Medications
What are the three medications specific to gout?
What medication can you use for gout & HTN
allopurinol- blocked production of uric acid (chronic)
Colchicine- produced dramatic anti-inflammatory effects with relief within 24-48 hrs(acute gout)
febuxostat- reduced serum uric acid levels
losartan- used for gout and HTN (helpful in older patents)
What are the nodules in patients with osteoarthritis?
Herberdens
Brouchards nodes
Rheumatoid factor (RF) absent
elevated ESR, synovial fluid
WBC<20,000
osteophytes present
osteoarthritis
What is the normal lab values for WBCs?
4,000-11,000 cu/mm
Morning stiffness lasts less than 30 minutes and is increased pain throughout the day,
disease is nto symmetrical, not systemic. and has tender joints
osteoarthritis
Topical medications used for RA & OA?
what do you want to avoid with these medications?
Capsaicin- avoid heating pad, warm pack
Diclofenan sodium- avoid sun, UV exposure
-increased side effects with salicylate/NSAIDs
What are deposits of urate crystals shown in gout called?
Tophi
What are the T-scores with normal, osteopenia, osteoporosis?
t-score: +1,-1 is normal
t-score: -1 to -2.5 osteopenia
t-score: -2.5 or lower osteoporosis
What levels should serum uric acids be at?
and if they are above this level what does this indicate?
below 6mg/dl
could indicate gout
If patient is
*having pain
*having pressure
*having paresthesia
*signs of pallor
*paralysis
*puslessness
* and temperature different in extremities
signs of compartment syndrome
anti- inflammatory drugs used in RA & OA
(1) intraarticular
(4) oral
intraarticular- methylprednisolone
oral- hydrocortisone, methylprednisolone, dexamethasone, prednisone
In what disease does the “butterfly rash” noticeable in?
Lupus
What are the diagnostic studies for intervertebral disc disease?
x-rays
-myelogram,MRI, or CT scan
- epidural venogram or discogram
-EMG
What is a normal creatinine or BUN level?
what do these test?
creatinine: <1.5mg/dL
BUN: 10-20mg/dL
checks: kidney function
Great-toe pain, joints are tender and cyanotic
gout
Biphosphates used for osteoporosis
(3 meds)
“ate”
risedronate
aledfronate
ibandronate
RA
Diagnostic studies for osteomyelitis
x-ray
bone scans
mri-ct scans
WBC count is elevated with inflammation and infection
ESR
What are normal HGB levels for males and females?
males: 13.2-17.3 gm/dl
females: 11.7-16gm/dl
Low back pain
radicular pain
+stright leg raise
absent flexes
paresthesia
what are severe signs of this disease?
intervertebral disc disease
severe signs:
sudden bowel and bladder incontinence
reflexed and grips are gone in hands or feet
Iv antibiotic therapy for osteomyelitis (4 types of antibiotics)
which medications do you need to check peak and through levels?
aminoglycosides: * gentamicin-nephrotxic *tobramycin- ototoxic,nephrotoxic,neurotoxic
cephalosproins- Ancef, cefepime, ceftriaxone
Fluroquinolones- ciproflaxin, levoflaxin
glycopeptides- vancomycin, tobramycin, gentamicin- these are the peak and though levels
Which disease can become avascular if not taken care of properly and increase risk of infection?
acute osteomyelitis
Diagnostic studies for Fat Embolism
* PaO2 (arterial O2) <60mm Hg
*ECG changes
*decreased platelet count, decreased HCT
*increased prothrombin time
* chest- X-rays for areas of pulmonary infiltrate
What lab values do you want to drawl when your pt is taking Heperin?
aPTT- activated partial thromboplastin time
Poor circulation is fingers and toes with cold exposure
raynaud’s syndrome