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What are the most common sites for fractures related to osteoporosis?
Vertebrae, wrist and hip
What is the rate of bone loss per year for women afer age 50 and why?
2-3%/year due to menopause
What age do we start testing women at risk, lower risk, and men or osteoporosis?
60 at risk, 65 not ask risk, 70 men
What is the T-score range for osteopnea? Osteoarthritis?
- 1 - 2.5 = osteopnea (negative numbers)
- -2.5 or greater is osteoarthritis
What is the MOA for calcitonin-salmon?
Decreases activity of osteoclast which thereby decreases bone reabsorption and inhibits tubular resporption of calcium (increases renal excretion)
What is the major indication for Calcitonin-salmon?
Treats ESTABLISHED osteoporosis; does NOT prevent it
What class of drugs is Alendronate?
What is the MOA of Alendronate?
Incorporates into the bone and reduces activity of osteoclast, thereby reducing bone resporption.
What are the indications of Alendronate?
Treats and Prevents osteoporosis. Also used with men.
What is the most common side effect of Alendronate (and the nursing implication), what are other side effects?
- Esophagitis (so drink full glass of H20 and sit up for 30 minuttes afterwards)
- osteonecrosis of jaw, atrial fibrillation, ocuular issues,, musculoskeletal pain
How would you not give calcitonin-salmon to?
a person with fish allergy
Why are mycobacterium difficult to stain?
Mycolic acid outer coat.
What does AFB stand for and what should you think about when you see those initials?
Acid Fast Bacillus; think TB
What is the resistance of mycobacterium to antitibercular agents attributed to?
The slow growth of mycobacterium
What do MDR and XDR mean?
Multi-drug resistance; Extensively-drug resistant
What drug is the principle first line of defense for TB?
How is Isoniazid always used when treating active TB?
In combination to decrease resistance and suprainfection.
What are the two phases of treatment of TB?
- 1: Induction; eliminate actively dividing extracellular tubercle bacilli (2 months)
- 2: Continuation treatment; eliminate intracellular bacilli (4 months)
What is Isoniazid an analogue of?
Pyridoxine (Vit B)
What is the MOA of Isonazid?
Inhibits assembly of mycolic acids in cell wall of TB
What is the most serious side effect of Isoniazid? What three things increases the risk?
Hepatic Toxicity; increased risk with alcohol abuse, >65 y.o., and combination treatment with Rifampin.
What is the most common side effect of Isoniazid? Describe it. What do you do to counter-act it?
- Peripheral neuropathy; tingling, numbness in extremities
- Administer Pyridoxine (Vit. B6) supplement
Describe RA, when it is at its worse, and where it begins in the body.
- Symmetric joint stiffness and pain
- Worse in the morning
- Inflammation begins in the synovium (the membrane that encloses the joint cavity)
What does DMARD stand for?
Disease-modifying AntiRheumatic Drug
How does a DMARD differ from an NSAID
DMARDS treat symptoms and can stop progression of the disease, NSAIDS only treat symptoms. DMARDS can take weeks to months to start working. NSAIDS are drugs of choice for RA.
Discribe the two categories of DMARDS.
- Non-Biological: small molecules created through traditional chemial techniques
- Biological: large moleclules created through recombinant DNA technology
What is the main non-biological DMARD?
What are side effects of Methotrexate?
- Hepatic fibrosis
- Bone marrow suppression
- GI Ulceration
- Premature death due to cancers, infections, cardiac failure
What is the main contraindication for Methotrexate?
Preggers; it kills babies
What labs are associated with Methotrexate?
What is the major Biological DMARD?
What are some side effects of Infliximab?
- Infusion rxns (fever, chills, urticaria, chest pain)
- Heart failure
What is the major contraindication for Infliximab?
Heart failure pts
What is the MOA for Infliximab?
What are the labs associated with Infliximab use?
- Liver function
- TB test/X-ray (can leave ppl suseptable to TB)