Week 2 Flashcards
(171 cards)
1
Q
Scapula label
A
2
Q
Where is scapula connected to clavicle?
What does it form with clavicle?
A
Acromion
Shoulder gridle
3
Q
What is special about clavicle with respect to the development?
What is the orgin?
A
First long bone to ossify wk5-6 and last one to fuse 25 yo
membranous origin
4
Q
Two joints of clavicle
A
Sternoclavicular joint
Acromioclavicular joint
5
Q
What is one structure that connects arm to the axial skeleton?
A
Clavicle
6
Q
Label ligaments
A
7
Q
Where does the shoulder separation occur?
WHere does the shoulder dislocation occur?
Where does the clavicle break most often?
A
AC joint
glenohumeral joint
Middle/lateral thirds
8
Q
What is unusal about Strenoclavicular joint
What is the disc made of?
A
Two bursas separated by articular disc
Fibrocartilage
9
Q
Movements of the Sternoclavicular Joint
Axis? Movement
A
Vertical axis —– protraction/retraction
AP axis —– elevation/depression
Oblique axis —– medial/lateral rotation
10
Q
How much degree of abduction occurs at glenohumeral joint?
How much occurs at sternoclavicular joint?
What is the name of this movement?
A
120
60
scapulohumeral rhythm
11
Q
Movements of the Trapezius
Verical axis?
AP axis?
Oblique axis?
A
Retract
(Superior) elevates (Infectior) depresses
Rotate
12
Q
Trapezius Muscle
Nerve supply
A
Spinal accessory nerve (XI) Supplies motor
Cervical segments C3 & C4 Supply proprioceptive
13
Q
Latissimus Dorsi
Direction of movement?
Nerve supply?
Connects between?
A
Adduction / Extension
Thoracodorsal nerve (middle subscapular)
Thoracolumbar fascia to humerus
14
Q
Superficial (extrinsic) Back Muscles
Movement?
Nerve?
A
Medially rotate scapula
Dorsal Scapular nerve
15
Q
Levator scapula
Movement?
Nerve?
A
Elevates and medially rotates scapula
Dorsal Scapular
16
Q
Pectoralis Minor
Movememnts?
Nerve?
A
Medial Pectoral Nerve
Depresses, Protracts, Medially Rotates
17
Q
Serratus Anterior
Movement? Structural importance?
Innervation?
A
Depression, protraction, lateral rotation
Holding medial border of scapula close to ribs
Lorng Thoracic Nerve
18
Q
What is winging
A
Loss of serratus anterior function e.g. loss of the neve
19
Q
Muscles of the SC-joint
Protraction
Retraction?
Elevation?
Depression?
Medial rotation?
Lateral rotation?
A
20
Q
Movements of glenohumeral joint
A
Horizontal transverse axis —– flexion/extension
Horizontal AP axis —– abduction/adduction
Vertical axis —– rotation
21
Q
Structures protecting muscle around Glenohumeral joint
A
Subdeltoid bursa
Subacromial bursa
Biceps brachii tendon
22
Q
Pectoralis Major
Nerve?
Movement?
A
Medial and Lateral Pectoral
Flexion, Adduction, medial rotation
23
Q
Deltoid
Movement?
Innervation?
A
Axillary
Flexion: Anterior
Extension: Posterior
Abduction: Middle
Adduction: Posterior and Anterior
Medial Rotation: Anterior
Lateral Rotation: Posterior
24
Q
Teres Major
Innervation?
A
Middle Subscapular or thoracodorsal (Latissimus)
Lower Subscapular (Teres)
Extension
Adduction
Medial Rotation
25
SITS
Function?
Supraspinatus
Infraspinatus
Subscapularis
Teres Minor
Stabilization of glenohumeral joint
26
How medial vs. lateral rotation affects abduction?
External rotation of the humerus during flexion or abduction prevents the greater tubercle from hitting the acromion.
27
Name the rotator cuff
28
Glenohumeral joins all movements and muscles
29
Blood supply and nerves for
Supra/infraspinatus?
Teres minor?
Subscapularis?
Supra and infraspinatus- suprascapular nerve + artery
Teres minor –axillary nerve and post humeral circumflex artery
Subscapularis – upper and lower subscapulars + circumflex scapular art
30
Collateral Flow of glenohumeral
Dorsal scapular
Suprascapular artery
Posterior circumflex humeral artery
Circumflex scapular from subscapular artery
31
Bones
32
Bones
33
Axillary arteries
superior thoracic
thoracoacromial trunk
lateral thoracic
subscapular
circumflex scapular
- thoracodorsal
- posterior humeral circumflex
anterior humeral circumflex
34
What is axilla?
The space below the shoulder joint, bounded by the pectoralis major anteriorly, the latissimus dorsi posteriorly, the serratus anterior medially, and the humerus laterally.
35
Posteior wall of Axilla
Members?
Subscapularis
Teres major
Latissimus dorsi
Thoracodorsal artery + nerve (to latissimus dorsi)
Quadrangular space with axillary nerve and posterior circumflex humeral artery
Anterior circumflex humeral artery
36
Medial Wall of Axilla
what muscle is it?
Serratus anterior
Long thoracic nerve
Lateral thoracic artery
37
What part of brachial plexus passes through axilla?
Medial cord
Lateral cord
Posterior cord
38
Brachial plexus
Roots: C5-T1
Turnks: Upper, Medial Pattern
Divisions: Anteior Posterio
Cord: Lateral Medial Posterior
Branches: Ulnar, Radial, Musculocutaneous, Median, Axllary
39
General patters of innervations to hand
40
Innervations of anteior compartment of arm?
Innervation of posterior compartment of arm?
**Anterior compartment**
anterior arm-musculocutaneous
anterior forearm-all median except FCU+2 heads of FDP (ulnar)
anterior hand-all ulnar except thenar comp muscles + lumbricals to the functional midline on radial side (median)
**Posterior compartment**
shoulder-axillary (deltoid and teres minor)
posterior arm & forearm-radial
41
What are the branches from each cord?
**Lateral=**lat pec,
**Post=**upper, middle and lower subscapulars,
**Medial=**M. pectoral, M. brachial, M. antebrachial cutaneous
42
Two compartments of arm and their components
43
Components for compartment of arm
Biceps brachii
Long head
Short head
Coracobrachialis
Brachialis
44
Triceps 3 heads
45
Damage of Terminal Branches affecting the Arm
Axillary nerve?
Musculocutaneous nerve?
Radial nerve?
**Axillary nerve**-severely weakened abduction, weakened lateral rotation
**Musculocutaneous nerve**- almost no forearm flexion, weakened arm flexion
**Radial nerve**-no forearm extension, arm may be slightly flexed
(note also has major effect on forearm and hand, see later)
46
Three joints on hand
```
metacarpophalangeal (MP)
proximal interphalangeal (PIP)
distal interphalangeal (DIP)
```
47
What flexor acts on
distal interphalangeal joint?
proximal interphalangeal joint?
Flexor digitorum profundus - distal
Flexor digitorum superficialis - proximal
48
Structure that surrounds all ligments of the hand?
Retinaculum
49
Where does most of posterior muscles originate from?
Exceptions?
lateral epicondyle or the supracondylar ridge
The exceptions are the three thumb muscles, the extensor indices and the supinator
50
Posterior Forearm (Thumb Muscles)
Abductor pollicis longus (APL)
Extensor pollicis brevis (APB)
Extensor pollicis longus (EPL)
51
Anatomical Snuffbox
Contents
Radial artery
Base of 1st metacarpal
Styloid process of radius
Crossed by dorsal digital branches of radial nerve
52
Posterior Forearm Muscles
53
Posterior Forearm Muscles
54
Posterior forearm muscles that don’t cross the wrist
55
Pronators and Supinators of forearm
Pronator Quadratus
Pronator Teres
Supinator
Biceps
56
What is innervated by deep Radial Nerve?
Posterior forearm muscles except brachioradialis and the externsor carpi radialis longus ECRL
57
Which radius branch is motor?
Which radius branch is sensory?
Deep
Sensory
58
Hand innervations
59
Compartment Syndrome
60
Arteries of the arm
Brachial artery
Profunda brachii artery
Radial recurrent artery
Ulnar recurrent artery
Interosseous arteries
Radial
Ulnar
61
Where does the blood supply come from to thumb/index?
Where does the blood supply the rest finers?
Deep palmar arch
Superficial palmar arch
62
Connective tissue between radius and ulna
Intraosseus membrane
63
Arteries of the forearm
64
List five muscles in superficial layer of the anterior forearm
1. Pronator teres
2. Flexor carpi radialis
3. Palmaris longus
4. Flexor digitorum superficialis (hidden – intermediate layer)
5. Flexor carpi ulnaris
65
What attaches anterior foream superficial muscles?
Common flexor tendon
66
Deep muscle the the anterior forearm
67
What supplies deep anteiror forearm muscle group?
\* Except two heads of Flexor digitroum profundus (FDP)
Anterior interosseus branche of the median nerve
68
Wrist flexors
Flexor carpi radialis
Palmaris longus
Flexor carpi ulnaris
69
Finger flexors
Flexor digitorum superficialis
Flexor pollicis longus
70
Finger Flexors
71
Musculocutaneous Nerve
Motor branches (to ant arm muscles)
Cutaneous branch (lateral cutaneous nerve of forearm)
72
Median Nerve
Innervation?
forearm anterior compartment muscles except flexor carpi ulnaris and the medial two heads of FDP (unlar)
Muscular branches to thenar compartment and lumbricals to the 2nd and 3rd digits
Cutaneous innervation of hand (3 ½ digits in hand including dorsal distal phalanges )
73
Ulnar Nerve
Innervations?
Muscular branches to forearm and hand
Cutaneous branches to hand
**Forearm:**
it innervates 1 ½ muscles:
flexor carpi ulnaris &
half of flexor digitorum profundus
**Hand:**
it innervates all muscles except…
thenar compartment
half the lumbricals (first two on radial side)
**Cutaneous innervation**
1 ½ digits- note that the dorsal branch of the ulnar leaves much higher in the forearm and can be used in analysis of lesions
74
Radial Nerve in Arm
Radial nerve to posterior arm muscles
Posterior cutaneous nerve of forearm
**Motor innervation**
**Arm & Forearm:**
it innervates all muscles in the posterior compartment (note innervation of posterior interosseus branch)
**Cutaneous innervation**
2 brachial cutaneous nerves in arm
Posterior antebrachial to forearm
Superficial radial to hand 3 ½ digits on the posterior surface
75
What is rubor?
What is tumor?
What is calor?
What is dolor?
What is functio laesa?
Redness, swelling, heat, pain, loss of function
76
What cells mediate inflammation?
Macrophages, mast cells, dendritic cells (myeloid lineage)
77
What recognizes necrosis?
What to these cells produce?
Mast cells or macrophages (sentinel cells)
Release
78
Stimuli for inflammation
**Infections** (bacterial, viral, fungal, parasitic) and microbial toxins
Tissue **necrosis** : ischemia (MI), chemical thermal irradation injury, foregin bodies, hypoxia
**Hypersensitivity** or **immunopathology** chronic autoimmune, allergies
79
What triggers inflmmation in case of microoorganisms?
Pathogen-associated molecular pattenrs (PAMSs) binds to pattern recognition receptors (PRR)
80
Two types of PRR
Toll-Like Receptors
Other receptors (dectin)
81
What triggers inflmmation in case of damaged tissue?
damage-associated molecular patterns (DAMPs) aka alarmis (HMGB1-1, S100A8/A9, ATP)
82
Side effect of inflammatory response (general name)?
Collateral damage
83
What is scarring?
Filling of the defect tissue with firbous tissue
84
Acute vs. Chronic inflammation
ACUTE: Rapid onset (minutes) and short duration
CHRONIC: follow acute inflammation or insidious (slow) onset
85
What is half life of neutrophil?
Short
86
What releses TNF-a tumor necrosis factor?
What is the target for TNF
Macrophage
Endothelium (dilatation)
87
What are the initial effect of actute inflammation on endothelium?
Vasodilation
Increase vascular permeability
Recruitment, adhesion, transmigration
Chemotaxis
Phagocytosis
88
What is immediate effect on blood vessels during injury? What follows after?
What is mediators of vasodilatation?
Result of dilatation of blood flow?
Vasoconstriction, vasodilation
Histamine and nitric oxide
Greater but slower blood flow (stasis)
89
What causes vascular leakage?
How long does it last?
What can cause damage to endothelium?
Histamine and leukotrienes
15-30 min
Severe injuries, microbes, neutrophils migrating
90
What is transudate?
What is exudate
Fluid with no cells (low protein content)
Fluid with cells (high protein concentrations)
91
Inflammation of lymphatics?
Inflammation of lymph nodes?
Lymphangitis
Lymphadenitis
92
What is the red streaks near a sking would is a clinical sing of?
Infection in the wound (streak follows lymphatic channels)
93
What produces chemokines? Example? What are they?
Molecules that recurit cells to site of injury, Macrophages, CXCL8
94
Extravasation steps
Margination, rolling, and adhesion
95
Four groups of adhesion molecules?
Where are they expressed?
selectins, vascular addressins, integrins, and immunoglobulin superfamily
Activated on endothelium
96
What blood vessels allow migration of white blood cells?
What is the name of the molecule that initially grabs WBCs?
Where are adhesion molecules present? Function?
What do leukocytes secrete to enter extravascular tissue?
Veins
Selectins
Migration of leukocytes (CD31/PECAM-1)
Collagenases
97
Examples of chemoattractants
Chemokines CXCL8
Complement system C5a
Leukotrienes LTB4
Bacterial origin N-formylmethionine terminal amino acid and some lipids
98
Steps of phagocytosis
Recognition and attachement
Engulfment of the particle into a phagosome
Fusion of the phagosome with th lysosome to from phagolysosome
99
NADPH oxidase
complex of **proteins** that assembles at the **phagolysosome** **membrane** and generates a hostile microenvironment that leads to **killing** and degradation of ingested materials
100
Pattern of actue inflammation:
Serous inflammation
Fibrinous inflammation
Purulent inflamation
**Seruous:** Exudation of cell-poor fluid into spaces created by cell injury (peritoneum, pleura, or pericardium)
**Fibrinous**: inflammation develops when vascular leaks are large or there is a local procoagulant stimulus
**Purulent** inflammation is characterized by the production of pus, an exudate consisting of neutrophils, the liquefied debris of necrotic cells, and edema fluid (abscesses)
101
Outcomes of acute inflamation
Resolution
Fibrosis
Chronic inflammation
102
Histopathology
Characteristic of acute inflammation
Chracterstics of chronic inflammation
Neutrophilic
Monocytic
103
What occurs when connective tissue replaces the old tissue?
Fibrosis and angiogenesis
104
What can cause chronic inflammation?
Pathogens such as mycobacteria (hard to eradicate)
Delayed-type hypersensitivity
Autoimmune diseases (rheumatoid arthiritis and multiple sclerosis), Allergic disease (asthma)
Exposure to toxic exogenous (particulate silica and silicosis) or endogenous (plasma lipids and atherosclerosis)
105
Tuberculous Granuloma
histopathology
Epitheloid cells and multi-nucleated giant cells
106
What is the most potent macrophage activator?
INFg
107
What stiumlates differentiation of macrophage
INFg and microbes to classical activation M1 inflammatory
IL13 and IL4 to alternative acitvation M2 anti-inflammatory (repair)
= balance
108
What is stimulated by cytokines TNFa and IL1 in hypothalamus?
What are cytokines?
Prostaglandins
Stimulate production of leukocytes from precurosrs in bone marrow
109
Examples of mediators intracellular granules?
Examples of signalling synthesized de novo?
Histamine
Prostaglandins, cytokines
110
What causes mast cell degranulation
Physical injurt (trauma, thermal)
Antibodies binding to mast cells (allergic reactions)
Complement anaphylatoxins (C3a C5a)
Cytokines (IL-1, CXCL8)
111
What molecules can be released from membrane to initiate inflamation? Enzyme?
Derivatives synthesized by? What molecules are synthesized?
Arachidonic acid (AA), phospholipase A2
Cycloocygenases (prostaglandins and thromboxanes) and lipoxygenases (leukotrienes and lipoxins)
112
Platelet activating factor
Importance?
Source?
Vasodilator with potency from 100 to 10000 times greater of histamine
Many cells: platelets, basophils, basophils, mast cell, neutrophils, macrophages, and endothelial cells
113
Derivative of NO
Enzymes in macrophages that produces NO
Peroxynitrite
Nitric oxide synthetase (iNOS)
114
What are examples of proinflammatory cytokines? Maily produced by?
TNF-a, IL-1, and IL-3
115
What synthesizes Arachidonic Acid?
Enzymes that catalyze Arachidonic acids?
Phospholipase A
Cytochrome p450 - epoxyeiocosatrienoic acids (vary)
Lipoxygenases - Leukotrienes, Lipoxins (phagocytosis, permiability)
Cyclooxygenases - Prostaglandins, Prostacyclins, Thromboxane (inflammation)
116
COX-1 functions
COX-2 functions
**COX-1 functions (physiological)**
Platelet function
GI Mucosal Integrity
Renal function
**COX-2 functions (inflammation)**
Inflammation
Pain
Fever
117
What are the effects of prostaglandins on pain?
Side effect of subudral injections of PGE1 with bradykinin/histamine?
They sensitize (hyperagesia)
Headache and pain
118
Examples of pyrogens secreted by neutrophils
cytokines such as interleukin-1 (IL-1), interleukin-6 (IL-6), interferons, and tumor necrosis factor-α (TNF-α)
119
What is the initial thermoregulatory response mediated by?
What regulates late response?
What suppresses PGE2 synthesis?
Prostaglandins and ceramide release in preoptic area in anterior hypothalamus = elevation of set point = fever
Coordinate induction of COX-2 and microsomal PGE synthase-1 (mPGES-1). Formation of PGE2. PGE2 corsses BBB acts on EP3 & EP1 receptors on thermosensitive neuros =\> hypothalamus elvates temperature and decrease heat loss.
NSAIDs
120
What molecules inhibit
121
What molecules inhibits inflammatory mediators?
5-LOX inhibitors and leukotriene receptor antagonists (Zafirlukast, zileuton)
Corticosteroid (Predinisone, Dexamethasone)
NSAIDs
122
Mechanism of Aspirin
Type of inhibition? Mechanism?
Downstream results?
Used for what condition?
Contraindicated to what patients?
Covalent modification (irreverisble inhibition) both COX-1 and COX-2 at serine-530 = acetylation
Results in steric block preventing arachidonic acid binding
\* COX-2 retains activity but ptorudces different products
Suppressing platelet adhesion and aggregation
Antiplatelet agent for acute ischemic stroke and prevention of stroke
Platelates disorder, pregnancy (postpartum hemmorage, closing fetal ductus arteriosus)
123
Action of aspirin with varying concentrations
124
Uses of aspirin
* *1.Fever**
* *2.Pain** (mild-to-moderate, such as headache, muscle pain, joint pain, postoperative pain, migraine, etc.)
* *3.Rheumatic fever**
* *4.Inflammatory diseases**, such as rheumatoid arthritis, pericarditis, and Kawasaki disease.
* *5**.Lower doses of aspirin have also shown to **reduce** the risk of death from a **heart attack,** or the risk of stroke in some circumstances.
125
pKa of Aspirin
Effect of low pH?
Effect of high pH?
3.5
low pH = favors absorption
high pH = favors excretion
126
What metabolizes and what are the metabolites of Aspirin?
urine as free salicylic acid (10%), salicyluric acid (75%), salicylic phenolic (10%) and acyl (5%) glucuronides and gentisic acid (\<1%)
127
Drug interactions
Heparin
Antiacids
Probenecid, Sulfinpyrazone
Bilirubin, Phenytoin, Naproxen, Thyroxine
Hemmorage
Reduced rate of absorption
Decreased urate excretion
Increased plasma concentration
128
Adverse effects of Aspirin
**Gastrointestinal symptoms (inhibition of COX-1), most common**
Gastric mucosal lesions, nausea, and vomiting. Possibly hemorrhage, peptic ulcers, perfoations
**Allergic reactions (Hypersnesitivity)**
Bronchospasms, rhinitism, conjunctivits
**Hematologic effects (****Antiplatelet)**
Increased blood fibrinolytic activity, thrombocytopenia
**Metabolic acidosis**
Respiratory alkalosis
**CNS**
Tinnitus via arachidonic acid and NMDA cascade
**Renal damge**
Reduction on GFR (inhibition of prostaglandins)
**Reye's sydrome - severe heptic damage (fatty liver) and encephalopathy**
129
What is Salicylism?
Dose?
Symptoms adults? Children?
Treatment?
Overdose of aspirin / Poisoning
5g/day of aspirin or salicylate
Adults: tinnitus, children: acidosis and hyperventillation
NaHCO3 (prevent uptake) IV, correction of acid-base disturbance, electrolyte replacement, cooling, forced diuresis
130
Contraindication of aspirin
Gastrointestinal?
Circulatory?
Immune?
Respiratory?
Children?
Stomach bleeding, peptid ulcers, gastritis
Hemophilia, bleeding
Allergic
Asthma or NSAID bronchospasm
Kidney disease, hyperuricemia, or gout
Reye's syndrome (cold or influenza symptoms)
131
5 COX-2 selective inhibitors
Celecoxib
Valdecoxib
Rofecoxib
Etoricoxib
Lumiracoxib
132
Families of NSAIDs
133
Ibuprofen
Examples?
Type? Function?
Application?
**Advil**, Motrin, Motrin IB, Nuprin
Strong antipyretic, analgestic, and anti-inflammatory
Mild antiplatelet
Vasoconstriction (hypertension)
Fever, inflammation, headach, menstul, pain, toothache, pack pain, arthitis, minor injuries
134
Naproxen
Example?
Clinical application?
Other effects?
Aleve
Pain, fever, inflammation, stiffness
Anti-virial effects
135
Indomethacin
Example?
Applications?
Long term use?
Indocin
**Ankylosing spondylitis**
**Reiter syndrome **(reactive arthritis due to bacterial infection in intestine, genitals, or urinary tracts)
**Acute gouty arthritis**
**Closure ductous arteriosus**
**NO LONG TERM USE - SEVERE ADVERSE EFFECTS**
Bleeding, ulcerations (need low doses + anti ulcer drug)
Life-threatening shock
Severe or lethal hepatitis and severe bone marrow damage
136
Piroxicam
Example?
Half-life?
Side effects?
Feldene, Fexicam
t1/2 = 45h = long acting anti-inflammatory and analgestic
Bleeding and ulceration
137
Meloxicam
Example?
Specificity?
Mobic
Low dose: COX-2\>COX-1
138
Acetaminophen
Examples?
Lack of what?
Asthma, Reye?
Side effects?
Treatment of toxicity?
(Tylenol, APAP)
Anti-inflammatory effects
OK with those diseases
Liver toxicity (4g/day)
N-acetyl cysteine to replenish gluathione
139
Mechanisms of action of NSAIDs
Anti-inflmmatory effect
Analgesic effect
Antipyretic effect
Aspirin irreversible inactivation of COX1/2. Other NSAID reverisble.
Inhibition of prostaglandin production.
Inhibition of prostaglandins incuded by IL1/IL2, resetting thermoregulatory system (vasodilation
140
Therapeutic effects of NSAIDs
141
How long does it take for anti-inflammatory effects to develop?
Even after several weeks
142
NSAIDs vs. glucocorditoicds (anti-inflammation)
Effect?
Clinical usage
Side effects?
143
NSAIDs vs. glucocorditoicds (Analgesia)
What do they alleviate? More effective with?
Effects?
Clinical use?
Side effects?
Headache, Myalgia, Neuralgia, Postoperative pain, Dysmenorrhea.
Integumental structures
144
NSAIDs vs. glucocorditoicds (Anti-pyresis)
Use?
Effects
Clinical usage
Side effects
Elevated body temperature
Viral infection (influenza and chickenpox) in children and adolescents Reye's syndome
145
Adverse effects of NSAIDs and tretments
**Gastrointestinal** (ulceration, gastric bleeding, anemia, shock) treatment with antiacids. Prostaglandin introduction PGE2 to reduce damage (cyctoprotective effect of PGE2). Time-release, nonacetylated use, with food.
**Hypersensitivity** anaphylactic reaction with hock, cross-hypersensitivity
**Analgestic Abuse Nepropaht** regulation renal blood flow
146
COX-2 Selective Drugs
What drug?
Stomach?
Celecoxib (only selective COX-2 inhibitor)
**Specifically inhibition of COX-2** would reduce the inflammatory response and pain but not inhibit the cytoprotective action of prostaglandins in the stomach, which is largely mediated by COX-1.
147
What COX-2 have been removed from the market?
Rofecoxib (Vioxx) and valdecoxib
Increase heart attack and stroke
148
Drugs to treat gout
**Relieve inflammation pain** (nonsalicylate NSAIDs, **colchicine**, glucocorticoids)
**To prevent inflammatory responses to crystals** (colchicine and NSAIDs)
**To inhibit urate formation** (allopurinol) or to augment urate excretion (probenecid)
149
Colchicine
Use?
Mechanism?
Adverse affects?
Liver damage?
Inflammation and pain relief in acute gouty arthritis
Prevent polymerization of tubulin into microtubules (prevents leukcyte migration and phagocytosis), inhibit cell mitosis
Diarrhea
Rare at higher doses
150
Probenecid (Benemid) and Sulfinpyrazone (Anturane)
Mechanism?
When used?
Side effects?
prevent reabsorption of uric acid.
used for chronic gout, often in combination with colchicine.
Urolithiasis (formation of urate stomes), GI distrubances, dermatitis,
151
Allopurinol (Zyloprim)
Mechanism?
Side effects?
Liver damage?
Allopurinol inhibits the synthesis of uric acid by inhibiting xanthine oxidase
GI distrubances, dermatitis
Yes!
152
Treatment of acute gout?
Acute gout is treated with Nonsalicylate NSAIDs (indomethacin, naproxen, and sulindac). + no diaraha
Chronic gout is treated with uricosuric agents (probenecid, sulfinpyrazone) or allopurinol
153
DMARDs
What are they?
Examples?
Disease-modifying antiarthritic drugs (DMARDs)
A category of otherwise unrelated drugs defined by their use in rheumatoid arthritis to slow down disease progression.
Azathioprine (Purine synthesis inhibitor)
Ciclosporin (Cyclosporin A) calcineurin inhibitor
Methotrexate (MTX) Purine metabolism inhibitor
Leflunomide Pyrimidine synthesis inhibitor
Anti-TNF- a Drugs
154
3 stages of recovery
.Resuscitative or Critical Stage
Acute Stage
Long Term Rehabilitation Stage
155
Resuscitative or Critical Stage
Psychological characteristics?
Treatment?
Stressors (over/understimulation), congitive challenges (drownsiness, confusion, disorientation), delurium, intubation limit communication, pain, sleep disturbance, family anxious
physical survival, coping skills & defense mechanism, manage pain, comfort, educate family
156
Acute Stage
Psychological characteristics?
Treatment?
Start to understand impact, guilt, anger, grief, loss of faith, depression, anxiety, sleep dissturbance, premorbid psychopathology, ASD/PTSD
Psychoeducation: symptoms resolve on their own, ASD not always turn into PTSD, psychotherapy, pain management, coping \> avoidance, drugs (sleep, depression, anxiety, pain) social support, premorbid psychpathology after discharge
157
ASD vs. PTDS
Both cause by trauma
2d-4w vs. More than a month
158
Long Term Rehabilitation
Psychological characteristics?
Treatment?
"SCARED" response, adjusting, physical changes, depression, anxiety, grief, PTSD, identitiy, work, finance, family, roles, sexual dysfunction, social withdrawal/support
outpatient psychotherapy, social skills, prepare for community, social support, improve self-esteem, vocational rehabilitation, premorbid psychoapthology
159
Long term effects on burn
Pediatric adjust well
Aggressiveness
Anxiety
Disturbed self-esteem
Depression
PTSD symptoms
Mother effect on child
Greater difficulty with adjustement if exposed surfaces
Younger better than older
Best predictor amount of function, then location of burn
Half have to change work
2 year
160
4 cell adaptations?
What is dysplasia?
hypertrophy, atrophy, hyperplasia and metaplasia
epithelial anomaly of growth and differentiation
161
Rotator Cuff Injury
Symptoms?
Causes?
Risk Factors?
Tenderness (especailly when reaching), weakness, loss of range of moition, keeping inactive
Tendinitis (overuse and overload), bursitis (irritationm iflammation, attrition of supraspinatus)
40yo+, althele, construction worker, poor posture & weak shoulder muscle
162
Rotator Cuff Impingement Syndrome
Tendons become entrapped under the acromion: compression, injury, rotator cuff tendonitis
163
liquefactive necrosis
necrosis which results in a transformation of the tissue into a liquid viscous mass
164
What occurs during necrosis?
[Na+] up
[Ca++] up
Lactic acid up
Inorganic PO4 up
165
What moves stuff into mitochondria
High conductance pores
166
Examples of oxygen reactive species
O2\*-, H2O2, OH\*
167
Functions of macrophages
168
Stages of wound healing
Injury
Coagulation
Inflammation
Proliferation
Remodeling
169
Granulation tissue
New connective tissue and tiny blood vessels that form on the surfaces of a wound during the healing process
170
Two types of angiogenesis
From pre-existing vessels
From EPCs from the bone marrow
171
primary and secondary intention
