and work by inhibiting either interleukin-1 or tumor necrosis factor- Which cause inflammation and joint damage |
| What are the side effects of DMARDs? | Simalar to chemotherapy.Can cause severe consequences and become barriers to treatment. Auranofin causes severe diarrhea |
| What are the cautions and considerations for DMARDs? | Liver,Kidney,and blood problems caused by them can be serious. Lab test conducted periodically.Because they are immunosuppressants they can increase risk of infection.Kidney damage.Drink plenty of water.Refrigerate.Special mixing and storage instructions. |
| What DMARD needs to be protected from light exposure to preserve potency? | Leflunomide Tablets |
| Drugs for Gouty Arthritis | If patient has severe attack or repeated gout exacerbations within a year, chronic low dose therapy will be used to prevent future attacks. Meds work by lowering uric acid levels in the bloodstream and reduce inflammation within joints |
| Colchicine | Drug of choice to lower uric acid levels in both acute and chronic attacks.. Used in preventive therapy at lower dose |
| Triamcinolone Injection | Corticosteroid administered directly into joint to relieve pain and swelling. For acute attacks it lasts for a few days to a week or 2 |
| Indomethacin | An NSAID and prenisone are used in combination with these agents to reduce the pain and inflammation of gout attack |
| What is the most frequently prescribed drug for gout prophylaxis? | Allopurinol |
| What are the side effects of gouty arthritis drugs? | IF diarrhea occurs while taking colchicine he should stop taking it and contact doctor. FOr acute attack the patient may be given colchicine until they have diarrhea |
| What are the cautions and considerations of Gouty arthritis drugs? | Drink plenty of water with probenecid. Avoid taking aspirin with this med because it decreases effectiveness |
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Tara3184
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