musculoskeletal system

axial skeleton

around 80 bones. contains skull, rib cage, and spine

appendicular skeleton

the rest of the bones in the body, includes arms, legs, pelvis and shoulders

osteoclast cells

removes old bone material

osteoblast cells

construct new bones

3 types of muscle

smooth muscle, cardiac muscle and skeletal muscle

connective tissues

tendons and ligaments

tendons

conduct the mechanical force supplied to the muscle by a bone.

ligaments

provide stability to the joints between bones.

opioids

any medications that have a similar mechanism of action to morphine. -addictive

NSAIDs (non steroidal anti-inflammatory drugs)

low schedule pain killers like ibuprofen, aspirin and naproxen.

how do NSAIDs work

they prevent the substance of the COX enzyme binding by blocking which prevents the body’s natural inflammatory responses from injury

acute pain

any pain that is short lived and doesn’t last for a long time

sprain

involves the stretching/tearing of a ligament

strain

the stretching/tearing of a muscle or tendon

paracetamol

most known pain killer. don’t take more than 4 tablets in 4 hours, it’s easy to overdose.

NSAIDS

non steroidal anti inflammatory drugs. the most common are aspirin, ibuprofen and naproxen. don’t take on an empty stomach.

opiods

examples could be codeine and morphine. patients should be aware of the side affect especially drowsiness

chronic pain

pain that lasts longer than 12 weeks. most common type of pain is neuropathic pain which is caused to damage or disease of nerves. this can be from stroke, surgery

antidepressants used to treat chronic pain

amitriptyline, citalooram and sertraline

drugs that are used to treat pain but aren’t recommended

gabapentin, pregabalin, carbamazepine

3 types of pain scales

usual analogue scale, numerical scale, wrong baker pain scale

what vitamin is important for the absorption of calcium

vitamin d

what type of muscle is the bladder

smooth muscle

gout

a type of arthritis caused by the build up of uric acid in the blood

symptoms of gout

severe pain, swelling and redness on the joint

causes of gout

being overweight, family history, being male, being older, taking certain medications like diuretics

how is diet linked to gout

many foods have a high purine content which increase the urate level when broken down

high purine level food

shell fish, sugary drinks, alcohol,

acute gout treatment

to stop pain and swelling. patient should rest the affected limb to reduce swelling. first line treatment is painkillers. NSAIDS, colchicine and corticosteroids

how do corticosteroids treat gout

reduce inflammation by stopping the release of chemicals which cause inflammation. examples could be dexamethasone, hydrocortisone and prednisone

how does allopurinol treat gout

it inhibits an enzyme that works on uric acid, decreasing the levels of it.

chronic grout symptoms

lifestyles changes like weight loss, diet, drinking water and exercise. drugs used can be allopurinol and febuxostat

arthritis

a condition which can cause pain or inflammation is a joint

osteoarthritis

most common form of arthritis caused by layered of cartilage becoming too thin leading bones to rub together

risk factors of osteoarthritis

age, joint injury, obesity, occupational stresses

symptoms of osteoarthritis

joint tenderness, increased pain, stiffness, limited range

treatment of osteoarthritis

NSaids, paracetamol, opiods like codeine. physiotherapy and in some cases surgery

rheumatoid arthritis

where someone’s immune system starts to attack healthy joints leading to inflammation around the joints

symptoms of rheumatoid arthritis

joint pain, stiffness and swelling. pain worse in the morning or after a period of inactivity

methotrexate

first line in rhematoid arthritis. it’s cytotoxic and very dangerous in an overdose. it inhibits the metabolism of folic acid and stops the inflammation in higher doses it is used as chemotherapy

leflunomide

it’s cytotoxic and used as a combination therapy. it suppress the blood cells involved with inflammation

hydroxychlorquine

used in milder cases of rheumatoid arthritis or as a combination therapy.

primary headache

where the headache is caused by itself

secondary headache

caused by another issues that leads to a headache

tension headaches

most common type of headache. it’s linked to emotional stress, anxiety and factors like dehydration

cluster headaches

very painful headaches that are extremely rare. treated through high strength opioids

neuralgia

sudden shooting spasm like pains caused by damage to a group of nerves it’s only lasts a couple of minutes

migraine

most common condition. caused by anxiety and stress, specific foods like cheese and citrus fruits, strenuous activity.

acute management for migraine

patients can take pain killers when the feel and attack coming on

prophylactic treatment for migraine

propranolol, amitriptyline and topiramate can be considered

lifestyles changes to stop migraines

relaxation, regularly routine and sleep pattern, avoid skipping meals and bright lights and loud noises

triptans

useful in patients who have migraine attacks who don’t respond to common pain killers. eg, sumpitriptan they work by relaxing book vessels and smooth muscles.

osteoporosis

a progressive skeletal disease of the deterioration of bone tissue

causes of osteoporosis

low calcium intake, low vitamin D, lack of mobility, high alcohol intake (toxic to bones), smoking and thin body type

T-score

a unit of measurement to define if someone has osteoporosis= 2.5 or less

primary osteoporosis

most common form, no other disorders cause the osteoporosis

secondary osteoporosis

related to another medical condition or the use of drug therapy of corticosteroids. medical conditions that can cause it could be cushing syndrome.

non-drug ways to prevent osteoporosis

exercise, not smoking, reduce alcohol, diet with calcium rich foods

Bisphosphates

alendronic acid, risedronate. they are absorbed on minerals in the bones and prevent osteoclasts (break down) from happening

calcium and vitamin d

supplements can help strengthen bones. drugs like colecalciferol and ADCAL-D3. tablet should be taken at the same time every day. no within 4 hours of taking the bisphophonate. - stops absorption.

what drug can cause a patients contact lenses to turn orange

sulfasazine

on a numerical pain scale what number would indicate moderate pain

4

methotrexate should be used with extra caution along side what drug

omeprazole, SHOULD TRY TO BE AVOIDED

what’s the maximum amount of paracetamol and adult should have in 24 hours

8×500mg tablets

Fentanyl

Binds to receptors, for severe pain, drug dependence and constipation

Allopurinol

It reduces the uric acid production, its a prophylactic treatment, ensure good fluid intake whilst taking

Sulfasalazine

Can colour bodily fluids yellow, prescribed as enteric coated tablets, report any unexplained bruising

Sumitriptan

Relaxes the muscles and contracting of blood vessels stopping migraine, one dose per attack, one the onset of symptoms

Alendronic acid

Take once a week, remain upright for 30 mins after taking, prevents action of osteoclast, report any swallowing difficulties

Infliximab

IV infusion, specialist treatment only, reduces the production of inflammation mediators

Ibuprofen

Caution in asthmatics, don’t take 48 hours after injury, GI bleeds, inhibits COX enzymes