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Pathophysiology and Pharmacology 2 > Chronic MS Conditions > Flashcards

Chronic MS Conditions Flashcards

1
Q

intervertebral disc degeneration

A

intervertebral disks (pads of fibrocartilage between vertebrae that resist spinal compression while permitting movement)

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2
Q

causes of intervertebral disc degeneration

A

normal wear & tear
arthritic conditions
inherited genetic disorder

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3
Q

intervertebral disc degeneration s/s

A

pain in back (spreading to buttocks & upper thighs)

numbness and tingling in leg/foot

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4
Q

intervertebral disc degneration dx

A

physical exam to assess location of spin affected
spinal x-ray
mri

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5
Q

intervertebral disc degeneration tx (initial, after and persisten)

A 
aspirin & NSAIDs, rest
physical therapy, back brace w/ ice&heat, massage, ultrasound, electrical stimulation
tramadol before Norco/Percocet
nerve block with steroid injections
continued w/ complementary medicine
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6
Q

herniated/ruptured disc

A

rupture of disc causing fluid to leak out & impinge/irritate nearby nerves
decreases cushioning of vertebral joints
back pain & limited mobility
can cause sciatica

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7
Q

herniated/ruptured disc RF

A 
30-50 years old
excess weight
regular heavy lifting/bending/twisting
previous back problems
smoking
genetic factors
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8
Q

herniated/ruptured disc most common locations

A

C5-6, C6-7, L4-5, L5-S1

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9
Q

Cause of herniated/ruptured disc

A

loss of fluid w/in disk
increased risk for microscopc tears
decreased ability to abosrb shock
increased risk for herniation

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10
Q

herniated/ruptured disc s/s

A

if abrupt: nerve root compression, severe pain, muscle spasms
gradual: slow onset of pain, weakness, tingling
forward tilt to trunk when standing
changes in mobility, motor fx/knee & ankle reflexes
cauda equina syndrome

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11
Q

herniated/ruptured disc dx

A 
mobility tests
ct
MRI
myelography
nerve conduction studies
blood tests
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12
Q

herniated/ruptured disc tx

A 
NSAIDS
opioids (if acute)
antispasmodics
hot/cold packs
cortisone
corticosteroids
anesthetics
mild, low-impact exercise to help strengthen back 
surgery (laminectomy, discectomy, spinal fusion, artificial disc surgery, laser surgery)
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13
Q

four stages of disc herniation

A

degeneration
prolapse
extrusion
sequestration

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14
Q

cyclobenzaprine

A

antispasmodic
r/t TCAs, acts at brain stem sedately (w/ ^HR and anticholinergic)
reduces muscle spasms/motor activity (motor neuron suppression)
se: constipation, indigestion, n, dizziness, fatigue, dysrhythmia, heart block, syncope, cholestasis, paralytic ileus, edema of tongue, BMD, CVA, NMS
avoid in 65+ y/o
Contra: heart conditions/disturbances, MAOIs, hyperthyroidism
Interx: may enhance CNS depressants or anti-cholinergic agets
B

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15
Q

cauda equina syndrome

A

compression of cauda equina due to disc herniation
bowel & bladder dysfunction
anesthesia of perineum
medical emergency

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16
Q

spinal stenosis

A

narrowing of spinal column

vertebral bone degeneration with aging

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17
Q

spinal stenosis s/s

A

slow progressive symptoms
numbness weakness
cramping
general pain (may radiate down arm or leg)

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18
Q

spinal stenosis dx

A 
medical hx and physical exam
 x-ray
mri
ct
myelography
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19
Q

spinal stenosis tx

A 
NSAIDs
steroid injections
nerve blocks
PT
lumbar brace
chiropractic tx
acupuncture
surgery
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20
Q

Lordosis

A

spinal column is concave

due to pregnancy or obesity

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21
Q

kyphosis

A

spinal column is convex (goes out)

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22
Q

scoliosis

A

lateral curve of spin
C or S shaped
severe: rotation of spine leading to deformities & disability

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23
Q

scoliosis RF

A

9-15 years old
neuromuscular disorder
family history

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24
Q

scoliosis type

A

idiopathic
congenital (incomplete formation, seperation of vertebrae)
neuromuscular scoliosis

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25
Q

structural vs nonstructural scoliosis

A

deformities of bones in spinal column

poor posture, differences in leg length, tumors, adaption to pain

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26
Q

dextroscoliosis

A

thoracic curve

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27
Q

kyphoscoliosis

A

outward & lateral spine curvature

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28
Q

rotoscoliosis

A

vertebral column turned on its axis

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29
Q

levoconvex

A

curvature of spin to left & thoracolumbar scoliosis

r/t both thoracic and lumbar regions

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30
Q

sideways curvature scoliosis rating

A

mild: 10-20 degrees
mod: 20-40 degrees
severe: over 40 degrees

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31
Q

scoliosis s/s

A 
spinal curvature to one side
uneven hips/shoulders
differences in leg lenghth
tiredness of spine
prominent shoulder blade
rib bump
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32
Q

scoliosis complications

A

heart/lung problems

paralysis

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33
Q

scoliosis dx

A 
adam forward bend test
x-ray
MRI
CT
bone scan
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34
Q

scoliosis tx

A

pain management (OTC or prescription NSAIDs)
PT (mild)
brace (moderate): Milwaukee [high curvatures} Boston [low/thoracic curves]
spinal fusion surgery (over 40)

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35
Q

osteomalacia & rickets

A

characterized by decreased mineralization of newlyformed bone
usually deficiency or abnormal metabolism of vitamin D

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36
Q

osteomalacia & rickets causes

A 
dietary deficiency (vit D/ca)
intestinal malabsorption
lack of sunlight
renal & liver disease
following a parathyroidectomy
supplement vit D/Ca
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37
Q

Calcium (recc/uses/normal)

A

800-1200 mg/day
increased for pregnancy, growing children, menopausal women
4.5-5.5

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38
Q

hypercalcemia

A

dangerous EKG changes
heart block
decreased odium permeability on cell membranes

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39
Q

hypocalcemia

A 
muscle cramps
tetany
\+ chvostek/trousseaus
torsades
arrhythmias
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40
Q

calcium supplements

A

calcium acetate
calcium carbonate / chloride/citrate/gluconate/lactate
SE: only w/ IV admin hypotension/bradycardia/dysrhythmias, cardiac arrest, confusion, delirium, coma
contra: ventricular fibrillation or using ceftriaxone in neonates
don’t give with digoxin or tetracyclines or calcium channel blockers, magnesium competes w/ absorption
C

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41
Q

normal serum vitamin D/intake

A

600 mg/day

20-100 ng/ml

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42
Q

vitamin D uses

A

enable normal mineralization of gone & prevents hypocalcemia tetany
needed for bone growth/remodeling
prevents rickets in children/osteomalcia in adults
helps w/ cell growth, neuromuscular, immune fx, reduction of inflammation

43
Q

vitamin D RF

A 
female
smoker
age
sedentary lifestyle
alcohol use
44
Q

calcitrol

A

calcium regulator
active form of vitamin D3
promotes intestinal absorption of calcium, elevates serum levels of calcium
tx rickets/hypoparathyroidism/impaired kidney fx
SE: ha, weakness, dry mouth , thirst, increased urination, muscle, bone pain
Contra: hypercalcemia, vitamin D toxicity
interx: thiazide diuretics can worsen hypercalcemia, w/ digoxin = dysrhythmias
C

45
Q

osteomalacia

A

softening of bones due to demineralization
thin, fragile bones
deficiency of vitamin D

46
Q

osteomalacia s/s

A

bone pain

fractures of vertebrae, hips, wrist

47
Q

osteomalacia dx

A

labs
^ alkaline phophatase
^ parathyroid hormones

48
Q

osteomalacia tx

A

calcium
vit D
sunlight

49
Q

rickets

A

children’s vit D deficiency = poor mineralization in growing = skeletal deformities
inadequate sunlight or vit D

50
Q

Rickets s/s

A 
bowed legs, knock-knees
pigeon breast (protrusion of sternum)
thinning & soft skull
late closing of fontanelles
poor musculature/weakness
51
Q

rickets tx

A

diet/sunlight

calcitriol

52
Q

osteopenia

A 
decrease in bone density (leads to fractures)
eating disorders, metabolism issues
chemo
glucocorticoids
radiation
history
white/asian
thin body structures
limited physical activity
smoking
drinking (cola and alcohol)
53
Q

osteopenia s/s

A

usually asymptomatic until fracture
limited pain
hormonal changes if woman/in menopause

54
Q

osteopenia dx

A

bone mass low

DEXA scan

55
Q

osteopenia tx

A

increased calcium vit D
increased wight-bearing exercises
smoking cessation
reduction of drinking

56
Q

DEXA

A

dual-energy X-ray
not a true density
T-scores calculated by comparing to range of “normal”
assesses presence/extent of osteoporosis
normal: +1 SD
low bone mass (osteopenia) BMD > 1D and < 2.5 SD
osteoporosis: BMD > 2.5 SD

57
Q

osteoporosis

A

low bone density

low intake of nutrients or b/c of aging

58
Q

1 degree osteoporosis

A

menopause/decreased bone formation due to aging

59
Q

2 degree osteoporosis

A

disease process, renal hypercalciuria, drug related

60
Q

osteoporosis tx

A 
nutrition (CA/D)
exercise
prevent falls
medications
weight-bearing exercise
ERT
calcitonin
bisphosphonates
61
Q

osteoporosis vs osteomalcia

A

decreased bone mass, low nutrients/aging vs bone softening/lack of calcification
lack of calcium/estrogen/testosterone vs lack of vit D
bone loss and fractures vs fractures
normal parathyroid hormone vs high/normal
normal alk phos vs high alk phos

62
Q

ostoeporosis tx

A

calcium/vitamin D
biphosphonates (most common, decreases enzyme important to bone turnover)
selective estrogen receptor modulators (SERMs) [decrease bone resorption]
calcitonin (increases bone density)
oral calcium mimic, human PTH teriparatide

63
Q

Paget’s disease of bone

A 
metabolic disorder
bone resorption faster than bone formation 
creates new bone that is weak/brittle
genetic disorder
usually older age, northern european
64
Q

paget’s disease of bone s/s

A 
pain
enlarged bones
deformed bones
fractures
damaged joint cartilage
DX: fracture, x-ray, blood test
65
Q

paget’s disease of bone tx

A 
bisphosphonates
calcitonin
calcium 
vitamin D
exercise
surgery
66
Q

alendronate (nates)

A

bisphosphonates
blocks bone resorption and increases bone density
TX osteoporosis/paget’s
se: d/n/v, gi irritation, altered taste, pathologic fractures w/ long-term use
contra: osteomalacia, abnormalities in esophagus, renal impairment, heart failure, liver disease
interx: CA, iron, antacids w/ aluminum/magnesium
X

67
Q

raloxifene

A

SERM
decreases bone resorption, lowers cholesterol/LDL
TX: osteoporosis in postmenopausal women
SE: hot flashes, migraine, HA, flu-like, endometrial disorder, breast pain, vaginal bleeding, fetal harm in pregnancy
BBW: ^ risk for venous thromboembolism/pulmonary embolism, stroke and MI
contra: estrogen-containing meds
Interx: decreases warfarin effect
X

68
Q

osgood-schlatter disease

A

abnormal ossification of cartilaginous tissue
usually children in growth spurts
if playing sports w/ jumping = most at risk
overuse injury = separation of proximal patellar tendon insertion = callous formed = pronouned tubercle = painful lump below kneecap

69
Q

osgood-schlatter disease tx

A

time & rest
usually resolves on own once bones stop growing
can stay as non-painful growth

70
Q

legg-calve-perthes disease

A

idiopathic avascular necrosis of proximal femoral head
compromises blood supply
insidious onset (can happen after injury to hip) usually unilateral

71
Q

legg-calve-perthes disease tx based on

A 
age, stage, amount of hip damage
petrie cast (hip-spica) or surgery
72
Q

bone growth disorders

A 
gigantism (^ GH = excessie growth)
acromegaly (adult ^ GH = overgrowth of bony areas ie face/feet/hands)
pituitary dwarfism (short long bones, max stature 4 ft)
73
Q

osteoarthritis

A 
most common form of arthritis
wear &amp; tear on joints = break down of cartilage
causes bone to rub on bone
mechanical disease
spurs
74
Q

osteoarthritis RF

A

men: hips/knees/spin
women: hips/knees/hands
hard labor/repetitive motion
obesity
age

75
Q

idiopathic OA

A

localized in one-two joints

generalized is 3+

76
Q

secondary OA

A

underlying condition

77
Q

osteoarthritis s/s

A 
mild symptoms worsen over time
pain associated w/ joint degeneration (worsened by activity/relieved by rest)
stiffness with prolonged inactivity
tenderness
swelling
effusion
crepitus
bone spurs
dx: x-ray
78
Q

osteoarthritis tx

A

alter load in painful joint/improve function of joint protectors
avoid activities that aggravate condition
improve strength/conditioning
use a brace/splint/cane/crutch
OTC analgesics
prescription NSAIDs
topical analgesics
cortisone injections
hyaluronic acid injections
various non-pharmacologic therapies (heat/cold/assistive tech)
surgery

79
Q

rheumatoid arthritis

A

chronic systemic authoimmune disorder
progressive arthritis, production of rheumatoid factor, extra-articular manifestation
caues unknown
usually females, age 20 - 50, genetics
antibodies bine with proteins/tissue = immune complexes = inflammation = enzymes damage joint more = pannus forms = osteoclasts cause underyling bone to demineralize

80
Q

pannus

A

break in bone

81
Q

rheumatoid arthritis s/s

A 
joint swelling, stiffness (morning), warmth, tenderness, pain
usually symmetrical (if not tx)
hand/wrist/knee/ankle most common 
systemic: fatigue, anorexia, weight loss, weakness, low-grade fever
rheumatoid nodules
pleural effusion 
vasculitis
pericarditis
enlarged spleen
82
Q

rheumatoid arthritis tx

A 
NSAIDs
low-dose oral corticosteroids
DMARDs
intraarticular steroid injection 
CAM
83
Q

boutonniere deformity

A

from RA,

v-bend that is stuck

84
Q

swan-neck deformity

A

from RA

bent downwards finger like a swan neck

85
Q

DMARDs

A

disease modifying antirheumatic drugs
can slow/modify progression of tissue damage
begin w/ non biologic is worsens after 3 mo add 2nd DMARD then 3 if needed

86
Q

hydroxychloroquine

A

DMARD
immunosuppressant, suppresses rheumatoid factor
TX: RA, lupus erythematosus, malaria
SE: anorexia, GI issues, alopecia, HA, mood changes, torsades, severe hypoglycemia, anemia, retinal disorder, angioedema
contra: visual changes with anti-malarials
interx: antacids decrease absorption, hepatoxic meds, alcohol, no digoxin
D

87
Q

methotrexate

A

folic acid antagonist (blocks synthesis of folic acid = immunosuppressant)
TX: RA/SLE/UC/Psoriasis
SE: heptatoxicity, hemorragic perforation (enteritis), opportunstic infections SJS
BBW: NSAIDS, embryo-fetal toxicity
contra: anemia, thrombocytopenia
interx: NSAIDS (fatal myelosuppression), aspirin (decreases effect of metho), live vaccines (decreases antibody response)
X
avoid live virus vaccines

88
Q

OA vs RA

A

non-inflammatory vs autoimmune inflammatory
HLA A1/B8 vs HLA DR4 DR1
degenerative vs systemic autoimmune disease
articular cartilage vs synovial tissue
weight-bearing joints vs small joints
asymmetrical, nodes, improves with rest vs symmetrical, migratory, deformities, improves with use
narrowing of joint space vs narrowing of joint space, bone erosion and fusion of joints
slightly elevated alk phosphatase vs positive rheumatoid factor w/ rheumatoid nodules ^ ESR

89
Q

spondyloarthropathies

A 
group of diseases affecting joints
ankylosing spondylities
reactive arthritis
psoriatic arthritis
enteropathic arthritis 
presence of enthesistis (site where ligament/tendon inserts to bone)
HLA-B27 gene
90
Q

spondyloarthropathies s/s

A

low back pain
morning stiffness of back or neck
gen fatigue

91
Q

Anklyosing Spondylitis

A

autoimmune inflammatory disease affecting spine
bone overgrowth
usually white males <40

92
Q

Ankylosing Spondylitis s/s

A

adults: stiffness, chronic low back pain moves to upper back, spinal joint fuse, can affect hips/chest wall/heels/iritis
children: begins in hips/knees/heels/big toe before moving to spine

93
Q

ankylosing spondylitis tx

A

pain management
NSAIDs
DMARDs

94
Q

Reiter’s Syndrome

A

reactive arthritis
complex syndrome: arthritis, conjunctivitis, urethritis
triggered by exposure to infection (STD: chlamydia)

95
Q

Reiter’s syndrome s/s

A 
pain
swelling &amp; inflammation of sacroiliac joint
finger/toe swelling
fever
weight loss
skin rash
eye infection 
dysuria
96
Q

Reiter’s Syndrome

A

tx
ABX
pain management
NSAIDs

97
Q

Psoriatic Arthritis

A

idiopathic
associated w/ psoriasis
scaly red patches on skin, pitting/thickening/yellowing nails
adults: hip/sacroiliac joint, edema in toes/fingers
children: stiffness/swelling/pain in joint

98
Q

psoriatic arthritis tx

A

NSAIDs

DMARDS (methotrexate)

99
Q

Juvenile Idiopathic Arthritis

A

no specific cause but w/ genetic marker
chronic inflammatory autoimmune disease in juveniles
joint inflammation resulting in decreased mobility/swelling/pain
DX: ESR, antibody testing, rheumatoid factor, anti-ccp, x-ray, CT, MRI, U/S, synovial biopsy

100
Q

juvenile idiopathic arthrits tx

A 
NSAIDs
DMARDs
biologic agents
intra-articular/oral corticosteroids
PT
OT
surgery
101
Q

Gout

A

increased serum uric acid > crystals in joint > inflammation
tophi (accumulation of crystalline deposits)
Gouty nephropathy (uric acid kidney stones)
TX: allopurinol

102
Q

what has purines

A

high: alcohol, anchovies, sardines, mussels, herring, codfish, scallops, trout, haddock, bacon, turkey veal, venison, organ meats
moderate: beef, chicken, duck, pork, ham, crab, lobster, oysters, shrimp

103
Q

allopurinol

A

anti-gout
decreases production of uric acid by inhibiting enzyme
SE: SJS, toxic epidermal necrolysis, hypersensitivity syndrome, GI retinopathy, thrombocytopenia, acute renal failure
interx: alcohol (inhibits renal excretion of uric acid), ampicillin & amoxicillin (^ risk of skin rashes), warfarin (enhanced anticoagulant), thiazides/ACE Inhibitors (ototoxicity), high purine foods (decreases effectiveness)

Pathophysiology and Pharmacology 2 (27 decks)

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