Pharm > Week 6 > Flashcards

Week 6 Flashcards

(72 cards)

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1
Q

Complete Fracture

A

Broken all the way through

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2
Q

Incomplete Fracture

A

Closed/simple: skin is intact

Open/compound: skin is broken

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3
Q

Comminuted

A

Bone breaks into more than two fragments

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4
Q

Linear Fracture

A

Fracture runs parallel to the long axis of the bone

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5
Q

Oblique Fracture

A

Fracture of the shaft of the bone is slanted

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6
Q

Occult Fracture

A

Hidden, difficult to see

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7
Q

Pathologic Fracture

A

Caused by disease like tumor

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8
Q

Segmented Fracture

A

similar to comminuted fracture

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9
Q

Spiral Fracture

A

involves twisting motion, could indicate abuse

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10
Q

Transverse Fracture

A

across the shaft of the bone

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11
Q

Greenstick Fracture

A

Break in one cortex of the bone, not complete break

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12
Q

Impacted Fracture

A

one part of bone wedges into another part of bone

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13
Q

Stress Fracture

A

occurs over time with repeated use, “microfracture”

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14
Q

Torus Fracture

A

“buckle fracture” where it does not fully break

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15
Q

Colle’s Fracture

A

distal radius often from falling on an outstretched hand

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16
Q

Pott’s Fracture

A

common ankle fracture caused by trauma while foot is out, difficult to bear weight

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17
Q

Osteoblasts

A

Produce bone, respond to parathyroid hormone, produce osteocalcin (more bone production), express the cytokine receptor activator kappa-B ligand (RANKL) necessary for forming osteoclasts

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18
Q

Callus Formation

A

Hematoma - collection of blood cells (bruise)

Cell activation - network of fibers

Osteoblasts lengthen thee strand and deposit calcium

Callus formation, osteoclasts resorb old bone

Bone remodeling

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19
Q

Bone Fracture Phases

A

Inflammatory Phase - inflammatory response, hematoma forms

Repair phase - granulation tissue, osteoblasts form callus

Remodeling phase - unnecessary callus is resorbed, trabeculae formed

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20
Q

Dislocation

A

Bone temporarily displacement of bone from its joint (can be popped back into place)

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21
Q

Subluxation

A

Contact between bones in the joint is only partially lost “partial dislocation”

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22
Q

Strain

A

Tear or injury to a tendon (muscle to bone)

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23
Q

Sprain

A

Tear or injury to ligament (bone to bone)

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24
Q

Avulsion

A

Complete separation of a tendon or ligament from its bony attachment site

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25
Tendinitis
Inflammation of a tendon, fluid accumulation, difficulty of movement, swelling
26
Bursitis
Inflammation of a bursa (filled with synovial movement), caused by repeated trauma Septic: caused by a wound infection
27
Epicondylitis
Inflammation of a tendon where it attaches to a bone
28
Tennis Elbow
Lateral Epicondylitis
29
Golfer's Elbow
Medial Epicondylitis
30
Osteoporosis
Porous bone, poorly mineralized bone, low bone density, high risk for fracture but can be a silent disease caused by older age, hormonal changes (more common in women), meds, endocrine disorders, tobacco and ETOH, disease
31
RANKL and Osteoporosis
Estrogen stimulates osteoprotegerin (OPG), which blocks RANKL causing inhibition of bone resorption because RANK can't bind to RANKL
32
Osteoarthritis
Age-related disorder of synovial joints, inflammatory, loss of cartilage, sclerosis (hardening) of underlying bone, formation of bone spurs (osteophytes) Rheumatoid - bilateral and autoimmune
33
Ankylosing Spondylitis
Chronic inflammatory joint disease of spine or sacroiliac joints - stiffening and fusion from uncontrolled bone formation Hunched Posture Enthesis - ligaments, tendons, joint capsule inserted into the bone Unknown cause but strong association with human leukocyte antigen B27
34
Gout
Systemic disease that disrupts body control of uric acid (overproduction or decreased excretion) crystals deposit in connective tissue prolonged: gouty arthritis tophi: small, white visible nodules in subcutaneous tissue
35
Acute Gouty Arthritis
Constant gout flare-ups to tophi, then period of time where it gets better
36
Fibromylagia
Chronic widespread joint and muscle pain, fatigue, tender points, sleep disturbances dopamine dysregulation so disorder of pain regulation CNS dysfunction - amplified pain transmission and interpretation Vague symptoms - increased sensitivity, absence of inflammation
37
Pathophys of Gout
Biosynthesis of purines from meat or alcohol into xanthines then uric acid Filtered and reabsorbed in kidneys
38
Acute vs Chronic Gout
Infrequent (less than 2 times/year) flare-ups vs three or more times per year
39
indomethacin (Indocin)
NSAID - reversibly inhibits cyclooxygenase-1 and 2 (COX-1 and 2) enzymes which prevents prostaglandins from forming to reduce pain GI distress, nausea, vomiting Do not use other NSAIDs, avoid use in creatinine clearance, do not use with known peptic ulcer disease
40
COX 1 and 2 enzymes
Block platelet function, gastric protection, renal function while reducing pain
41
Colchicine
Gout specific Anti-mitotic/Antigout anti-inflammatory - inhibit B-tubulin polymerization into microtubules preventing migration of neutrophils nausea, vomiting, diarrhea concomitantly with NSAID or allopurinol ok, most effective during first 2 days of episode, avoid use in hep or renal disease, narrow therapeutic index
42
prednisone, cortisone, triamcinolone
Corticosteroid - decrease inflammation by suppression of migration of PMN leukocytes and reversal of increased cap permeability insomnia, anxiety, hyperglycemia, weight gain, adrenal suppression strict monitor of blood sugar and weight, avoid use in recent surgery with unhealed wounds, short term due to adrenal suppression with long term, give intraarticular (at joint) for less side effects
43
allopurinol (Aloprim)
SEVERE GOUT Xanthine Oxidase Inhibitor - lower serum uric acid levels through competitive inhibition of XO diarrhea, vomiting, nausea monitor liver enzymes, caution with renal impairment genetic consideration - increased risk of Allopurinol Hypersensitivity Syndrome (AHS), southeast asian and african ancestry, if rash or fever immediately stop giving med
44
Probenecid
SEVERE GOUT Uricosurics - increased excretion or urate by inhibiting protein transporter or urate (URAT-1) Urinary frequency, kidney stone formation, nausea, vomiting must educate on adequate fluid intake, not for acute gout episodes because it can worsen, not for use in patients with known kidney stones or CKD
45
Uricase
SEVERE GOUT Urate Oxidase Enzyme - converts uric acid to allantonin which can be easily excreted nausea, antibody development (rare) Not for use in heart failure patients, do not use with other uricosuric, can be used with NSAID or colchicine
46
Biphosphonates
Alendronate (Fosamax, ibandronate (Boniva) inhibit bone resorption by acting osteoclasts esophagitis, ocular inflammation, osteonecrosis of jaw Take of empty stomach with water because of low bioavailability, keep upright a minimum of 30 minutes after taking med because of ESOPHAGITIS, caution with renal failure, report any vision changes, eye pain, jaw pain
47
Raloxifene
Hormonal, Selective estrogen receptor modulator (SERM) - similar to estrogen and binds to estrogen receptor to help produce OPG hot flashes, increased risk of venous thrombosis (clotting) Educate on immobility and its risk because of deep vein thrombosis risk, not for high cardio risk
48
Teriparatide (Forteo)
Hormonal, analog of parathyroid hormone - stimulate osteoblasts increase risk of osteosarcoma (tumor), hypercalcemia no Paget disease (brittle bones) patients or history of cancer with radiation therapy
49
Sharp, fast pain fiber
A-delta myelinated fibers, nociceptor
50
Dull, aching, burning pain fiber
Unmyelinated C polymodal fibers, nociceptor
51
Perceptual dominance
feeling pain at one location increases threshold in another location
52
Acute Pain
new onset from tissue damage
53
Break-through pain
opioid use related and more extreme than chronic pain
54
Chronic Pain
3-6 months or beyond healing
55
Nociceptive pain
Somatic injury (tissue) Visceral pain (stretch receptors) that are poorly localized, dull, deep
56
Neuropathic Pain
Burning, shooting, shock-like, tingling abnormal neuronal activity secondary to disease, injury, dysfunction of the nervous system
57
OR throughout CNS
muu MOP
58
OR in dinecephalon, brain stem, spinal cord
Kappa (KOP)
59
OR in brain, spinal cord, digestive tract
Delta (DOP)
60
Drug Schedules
1 - most potential for abuse 5 - lowest potential for abuse
61
acetaminophen (Tylenol)
Non-opioid, antipyretic (reduces fever) very few adverse effects risk of liver failure
62
aspirin (ASA)
Non-opioid analgesic/anti-inflammatory/antipyretic/salicylate: Inhibit COX-1 and 2 enzymes which release prostaglandins thrombocytopenia, bleeding, gastric ulcers CARDIO PROTECTIVE PROPERTIES TO PREVENT HEART ATTACK AND STROKE caution with known peptic ulcer, monitor acute bleeding, don't use with NSAIDs
63
ibuprofen (Motrin)
NSAID, antipyretic: decrease prostaglandin synthesis through blocking COX enzyme nausea, vomiting, ulcerations, CV thrombotic avoid use in renal disease, may prolong bleeding, caution daily use >2 weeks, not for pregnant because it could close heart valve in fetus
64
naproxen (Naprosyn)
NSAID: inhibit COX 1 and 2 bleeding, ulcers, nausea, vomiting caution in renal disease, highly protein bound, prolong bleeding time, caution use >2 weeks
65
tramadol (Ultram)
Opioid analgesic: binds to mu receptors, inhibit reuptake of norepi and serotonin GI upset, constipation, dizziness, lethargy caution with bleeding, renal, hepatic disease, monitor renal and liver, avoid ETOH, monitor bowel and urine
66
morphine (MS Contin)
opioid receptor agonist: binds to mu and kappa to slow transmission of pain response respiratory depression, sedation, hypotension, nausea, vomiting, itching do not open or crush capsules, assess vitals, abuse risk, avoid ETOH, monitor bowel and urine
67
hydromorphone (Dilaudid)
Opioid analgesic: bind to opioid receptors in CNS respiratory depression, sedation, othro hypotension, nausea, vomiting, itching lower dose than morphine, moniotr abuse, avoid ETOH, monitor bowel and urine On Beers Criteria (not good for geriatrics)
68
fentanyl (Duragesic, Sublimaze, Fentora, Actiq)
anilidopiperidine opioid: bind to sites in CNS respiratory depression "frozen chest" if too quickly, ortho hypotension, nausea, vomiting, itching abuse risk, monitor vitals, mointor bowel and urine, dosed in mcg, remove old patch no more than one
69
hydrocodone with acetaminophen (Lortab, Norco, Vicodin)
Opioid analgesic: binds to opiate receptors in CNS respiratory depression, sedation, ortho hypotension, nausea, vomiting, itching lower dosage for naive or geriatric, administer with food or milk to decrease GI distress, VS, bowel and urine, abuse risk
70
codine (Tylenol #3 and #4)
opioid, antitussive: bind to OR and causes cough suppression respiratory depression, sedation, nausea, vomiting, itching abuse risk, monitor VS and LOC, monitor bowel and urine, Beers Criteria
71
buprenorphine (Buprenex, Butrans)
MIXED opioid agonist-antagonist (partial agonist): bind to mu as agonist and weak kappa antagonist (analgesic plateu at higher doses) to suppress opioid withdrawal respiratory depression, sedation, ortho hypotension, nausea, vomiting assess LFTs, monitor VS
72
naloxone (Narcan)
opioid receptor antagonist (competitive): interact with mu and kappa receptors reverse resp depression and other acute symptoms minimal toxicity, increased BP, tremors, nausea, vomiting, aggression monitor RR, keep resuscitative equipment accessible, will wake up in extreme pain, immediate symptoms of withdrawal
Pharm
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