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
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Term
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Definition
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Definition
Fe Zn I Se Mn Mo F Cu Cr Co B |
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Definition
aresenic aluminum tin nickel vanadium silicon |
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what is bad in regards to drug disposition with vitamins? |
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Definition
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example of absorption w/vitamins |
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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
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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
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Term
_____ is needed by all women of reproductive age. recommended 400 micrograms/day |
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Definition
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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
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Term
do antioxidants confer health benefits? |
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Definition
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Term
what has a possible increased mortality with a very high dose? |
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Definition
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Term
where do you need exposure to UV lights for vit D? |
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Definition
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Term
what vitamin do you not have to worry about toxicity with? |
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Definition
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Term
increasing vitamin ___ is bad and increases morbidity |
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Definition
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Term
what vitamins are inversely proportional? |
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Definition
Na and K Ca and Phosphorus |
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Term
older than ___ yo with poor Ca absorption are at ____ risk for type 2 osteoporosis |
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Definition
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Term
women ____ or older and postmenopausal or have been on ___ for a long time are at increased risk for osteoporosis |
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Definition
65 HRT (hormone replacement therapy) |
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Term
patients with RA are at increased risk for what |
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Definition
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Term
what is currently the 1st line tx for osteoporosis? examples? when should they take it? |
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Definition
Bisphosphonates alendronate (Fosamax) risedronate (actonel) ilbandronate (boniva) - taken on an EMPTY stomach and pt must sit for 1/2 hour |
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Term
what is the only selective estrogen receptor modulator (SERM) that is used to tx OA? what does it do? |
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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
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Term
most people with gout have reduced _____ clearance |
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Definition
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Term
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Definition
pruine metabolism abnormalities : (PRPP, HGPRT) |
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Term
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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. |
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Term
what is tophi? what does it look like? |
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Definition
deposits of monosodium urate crystals white nodules |
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Term
____ are 1000x more prevalent in pts with gout |
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Definition
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Term
acute tx for gout? chronic? |
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Definition
Cochicine Allopurinol (aloprim, zyolprim) |
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Term
___ for gout prevents proliferation and migration of leucocytes and STOPS INFLAMMATION (stops the pain) |
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Definition
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Term
what replaced Colchicine bc of GI upsets? what is commonly used? |
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Definition
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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? |
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Definition
Cocrys ***diarrhea, abdominal cramps, nausea, vomiting Rarely: bone marrow suppression, neuropathy and myopathy |
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Term
uricosuric agents ______ and _______ effect ion exchangers in the renal tubules to inhibit reabsorption of uric acid by the kidneys |
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Definition
Probenecid, Sulfinpyrazone |
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Term
cautions with uricosuric agents? how can we prevent this? |
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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 |
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Term
secretion of other weak acids (penicillin) may be inhibited by what agents? |
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Definition
Uricosuric - Probenecid was originally developed to prolong penicillin blood levels |
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Term
what is the 1st new gout drug in 40 years? its potent and selective inhibitor of xanthine oxidase |
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Definition
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Term
what drug for gout is used prophylactically like allopurinol? |
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Definition
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Term
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Definition
NSAIDs -- Indomethacin MC - or Naproxen (Aleve) -- prescription strength of 500 mg |
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Term
gout management strategies |
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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 |
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Term
Currently believed that RA is triggered by a combination of _______ |
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Definition
genetic, environmental, hormonal, and reproductive factors |
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Term
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Definition
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Term
80% of people with RA are positive for ______ |
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Definition
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Term
comparison of OA and RA: - duration of pain - joint location - labs |
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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 |
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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 |
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Definition
morning stiffness arthritis of 3+ joints arthritis of hands symmetric arthritis rheumatoid nodules serum rheumatoid factors radiographic changes |
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Term
examples of NSAIDs for RA |
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Definition
Celebrex ASA - short onset of action |
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Term
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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 |
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Term
what is most often selected as initial therapy for RA due to ability to induce a long-term response |
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Definition
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Term
Adverse effects of low-dose MTX in patients with RA are related to what? so what is typically added to this therapy? |
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Definition
folate antagonism and/or folate deficiency - folic acid **birth control must be used!! |
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Term
what RA tx has a side effect of liver toxicity and the patients must used effective contraception (X) |
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Definition
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Term
Useful in early RA or in patients *who have failed other DMARDs (disease Modifying Antirheumatic Drugs) |
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Definition
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Term
what RA tx must be used in combo with MTX? |
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Definition
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Term
dosing rule in regards to Anakinra (tx for RA) |
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Definition
Reduce dose(100 mg QOD in severe impairment) |
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Term
what should you start with for RA tx in mild disease? |
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Definition
Start with NSAIDS or glucocorticoids in mild disease then use as adjunctive therapy |
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Term
what should you start asap with RA tx? |
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Definition
Get DMARD on board ASAP (within 3 months of diagnosis) |
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Term
what is the last alternative for RA tx? |
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Definition
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Term
what is the most common joint disease and is "wear and tear" |
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Definition
OA more common in athletes |
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Term
0-90% of people (male and female) have evidence of _______ by the time they reach age 65 |
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Definition
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Term
in OA, when does inflammation occur? |
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Definition
secondary to joint damage! leads to erosion of articular cartilage |
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Term
is OA systemic? what is involved? |
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Definition
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Term
what is the oral 1st line tx for OA? topical? |
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Definition
tylenol
capsaicin, arnica |
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Term
prescription oral agents for OA topical? |
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Definition
NSAIDs - ibuprofen max 3.2 g/day - opiate analgesics (Lortab, Percocet) Topical - diclofenac in DMSO |
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Term
what is the njection of hyaluronate into joint to help lubricate it for OA called? |
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Definition
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Term
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Definition
Imbalance in osteoblast and osteoclast activity |
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Term
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Definition
Low calcium/Vitamin D intake Sedentary Lifestyle Low body weight (< 125 lbs) Alcohol excess Cigarette smoking Caffeine (increases calcium excretion) |
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Term
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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 |
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Term
Potentially Modifiable Risk Factors for OP? |
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Definition
Impaired vision despite correction Dementia Poor health/frailty Frequent falls Low physical activity |
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Term
OP is a ____ onset. fx with ___ trauma |
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Definition
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Term
Physical activity is associated with ______ reduced risk of hip fracture compared with sedentary lifestyle for OP |
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Definition
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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)? |
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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!! |
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Term
best form of vit D tx for OP? |
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Definition
D3 (Cholecalciferol) is best absorbed oral form |
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Term
example of a SERM for OP? |
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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 |
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Term
most commonly used tx for OP? |
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Definition
bisphosphonates - 1st line: Alendronate sodium (Fosamax) - Ibandronate sodium - Boniva - 2nd line |
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Term
how to bisphosphonates work for OP? |
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Definition
Decrease bone resorption by causing osteoclast apoptosis and decreased function |
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Term
whats the best bisphosphonate to use for OP? |
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Definition
Alendronate sodium (Fosamax®) 70 mg/wk |
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Term
whats a good bisphosphonate for OP thats useful in patients unable to take oral formulation |
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Definition
Ibandronate sodium (Boniva) injection (2nd line) (This is brand only and expensive –most patients switch over to fosamax ($3)) |
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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? |
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Definition
Calcitonin nasal spray bc inactivated by gastric fluid |
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Term
what is an OP tx that has an increased risk for osteosarcoma? |
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Definition
Recombinant Parathyroid - Teriparatide use is limited to 2 years - only used in postmenopausal osteoporosis with high risk for fracture |
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Term
what is the only approved for tx of postmenopausal osteoporosis in women with high risk of fracture |
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Definition
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Term
what is a cause of OP in men? |
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Definition
Hypogonadism *Low levels of testosterone Lack aromotase |
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Term
glucocorticoids can induce ___ |
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Definition
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Term
tx for acute attack of gout? |
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Definition
NSAID’s *Naproxen (Naprosyn) and *Indomethacin (Indocin) |
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