Musculoskeletal Pharmacology Flashcards
(85 cards)
1
Q
Osteoarthritis
A
Progressive disease that can result in chronic pain, restricted range of motion, muscle weakness especially when a weight bearing joint is affected .
2
Q
What contributes to primary OA?
A
Primary OA is either idiopathic or related to age and hormone changes
3
Q
What contributes to secondary OA?
A
Secondary OA is formed by trauma, infection, or loss of synovial fluid in the affected joint
4
Q
Modifiable risk contributing to OA?
A
- Obesity ( either prior to diagnosis to OA or after
- Occupation with heavy weight lifting related to repetitive movements
- smoking
- Vitamin D Deficiency
5
Q
What are the non-modifiable risk factors leading to OA?
A
- Age
- Race
- Gender
- Genetics
6
Q
What Gender is more common for OA
A
women
7
Q
What race is more prone to OA
A
White and Native American
8
Q
What is the non-pharmalogical treatment for OA of the hand?
A
- Exercise
- Self management
- Thumb brace (CMC orthosis)
9
Q
What is the non-pharmalogical treatment for OA of the knee?
A
- Exercise
- Self Management
- Weight loss
- Tai Chi
- TF knee brace
10
Q
What is the non-pharmalogical treatment for OA of the hip?
A
- Exercise
- Self management
- Weight loss
- Tai Chi
- Cane
11
Q
What is the pharmacological treatment for OA of the hand?
A
Oral NSAIDS
12
Q
What is the pharmacological treatment for OA of the knee?
A
- NAIDS
- Topical NSAIDS
- Intra-articular glucocorticoid injections
13
Q
What is the pharmacological treatment for OA of the hip?
A
- NSAIDS
- Intra-articular glucocorticoid injections
- US guided intra-articular glucocorticoid injections
14
Q
First line treatment for OA?
A
Oral NSAIDS
15
Q
What are the risks associated with oral NSAID use?
A
GI bleeding and cardiac events
16
Q
Name the oral NSAIDs used in OA that can cause GI bleeding?
A
- aspirin
- Naproxen
- Ibprofen
17
Q
Name the oral NSAID used to in OA that can cause cardiac events?
A
Celecoxib
18
Q
What patient population with OA can you not give oral NSAIDS to?
A
- Cardiac
2. Renal
19
Q
What drug would you use to treat a patient with OA and renal disease?
A
Tramadol
20
Q
A nurse practitioner is prescribing a topical NSAID for OA of the knee, what is the topical agent called?
A
Diclofenac (Voltaren)
21
Q
The nurse practitioner knows that the black box warning for Diclofenac is..
A
Increased risk for cardiac events
22
Q
What is a topical agent used for OA made out of peppers?
A
Capsaican (Salonpas)
23
Q
Refractory agents used for OA
A
- Cymbalta
2. Glucorticosteriod injections
24
Q
What is Gout?
A
An inflammatory condition that results from monosodium urate crystals precipitating in the synovial fluid between joints due to hyperuricemia
25
What is the most common affected joint in a patient with Gout?
Big toe (metatarsophlangeal joint)
26
What other joints can gout affect?
1. ankles
2. knees
3. fingers
4. wrists
5. elbows
27
Risk factors for Gout?
1. obesity
2. Hypertension
3. Thiazide and loop diuretics
4. Alcohol
5. meats
6. aged cheeses
28
Teaching for patient with Gout
1. limit alcohol intake
2. limit purin intake
3. limit high fructose corn syrup
4. weight loss
5. Switch to alternative diuretics
6. Losartan as an anti-hypertensive drug
29
Indications for urate lowering therapy
1. one or more sq tophi
2. radiographic damage due to gout
3. gout inflammatory activity
- Frequent gout flare ups greater or equal to 2 flares a year
30
This class of medication increases excretion of uric acid by blocking reabsorption in the kidney
Uricosurics
31
Drugs classified as uricosurics
1. Probenecid (Probalan)
| 2. sulfinpyrazone (Anturane)
32
This class of drugs inhibits formation of uric acid
1. Allopurinol (lopurin, zyloprim)
| 2. febxostat (uloric)
33
This class of drugs converts uric acid into a less toxic form
1. Pegloticase (Krystexxa)
34
Black box warning for Febuxostat (Uloric)
Risk for cardiac events
35
How is pegloticase (krystexxa) administered?
IV
36
Adverse reactions when giving pegloticase?
1. Anaphylaxisis
37
To prevent adverse reactions from occurring when adminstering pegloticase (krystexxa) the provider should prescribe
1. Steroids
| 2. Antihistamines
38
This drug class inhibits phagocytosis of urate crystals
NSAIDs
39
Refractory agent used for gout
Colchicine
40
This medication has a CYP3A4 substrate and is classified as an anti-inflammatory that prevents the activation of neutrophils
Colchicine
41
Which drug can you not give to help a gout patient with pain and why?
Aspirin; Can inhibit excessive uric acid from being excreted from the tubule
42
What is the considered and preferred the first line medication for treating gout?
Allopurinol
43
Can allopurinol be given to patients with CKD?
yes they can receive this treatment up until stage 3 of CKD
44
Drug used for patients with CKD greater than 3
Probenicid
45
Provider considerations when starting a patient on medication for gout
1. Start with a low dose and titrate up to target
| 2. Use anti-inflammatory prophylaxis for 3-6 months and longer if persistent active anti-inflammatory disease
46
As providers treating patients with gout, the providers would like to see the serum uric acid level where?
below 6
47
What will the provider prescribe if a patient is having a gout flare?
1. Colchicine
2. NSAIDS
3. Glucocorticoids
48
What medication will a provider prescribe for gout when the patient is NPO?
glucocorticoids
49
When should a provider check a uric acid level after prescribing medication
3-6 months
50
Food and Beverages that can increase serum urate levels
1. Red meat
2. Organ meat: kidney, liver
3.Seafood: sardines and shellfish
4. High fructose corn syrup: soda and sport drinks
5. Alcohol: wine, beer, spirits
6, Aged cheese
51
Rheumatoid Arthritis
Chronic autoimmune inflammatory disease characterized by symmetric poly arthritis and joint changes, including erythema, effusion, and tenderness
52
Rheumatoid Arthritis affects what?
synovial tissue changes in the freely moveable joints
53
Key principles the provider uses when diagnosing and treating a patient with RA?
1. Focus on common clinical goal, not exceptional cases
2. Cost effectiveness
3. Assessment questionnaires for patients
4. If a patient has a low RA disease activity or is in clinical remission, switching from one therapy to another should be considered
54
Preferred drugs in treating RA
Disease modifying anti-rheumatic drugs
55
First line therapy for RA: Older class of DMARDS
1. Methotrexate
2. Sulfasalazine
3. Hydroxycholoriquine
4. Leflunomide
56
This drug breaks down folic acid which target proliferating cells and proliferating tissue
Methotrexate
57
Severe adverse reactions to methotrexate
1. Hepatotoxicity
| 2. Bone marrow suppression
58
What should a provider watch for when prescribing DMARDS?
Infection
59
This DMARD has a narrow therapeutic level and if it becomes to high it becomes toxic and to low it does not work
Methotrexate
60
Due to the MOA of methotrexate what should the provider consider prescribing along with the medication?
Folic Acid
61
Which DMARD is given to patients who can not tolerate methotrexate or NSAIDS
Sulfasalazine
62
What the adverse reaction the patient and provider should look out for when prescribed sulfasalazine
Skin Rash
63
Name a Target Stimulating Disease Modifying Anti-Arthritic drug
Tofacitinib (Xeljanz)
64
What class of drugs are used as second line therapy to treat RA after DMARDS and NSAIDS?
tsDMARDS
65
This drug is a JK inhibitor and helps inhibit activation of the immune response
Tofacitinib (Xeljanz)
66
Adverse effects of Xeljanz
1. TB
2. Fungal infections
3. lymphomas
4. Thrombosis
67
Considerations a provider may think about when prescribing DMARDS
renal adjustment for patients
68
When prescribing a DMARD what should the provider monitor?
1. CBC with Dif
2. Urine analysis; creatine, BUN
3. Serum bilirubin; liver enzymes
4. ESR
5. platelet study's
6. eye examinations
69
Progressive systemic disease characterized by a decrease in bone mass and microarchtectural deterioration of bone tissue, resulting in bone fragility and increased susceptibility to fractures
Osteoporosis
70
Daily dose of calcium for men
1 gram
71
Daily dose of calcium for women
1.2 grams women 50 years and older
72
Patient teaching about taking calcium supplements
1. Take throughout the day with vitamin D because the dose is so large not all of it will get absorbed if you take it at once
2. Alcohol, smoking, and caffeine interfere with bone growth and reabsorption so watch your intake
3. Everyone should get a screening for osteoporosis over 65 or after menopause
4. Medications like steroids decrease bone density
73
Risk Factors for osteoporosis
1. Female (older age asian or white)
2. Family history, petite stature or low body weight
3. Menopause or Amenorrhea
4. Sedentary lifestyle, low calcium intake
5. Excessive alcohol, smoking and caffeine intake
6. low testosterone in men
74
Diagnostic tool for osteoporosis
FRAX
75
First line therapy for treating osteoporosis
Bisphosphonates
76
This medication class decrease action of osteoblasts increasing bone density
bisphosphonates
77
Bisphosphonates
1. Alendronate
2. Risdronate
3. Ibandnate
4. Zoledronic acid
78
Adverse effect of bisphosphonates
bone necrosis
79
Who can be prescribed a bisphosphonate?
1. a patient who has to be able to sit or stand up for 30 minutes are taking this medication
80
If patients can not tolerate oral bisphosphonates they can receive the IV version once a year and it is called?
Zoledronic acid (Reclast)
81
Agents used to prevent or treat osteoporosis besides bisphosphonates
1. Selective Estrogen Receptor modulator: Raloxidine (Evista)
2. Rank Ligand Inhibitor: Densoumab (Prolia)
3. Calcitonin
4. Hormone modulators: Teriparatide
82
First line prevention for osteoporosis
1. Raloxidine
2. Alendronate
3. Ibandronate
4. Zoledronic acid
5. Risdronate with calcium and vitamin D
83
First line treatment of osteoporosis
1. Raloxidine
2. Alendronate
3. Ibandronate
4. Zoledronic acid
5. Calcitonin
84
Second line treatment for osteoporosis
add a hormone modifier to original medical treatment
85
Patient Education on Bisphosphonates
1. Should be taken with 8 oz of water before meals and the patient should remain upright for 30 minutes after administration
