Term
| What is a skeletal disorder characterized by compromised bone strength? |
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Definition
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|
Term
| what are 3 major risk factors for osteoporosis? |
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Definition
| adv. age, race, low weight/sm. frame, vitamin deficiency, nulliparity, certain diseases, postmenopause, fam. hist., cetain meds (corticosteroids, etc) |
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Term
| Define primary osteoporosis |
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Definition
| deterioration of bone mass NOT associated with another chronic illness |
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Term
| Define secondary osteoporosis |
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Definition
| osteoporosis resulting from chronic conditions that accelerate bone loss |
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Term
| What is the most widely used bone density measuring techniques? |
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Definition
| DEXA (dual energy x-ray absorptiometry |
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Term
| List three nonpharmacologic treatments that appear effective in preventing the progession of osteoporosis |
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Definition
Sufficiant calcium and vitamin D intake
Exercise
No tobacco
Reduced alcohol consumption
Fall reducing strategies |
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Term
| List some nonpharmacological options for VCFs |
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Definition
| phy therapy, ice massage, braces, vertebroplasty, kyphoplasty |
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Term
| Describe effect of HRT (Hormone Replacement Therapy) on osteoporosis |
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Definition
| Can prevent bone loss, but will not restore mass |
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Term
| Effect of HRT on postmenopausal symptoms? |
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Definition
| Relieves them (hot flashes & vaginal dryness) |
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Term
| Effect of HRT on osteoporotic fractures? |
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Definition
| Decreases the risk of fractures |
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Term
| What are the 5 pharmacologic classes used to treat VCFs: |
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Definition
| HRTs, SERMs, bisphosphonates, calcitonin, recombinant parathyroid hormone |
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Term
|
Definition
22% Increased Risk of CVD.
29% increased risk of coronary disease. |
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Term
| Name three types of HRT (Hormone Replacement Therapy) |
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Definition
| premarin, prempro, premphase, femHRTTM, CombiPatch, Activelle, OrthoPrefest. |
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Term
| How are SERMs diff from estrogen? |
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Definition
| mimics the effect in some tissues, but blocks it in others |
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Term
| What are the advantages of SERMs (Raloxifene)? |
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Definition
| effective @ preventing postmenopausal osteoporosis w/o causing increase in breast cancer risk - improves lipid profile |
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Term
| What are the disadvantages of SERMs (raloxifene)? |
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Definition
| shown to cause venous thrombosis, hot flashes and cramps |
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Term
| What SERMs are currently avail? |
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Definition
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Term
| How do bisphosphonates prevent bone resorption? |
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Definition
| bind permanently to mineralized bone surfaces and inhibit osteoclastic activity during resorption |
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Term
| Advantages of bisphosphonates? |
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Definition
| effective in prevention and treatment of osteoporosis - Fosamax approved for men |
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Term
| Disadvantages of bisphosphonates? |
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Definition
| abdominal and musculoskeletal pain, nausea, heartburn, and irritation of the esophagus. must also be taken on empty stomach |
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Term
| Name currently available bisphosphonates |
|
Definition
fosamax (alendronate)
zoledronic acid (reclast)
risedronate sodium (actonel) ibandronate (boniva) |
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Term
| How does calcitonin prevent bone resorption? |
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Definition
| increases levels of calcium and potassium in the bones and lowers the level of calcium in the blood |
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Term
| Advantages and disadvantages of calcitonin? |
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Definition
| reduces risk of new VCFs and occas. relieve VCF pain - minimal risks incl diarrhea and flushing |
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Term
| How does forteo (recombinant parathyroid) stimulate bone growth? |
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Definition
| can rebuild bone by stimulatings osteoblasts - is the only med that can do this; other osteo meds rely on anti-resorptive mechanism |
|
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Term
| what are the risk of Forteo? |
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Definition
| bone cancer and little long term data - as such Forteo is only recommended for a 2 yr max duration |
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Term
| subacute back pain is described as mild to moderate and can persist for how long? |
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Definition
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Term
| Acute pain after a VCF will often subside after how long? |
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Definition
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Term
| of women with VCFs, how many gave a hist. of pain severe enuf to require a medical consultation and xray? |
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Definition
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Term
| what 4 major categories of pain meds can be used to treat VCF pain? |
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Definition
1)Acetaminophen
2)NSAIDs (Nonsteroidal anti-inflamatory drugs
3)Prescription non-narcotic meds (cox2 inhibitors)
4)Narcotic pain meds |
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Term
| Mechanism of action of NSAIDs (Non-Steroidal anti-inflamatory drugs)? |
|
Definition
| inhibit cox 1 & 2 enzymes (cox 2 is almost entirely responsible for inflammation) |
|
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Term
| what is the most sig. risk with NSAIDs used over 2 mo? |
|
Definition
| peptic ulcers and gastric bleeding |
|
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Term
| T/F narcotic analgesics work indirectly on the central nervous system. |
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Definition
|
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Term
| What is one side effect of narcotic pain meds seen in elderly populations? |
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Definition
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|
Term
| List Three nonpharmacologic treatments for pain associated with vetebral compression fractures: |
|
Definition
Ice Massage
Kyphoplasy
Vertebroplasty
Exercise |
|
|
Term
Which of the following is information provided by the physical examination and patient history?
A) Presence of chronic conditions, behaviors, and level of physical fitness
B)Fracture History
C)Dowager's Hump
D)All of the above |
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Definition
|
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Term
| What is one substantial risk that motivated the FDA to require warning on lables of acetaminophen? |
|
Definition
| High risk of liver damage if taking acetaminophen and high alcohol intake. |
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Term
| What type of non-narcotic analgesic is likely to be prescribed to an elderly patient who has a history of gastric bleeding? |
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Definition
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Term
| What are the biggest advantages of narcotic pain medications in the treatment of patients with VCF's? |
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Definition
| Side effects can be less severe and less likely to occur than those of NSAIDs. Effective for even high levels of pain. |
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Term
| Name two examples of narcotic pain medication: |
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Definition
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Term
| T/F: DEXA can measure bone density in the spine, arm, leg, and total body. |
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Definition
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|
Term
| T/F: Osteoporosis is diagnosed when the T-Score is more than 2.5 standard deviations below the sex adjusted mean for normal young adults at peak bone mass OR the patient has a fragility fracture. |
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Definition
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Term
| T/F: It is currently not possible to reverse osteoporosis. |
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Definition
|
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Term
| T/F: Ultimately, half of all women and men will have a hip fracture. |
|
Definition
| False. 1\3 of women and 1\6 of men. |
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Term
| T/F: Osteopenia is not as clinically severe as osteoporosis. |
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Definition
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Term
| T/F: Typical osteoporotic fractures include fractures of the vertebra, forearm, wrist, and hip. |
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Definition
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|
Term
Which of the following is part of the downward spiral?
A)The VCF can put stress on the spine, which can predispose towards more fractures, which can, in turn exacerbate the initial fracture.
B)Increased Flexibility
C)Blood Loss |
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Definition
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|
Term
Which of the following are types of VCF's?
A)Crush Fractures
B)Wedge Fractures
C)Both A and B |
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Definition
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|
Term
Which of the following are risk factors for VCF's?
A)Age
B)Gender
C)Both A and B |
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Definition
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Term
Which of the following describes the risk factors of VCF's?
A)Common primarily in very active people?
B)Frequently the result of falls?
C)Similar to the risk factors of osteoporosis. |
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Definition
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Term
| VCF's impact patients, their families, and society through: |
|
Definition
Hospitalization
Cost of Illness
Quality of Life |
|
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Term
| T/F: The financial cost of VCF's includes medical care, loss of productivity, caregiver time, and lost activities of daily living. |
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Definition
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Term
| T/F: VCF's have little impact of the patients quality of life. |
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Definition
| False. VCF's decrease the patients QOL. |
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|
Term
Which of the following describes the physical consequences of VCF's?
A)Back pain, spinal deformity, and decreased lung capacity.
B)Increased Appetite
C)Forgetfulness |
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Definition
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Term
| T/F: The purpose of VCF treatment is to halt bone resorption, prevent subsequent fractures, lessen pain, and re-establish vertebral height. |
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Definition
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Term
| T/F: Pharmacological treatments for VCFs are distict from treatments used for osteoporosis. |
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Definition
| False. Pharmacological treatments are similar to that of osteoporosis. |
|
|
Term
| Nonpharmacological options for VCFs include: |
|
Definition
Physical Therapy
Ice Massage
Braces
Vertebroplasty
Kyphoplasty |
|
|
Term
| Of clincially manifested cases of back pain, about ____% are a consequence of VCFs. |
|
Definition
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Term
| T/F: Acetaminophen rarely has side effects, and has few contraindications and drug interactions. |
|
Definition
|
|
Term
| What is one substantial risk that motivated the FDA to require warning on labels of acetaminophen? |
|
Definition
| High risk of severe liver damage if taken by a person who drinks large amounts of alcohol. |
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Term
| T/F: Some antidepressant and anticonvulsant drugs are prescribed to help relieve some types of pain. |
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Definition
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Term
| Narcotic pain medications are benificial for _________(LOW or HIGH) levels of pain. |
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Definition
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|
Term
| Addiction to narcotic pain medication is ________(RARE or COMMON) among older adults. |
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Definition
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