Term
| what vitamins can be toxic because they build up in the body while other vitamins are water soluble and not stored? |
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Definition
|
|
Term
|
Definition
|
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Term
|
Definition
| Fe Zn I Se Mn Mo F Cu Cr Co B |
|
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Term
|
Definition
aresenic
aluminum
tin
nickel
vanadium
silicon |
|
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Term
| what is bad in regards to drug disposition with vitamins? |
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Definition
|
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Term
| example of absorption w/vitamins |
|
Definition
Alendronate (fosamax)
negligible if taken with food and reduced by 60% if taken with coffee or orange juice |
|
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Term
| distribution of vitamins: inadequate protein intake as Warfarin is ____ and phenytoin is ____ protein bound. low albumin level in especially elderly may cause excessing bleeding and toxic levels of phenytoin. |
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Definition
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Term
| foods can both inhibit and enhance the METABOLISM of drugs by altering the ______ _____. example? |
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Definition
enzyme system
- diet high in protein/low in carbs can increase the hepatic metabolism of theophylline
- grapefruits can inhibit the intestinal metabolism of CCB and can last up to 72 hours |
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Term
| what can alter reabsorption of drugs from the renal tubule by altering the pH? |
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Definition
| food and nutrients (milk, most fruits, and juices) |
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Term
| loop diuretics (Furosemide or Bumetanide) ___ the excretion of potassium but also _____ Mg, Na, Cl, and Ca |
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Definition
|
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Term
| high dose of diuretics and low sodium diets can lead to ____ especially in older pts and lead to mental confusion |
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Definition
|
|
Term
| thiazide diuretics ____ the excretion of K & Mg but ____ Ca |
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Definition
|
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Term
| K sparing diuretics (Spironalactone or Triameterene) ___ excretion of Na, Cl, and Ca. what can happen with this> |
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Definition
increase
blood levels of K can rise to dangerous levels if they take K supplements or suffer from renal insufficiency |
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Term
| ACE inhibitors (Enalapril or Fosinopril) ____ K. so use of an ACE & K sparing diuretic ____ the danger of hyperkalemia |
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Definition
|
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Term
| long term corticosteroids (prednisone) can __ Na excretion that leads to water and Na retention so what is recommended? |
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Definition
decrease
Ca and vit D recommended |
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Term
| drugs that alter taste or smell of food (2) |
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Definition
|
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Term
| sympathomimetics tx for obesity |
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Definition
| phentermine (alters taste/smell of food!) |
|
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Term
| are vitamins an energy source? |
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Definition
|
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Term
| what are catalysts in the body? |
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Definition
|
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Term
| ____ are inorganic (dont have carbon) are are "catalysts catalysts" |
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Definition
|
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Term
| at what are are men considered at risk for osteoporosis? |
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Definition
|
|
Term
| _____ is needed by all women of reproductive age. recommended 400 micrograms/day |
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Definition
|
|
Term
| bone lose increases ____ years post menopause |
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Definition
|
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Term
| at what age does Ca decrease and we need supplementation? |
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Definition
|
|
Term
| do antioxidants confer health benefits? |
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Definition
|
|
Term
| what has a possible increased mortality with a very high dose? |
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Definition
|
|
Term
| where do you need exposure to UV lights for vit D? |
|
Definition
|
|
Term
| what vitamin do you not have to worry about toxicity with? |
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Definition
|
|
Term
| increasing vitamin ___ is bad and increases morbidity |
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Definition
|
|
Term
| what vitamins are inversely proportional? |
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Definition
Na and K
Ca and Phosphorus |
|
|
Term
| older than ___ yo with poor Ca absorption are at ____ risk for type 2 osteoporosis |
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Definition
|
|
Term
| women ____ or older and postmenopausal or have been on ___ for a long time are at increased risk for osteoporosis |
|
Definition
65
HRT (hormone replacement therapy) |
|
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Term
| patients with RA are at increased risk for what |
|
Definition
|
|
Term
| what is currently the 1st line tx for osteoporosis? examples? when should they take it? |
|
Definition
Bisphosphonates
alendronate (Fosamax)
risedronate (actonel)
ilbandronate (boniva)
- taken on an EMPTY stomach and pt must sit for 1/2 hour |
|
|
Term
| what is the only selective estrogen receptor modulator (SERM) that is used to tx OA? what does it do? |
|
Definition
Raloxifene (evista)
reduces resorption of bone and decreases overall bone turnover |
|
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Term
| alert that __, ___, ___ containing medicine (antacids) may interfere with absorption of bisphosphonates so avoid for 2 hours (tx for OA) |
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Definition
|
|
Term
| most people with gout have reduced _____ clearance |
|
Definition
|
|
Term
|
Definition
| pruine metabolism abnormalities : (PRPP, HGPRT) |
|
|
Term
|
Definition
- When uric acid reaches high levels in the blood it crystalizes and forms insoluble precipitates.
- These crystals can aggregate in the joints and cause inflammation. |
|
|
Term
| what is tophi? what does it look like? |
|
Definition
deposits of monosodium urate crystals
white nodules |
|
|
Term
| ____ are 1000x more prevalent in pts with gout |
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Definition
|
|
Term
acute tx for gout?
chronic? |
|
Definition
Cochicine
Allopurinol (aloprim, zyolprim) |
|
|
Term
| ___ for gout prevents proliferation and migration of leucocytes and STOPS INFLAMMATION (stops the pain) |
|
Definition
|
|
Term
| what replaced Colchicine bc of GI upsets? what is commonly used? |
|
Definition
|
|
Term
| Colchicine has been pulled off the market in its generic form. the brand ___ is the only colchicine available now so increased cost. what are the adverse effects? |
|
Definition
Cocrys
***diarrhea, abdominal cramps, nausea, vomiting
Rarely: bone marrow suppression, neuropathy and myopathy |
|
|
Term
| uricosuric agents ______ and _______ effect ion exchangers in the renal tubules to inhibit reabsorption of uric acid by the kidneys |
|
Definition
| Probenecid, Sulfinpyrazone |
|
|
Term
| cautions with uricosuric agents? how can we prevent this? |
|
Definition
- Excess uric acid secretion may predispose patients to stone formation
- Maintain fluids and high urine output
Alkalinize urine [>6.0] to enhance solubility of uric acid |
|
|
Term
| secretion of other weak acids (penicillin) may be inhibited by what agents? |
|
Definition
Uricosuric
- Probenecid was originally developed to prolong penicillin blood levels |
|
|
Term
| what is the 1st new gout drug in 40 years? its potent and selective inhibitor of xanthine oxidase |
|
Definition
|
|
Term
| what drug for gout is used prophylactically like allopurinol? |
|
Definition
|
|
Term
|
Definition
NSAIDs -- Indomethacin MC
- or Naproxen (Aleve) -- prescription strength of 500 mg |
|
|
Term
| gout management strategies |
|
Definition
1. reduce uric acid levels -- nhibit uric acid production by xanthine oxidase (allopurinol, febuxostat)
Promote uric acid excretion by kidneys (uricosurics - probenacid)
2. Stop inflammatory cascade
NSAIDS (naproxen, indomethacin, NOT aspirin)
Colchicine - antimicrotubular agent that prevents proliferation and migration of leucocytes
Corticosteroids |
|
|
Term
| Currently believed that RA is triggered by a combination of _______ |
|
Definition
| genetic, environmental, hormonal, and reproductive factors |
|
|
Term
|
Definition
|
|
Term
| 80% of people with RA are positive for ______ |
|
Definition
|
|
Term
comparison of OA and RA:
- duration of pain
- joint location
- labs |
|
Definition
- OA: <30 mins, RA: >30 mins
- OA: DIP, PIP, hips (may be asymmetrical), RA: PIP, MCP, wrist, elbow, MTP (symmetrical)
- OA: no change in ESR, RA: inc ESR |
|
|
Term
A patient has RA if at least 4 of these criteria are satisfied.
Criteria 1-4 must have been present for at least 6 weeks |
|
Definition
morning stiffness
arthritis of 3+ joints
arthritis of hands
symmetric arthritis
rheumatoid nodules
serum rheumatoid factors
radiographic changes |
|
|
Term
| examples of NSAIDs for RA |
|
Definition
Celebrex
ASA
- short onset of action |
|
|
Term
|
Definition
Examples: Aspirin, Celebrex (COX-2 Inhibitor), Naproxen, Ibuprofen (tolerate, cost, frequency)
Voltaren Gel (diclofenac topical) – can be rubbed on hands or other affected joint |
|
|
Term
| what is most often selected as initial therapy for RA due to ability to induce a long-term response |
|
Definition
|
|
Term
Adverse effects of low-dose MTX in patients with RA are related to what?
so what is typically added to this therapy? |
|
Definition
folate antagonism and/or folate deficiency
- folic acid
**birth control must be used!! |
|
|
Term
| what RA tx has a side effect of liver toxicity and the patients must used effective contraception (X) |
|
Definition
|
|
Term
| Useful in early RA or in patients *who have failed other DMARDs (disease Modifying Antirheumatic Drugs) |
|
Definition
|
|
Term
| what RA tx must be used in combo with MTX? |
|
Definition
|
|
Term
| dosing rule in regards to Anakinra (tx for RA) |
|
Definition
| Reduce dose(100 mg QOD in severe impairment) |
|
|
Term
| what should you start with for RA tx in mild disease? |
|
Definition
| Start with NSAIDS or glucocorticoids in mild disease then use as adjunctive therapy |
|
|
Term
| what should you start asap with RA tx? |
|
Definition
| Get DMARD on board ASAP (within 3 months of diagnosis) |
|
|
Term
| what is the last alternative for RA tx? |
|
Definition
|
|
Term
| what is the most common joint disease and is "wear and tear" |
|
Definition
OA
more common in athletes |
|
|
Term
| 0-90% of people (male and female) have evidence of _______ by the time they reach age 65 |
|
Definition
|
|
Term
| in OA, when does inflammation occur? |
|
Definition
secondary to joint damage!
leads to erosion of articular cartilage |
|
|
Term
| is OA systemic? what is involved? |
|
Definition
|
|
Term
| what is the oral 1st line tx for OA? topical? |
|
Definition
tylenol
capsaicin, arnica |
|
|
Term
prescription oral agents for OA
topical? |
|
Definition
NSAIDs - ibuprofen max 3.2 g/day
- opiate analgesics (Lortab, Percocet)
Topical - diclofenac in DMSO |
|
|
Term
| what is the njection of hyaluronate into joint to help lubricate it for OA called? |
|
Definition
|
|
Term
|
Definition
| Imbalance in osteoblast and osteoclast activity |
|
|
Term
|
Definition
Low calcium/Vitamin D intake
Sedentary Lifestyle
Low body weight (< 125 lbs)
Alcohol excess
Cigarette smoking
Caffeine (increases calcium excretion) |
|
|
Term
|
Definition
Sex
Race (Caucasian, Asians at higher risk)
Advanced age
History of 1st degree relative, low trauma fracture, or osteoporosis
Early menopause (< 45 YO)
Small thin frame |
|
|
Term
| Potentially Modifiable Risk Factors for OP? |
|
Definition
Impaired vision despite correction
Dementia
Poor health/frailty
Frequent falls
Low physical activity |
|
|
Term
| OP is a ____ onset. fx with ___ trauma |
|
Definition
|
|
Term
| Physical activity is associated with ______ reduced risk of hip fracture compared with sedentary lifestyle for OP |
|
Definition
|
|
Term
Only 500-600mg of calcium can be absorbed at one time
in regards to OP tx. what is a good example of a Ca medication (2)? |
|
Definition
1. Calcium citrate (Citracal®) –can take without meals. Does NOT require acidic environment to promote absorption –recommended for pts on chronic acid suppression therapy (H2 antagonists & PPIs)
2. Calcium carbonate – best taken with meals
Cheaper!! |
|
|
Term
| best form of vit D tx for OP? |
|
Definition
| D3 (Cholecalciferol) is best absorbed oral form |
|
|
Term
| example of a SERM for OP? |
|
Definition
Raloxifene (Evista®)
Bones = Estrogen Agonist
Breast = Estrogen Antagonist
- Raloxifene increases bone mineral density and reduces vertebral fracture rates 40-49% in postmenopausal women with or without prior fracture |
|
|
Term
| most commonly used tx for OP? |
|
Definition
bisphosphonates
- 1st line: Alendronate sodium (Fosamax)
- Ibandronate sodium - Boniva - 2nd line |
|
|
Term
| how to bisphosphonates work for OP? |
|
Definition
| Decrease bone resorption by causing osteoclast apoptosis and decreased function |
|
|
Term
| whats the best bisphosphonate to use for OP? |
|
Definition
Alendronate sodium (Fosamax®)
70 mg/wk |
|
|
Term
| whats a good bisphosphonate for OP thats useful in patients unable to take oral formulation |
|
Definition
Ibandronate sodium (Boniva) injection (2nd line)
(This is brand only and expensive –most patients switch over to fosamax ($3)) |
|
|
Term
| whats an OP tx that is an inhibitor of bone resorption (inhibits osteoclasts) and is a last line therapy (tx only). how is it used? |
|
Definition
Calcitonin
nasal spray bc inactivated by gastric fluid |
|
|
Term
| what is an OP tx that has an increased risk for osteosarcoma? |
|
Definition
Recombinant Parathyroid - Teriparatide use is limited to 2 years
- only used in postmenopausal osteoporosis with high risk for fracture |
|
|
Term
| what is the only approved for tx of postmenopausal osteoporosis in women with high risk of fracture |
|
Definition
|
|
Term
| what is a cause of OP in men? |
|
Definition
Hypogonadism
*Low levels of testosterone
Lack aromotase |
|
|
Term
| glucocorticoids can induce ___ |
|
Definition
|
|
Term
| tx for acute attack of gout? |
|
Definition
| NSAID’s *Naproxen (Naprosyn) and *Indomethacin (Indocin) |
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|
