N351 MSK

Function of MSK

protect vital organs

framework to support body structures, mobility

movement, produce heat and maintain body temp

facilitate return of blood to heart

reservoir for immature blood cells

reservoir for vital minerals

osteoblasts

bone forming cells

osteocytes

mature bone cells that occupy the lacunae, bone maintenance cells

osteoclasts

break down bone, located in howship lacunae

osteogenesis

process of formation of bone

ossification

the process of formation of the bone matrix and deposition of minerals

regulating factors of bone formation

Stress and weight bearing

Vitamin D

Parathyroid hormone and calcitonin

Blood supply

stages of bone healing

1. hematoma formation- 1-2 days after fracture

2. fibrocartilage callus formation - fibroblasts and osteoblasts migrate to fracture site

3. bony callus formation - ossification begins in 3rd or 4th week

4. bone remodeling- osteoclasts remove necrotic bone

Synarthrosis

immovable joint

Amphiarthrosis

slightly movable joint

diathrosis (synovial)

freely movable

muscles are attached to bones by

tendons

fibrous tissue around muscles is called

fascia

Sarcomere

Contractile unit of muscle

Bursitis and Tendonitis

Inflammation of a bursa or the tendon sheath respectively

impingement syndrome

impaired movement of rotator cuff usually from repetitive movement or trauma

carpal tunnel syndrome

entrapment neuropathy of the median nerve typically caused by inflammatory disorders, repetitive hand movement, and trauma

ganglion

collection of neurologial gelatinous material near the tendon sheaths and joints that cause inflammation

callus

a thickening of part of the skin on the hands or feet caused by repeated rubbing

corn

hyperkeratosis of epidermis usually on 5th toe

hallux vagus (bunion)

deformity where great toe deviates laterally with prominence of the medial aspect of the first metatarsopharengeal joint

hammer toe

flexion deformity of the interphalangeal joint that may involve several toes

ingrown toe nail

free edge of the nail plate penetrates the surrounding skin

flatfoot

longitudinal arch of the foot is diminished by congenital abnormalities, trauma, or excessive pressure

plantar fasciitis

an inflammation of the plantar fascia on the sole of the foot

Gout pathophysiology

uric acid crystals deposited in joint/connective tissue

inflammation at joint

hyperuricemia

over production of uric acid

inability to excrete uric acid

Gout clinical manifestations

hyperuricemia

painful joints

tophi

inflammation

Gout treatment

lifestyle changes

reduce inflammation with NSAIDs and corticosteroids

Increase uric acid elimination

long term treatment to lower levels of uric acid for gout

colchicine and allopurinol

is allopurinol a prototype

yes, prototype uricosuric agent

allopurinol brand name

Zyloprim

allopurinol MOA

Inhibits enzyme that converts purines to uric acid. Reduces blood levels of uric acid.

Allopurinol administration

PO

therapeutic uses of allopurinol

management of primary and secondary gout

acute and chronic tophaceous gout

malignancies that result in elevates serum uric acid levels

Allopurinol adverse effects

CNS effects

Bone marrow depression

GI effects

Hepatotoxicity

allopurinol drug interactions

Warfarin and aspirin (increased risk of bleeding)

Alcohol (decreases excretion of uric acid)

is Colchicine an prototype

yes, prototype mitotic agent

what is the most commonly given antigout medication

Colchicine

Colchicine brand name

Colcrys

Colchicine MOA

inhibits migration of leukocutes into tissue

Colchicine therapeutic use

treatment of acute gout

prophylaxis of acute gout

Colchicine adverse effects

GI upset

bone marrow depression

causes of lower back pain

acute lumbar strain

unstable lumbosacral ligaments

weak muscles

intervertebral disc problems

unequal leg length

disuse of supporting structures such as abdominal muscle weakens vertebrae and discs

radiculopathy

pain radiating down leg

sciatica

pain radiating from inflamed sciatic nerve

Degenerative Disc Disease

is a herniated vertebral disc causing protrusion of disc onto nerve causing compression. Ruptured nucleus pulposus is protruding onto annulus. Loss of protein polysaccharides in the disc decreases water content causing cracks in annulus that weakens resistance to nucleus from herniating

cervical intervertebral disc herniation

caused by spondylosis, can lead to lesions that damage spinal cord

spondylosis

degenerative changes in disc alignment and adjacent vertebral bodies

cervical intervertebral disc herniation manifestations

pain and stiffness of neck, shoulders and scapulae

paresthesia in upper extremities

Bacleofen class

gamma-aminobutyric acid derivative

Bacleofen brand name

lioresal

Bacleofen MOA

exact mechanism is unknown. Inhibits reflex transmission at spinal cord

Bacleofen administration

PO, intrathecal

Bacleofen therapeutic uses

muscle spasticity/pain

Bacleofen adverse effects

CNS depression, hypotonia, hypotension, difficulty with urination, risk of OD and withdraw

Bacleofen nursing considerations

do not stop taking med abruptly

avoid CNS depressants

do not take if pregnant or breastfeeding

Dantrolene sodium class

direct acting skeletal muscle relaxant

Dantrolene sodium brand name

Dantrium

Dantrolene sodium MOA

acts directly on skeletal muscle, interferes with calcium ion release to relax skeletal muscle

Dantrolene sodium administration

PO, IV

Dantrolene sodium therapeutic uses

chronic spasticity

malignant hyperthermia

Dantrolene sodium adverse effects

BLACK BOX WARNING- hepatotoxicity

CNS depression

flushing

GI upset

Dantrolene sodium nursing considerations

liver function tests

Cyclobenzaprine Hydrochloride class

tricyclic antidepressant derivative

Cyclobenzaprine Hydrochloride MOA

Exact mechanism is unknown. Centrally-acting skeletal muscle relaxant pharmacologically related to tricuclic antidepressants. Depressed motor activity

Cyclobenzaprine Hydrochloride brand name

Flexeril

Cyclobenzaprine Hydrochloride administration

PO

Cyclobenzaprine Hydrochloride therapeutic use

muscle spams (short term 2-3 weeks only)

Cyclobenzaprine Hydrochloride adverse effects

anticholinergic

CNS depression

Cyclobenzaprine Hydrochloride nursing considerations

CNS depression, monitor for sedation and coadministration with other sedatives

Tizanidine Hydrochloride class

imidazoline Derivative

Tizanidine Hydrochloride brand name

Zanaflex

Tizanidine Hydrochloride MOA

centrally acting alpha 2 adrenergic agonist. decreases spasticity by indirectly depressing postsynaptic reflexes to reduce facilitation of spinal motor neurons

Tizanidine Hydrochloride administration

PO

Tizanidine Hydrochloride therapeutic uses

spasticity management, muscle spams/pain

Tizanidine Hydrochloride adverse effects

hypotension, drowsiness, dizziness, xerostomia, constipation, hallucinations

Tizanidine Hydrochloride nursing considerations

use with caution in elderly, taper off

Risk factors for osteoporosis genetics

caucasian or asian

female

family history

small frame

Risk factors for osteoporosis age

postmenopause

advanced age

low testosterone in men

decreased calcitonin

Risk factors for osteoporosis nutrition

low calcium intake

low Vitamin D intake

high phosphate

inadequate calories

Risk factors for osteoporosis physical exercise

sedentary

lack of weight bearing exercise

low weight and BMI

Risk factors for osteoporosis lifestyle

caffine

alcohol

smoking

lack of sunlight exposure

Risk factors for osteoporosis medications

corticosteroids, antiseizure, heparin, thyroid hormone

Risk factors for osteoporosis comorbidities

anorexia, hyperthyroidism, malabsorption, kidney failure

pharmacological therapy for osteoporosis

calcium and vitamin D

bisphosphonates

estrogen agonist/antagonists

bisphosphonate drugs

Alendronate (fosamax)

Risedronate (Actonel)

Ibandronate (Boniva)

Zoledronic acid (Reclast, Zometa)

bisphosphonate drugs uses

treatment of Pagets disease, osteoporosis in men and postmenopausal women

bisphosphonate drugs MOA

bind to bone and inhibit calcium resorption from bone

for treatment of osteoporosis, suppresses osteoclast activity on newly formed resorption surfaces, which reduces bone turnover

bone formation exceeds resorption at remodeling sites to gain bone mass

bisphosphonate drugs adverse effects

esophagitis, esophegeal ulcers

dysphagia

MSK pain

decreases serum calcium

bisphosphonate drugs nursing considerations

to prevent GI upset ensure patient sits upright for 30 min after administration

monitor serum calcium

education pt to report GI upset

Estrogen agonist/antagonist drugs

Denosumab (Prolia, Xgeva)

Raloxifene (Evista)

Estrogen agonist/antagonist drugs uses

treatment of osteoporosis

Estrogen agonist/antagonist drugs MOA

Raloxifene-preserves bone mass density by decreasing bone reabsorption

acts like estrogen in body by decreasing bone breakdown and increase bone mass density

Estrogen agonist/antagonist drugs adverse effects

MSK pain

hot flashes

leg cramps

decreased serum calcium

Estrogen agonist/antagonist drugs nursing considerations

monitor serum calcium

education patient on hypocalcemia

osteomalacia

metabolic bone disease characterized by inadequate bone mineralization, softening and weakening of long bones

osteomalacia causes

GI disorders, severe renal insufficiency, hyperparathyroidism, dietary deficiency

pagets disease

disorder of localized bone turnover (skull, femur, tibia, pelvic bone, vertebrae)

most common in men

pagets disease pathophysiology

excessive bone resorption by osteoclasts is followed by increased osteoblastic activity; bone structure disorganized, weak, and highly vascular. cause is unknown

pagets disease manifestations

skeletal deformities, mild to moderate aching pain, and tenderness and warmth over bones