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pathopharm osteomyelitis and gout

Terms in this set (139)

in osteomyelitis, a severe infection is happening in which 3 things? (BBT)
in osteomyelitis, a severe infection is happening in the:
1. bone
2. bone marrow
3. surrounding tissue
what is the most common microorganism that causes osteomyelitis? (S)
most common microorganism that cause osteomyelitis is staph. aureus
what are the 2 entry ways of osteomyelitis? (ID)
2 entry ways of osteomyelitis:
1. indirect entry
2. direct entry
indirect entry of osteomyelitis AKA
hematogenous spread
the indirect entry of osteomyelitis is most common in which pt population? (B)
indirect entry of osteomyelitis is most common in young boys
what kind of trauma can cause the indirect entry of osteomyelitis? (B)
blunt trauma can cause the indirect entry of osteomyelitis
what happens to the skin during blunt trauma that can cause the indirect entry of osteomyelitis?
in blunt trauma, skin can be broke (which may not always be visible) but this can allow microorganisms to enter the bloodstream
where will the microorganism get lodged next after its made its entry into the bloodstream? (B)
microorganism will get lodged in a bony prominence after its made its entry in the blood stream which is what causes the indirect entry of osteomyelitis
what are the 2 types of infections that fall under the indirect entry category that can cause osteomyelitis? (GR)
2 types of infections that fall under the indirect entry category that can cause osteomyelitis:
1. GU infections
2. respiratory infections
in direct entry of osteomyelitis, what kind of wound will be present? (O)
open wound will be present in the direct entry of osteomyelitis
is there a specific age where direct entry of osteomyelitis can occur?
no, direct entry of osteomyelitis can occur at any age
can foreign body presence that gets close to a bone cause direct entry of osteomyelitis?
yes
what is the first step of osteomyelitis? (hint: what grows?)
the first step of osteomyelitis is that microorganisms will begin to grow
in osteomyelitis, when microorganisms begin to grow, will there be an increase or decrease in the pressure in the bone?
in osteomyelitis, as microorganisms begin to grow, there will be an increase in pressure in the bone
what will the pt feel when there will be an increase in the pressure in the bone? (P)
pt will feel pain when there will be an increase in the pressure in the bone
in osteomyelitis, because of increased pressure in the bone, which 2 things will occur? (IV)
in osteomyelitis, because of increased pressure in the bone:
1. ischemia
2. vascular compromise
will occur
in osteomyelitis, because of increase pressure in the bone, ischemia and vascular compromise will occur. what will happen to the bone because of this? (B)
because of ischemia and vascular compromise, bone will begin to breakdown
in osteomyelitis, when bone begins to breakdown, what will be able to spread through the bone? (I)
when bone begins to breakdown, infection will be able to spread through the bone
in osteomyelitis, when bone begins to breakdown and infection spreads throughout the bone, what will get devascularized? (C)
when bone begins to breakdown and infection spreads through the bone, the cortex will begin to get devascularized
in osteomyelitis, when the cortex gets devascularized, what will happen? (N)
necrosis will occur
what are the 2 categories of clinical manifestations of osteomyelitis? (AC)
2 categories of clinical manifestations of osteomyelitis:
1. acute
2. chronic
how long is the duration of the acute clinical manifestation of osteomyelitis?
duration of acute clinical manifestation of osteomyelitis is < 1 month
is the acute clinical manifestation of osteomyelitis local or systemic?
acute clinical manifestation of osteomyelitis is local
in the local manifestation that falls under the acute category of osteomyelitis, when will pain worsen?
in the local manifestation, pain will worsen with activity
in the local manifestation that falls under the acute category of osteomyelitis, is pain relieved at rest?
no, pain is not relieved at rest
what are the 3 symptoms that fall under the local manifestations of the acute category of osteomyelitis? (SWT)
3 symptoms that fall under the local manifestations:
1. swelling
2. warmth
3. tenderness
what kind of movement will be present under the local manifestations of the acute category of osteomyelitis? (R)
restricted movement will be present under the local manifestations of the acute category
under the chronic clinical manifestation of the acute category of osteomyelitis, will there be local manifestations or systemic manifestations?
under the chronic clinical manifestation of the acute category of osteomyelitis, there will be systemic manifestations
what is the primary symptom that falls under the chronic clinical manifestations of the acute category of osteomyelitis? (F)
fever is the primary symptom that falls under the chronic clinical manifestations of the acute category of osteomyelitis
do the symptoms that fall under the chronic clinical manifestations of the acute category of osteomyelitis wax and wane?
yes
can some acute osteomyelitis become chronic?
yes
can acute myelitis also have systemic manifestations will it have?
yes
when acute osteomyelitis exhibits systemic manifestations, does it does it share the same symptoms as the systemic manifestations of chronic osteomyelitis?
yes
do symptoms wax and wane in acute osteomyelitis?
no
what is a late symptom of chronic osteomyelitis? (D)
a late symptoms of chronic osteomyelitis is drainage
what is a late symptom of systemic manifestation that is caused acute osteomyelitis? (D)
drainage
what is a primary cause of chronic osteomyelitis?
primary cause of chronic osteomyelitis is from poorly treated acute osteomyelitis
is it hard to completely treat osteomyelitis?
yes
can it be hard to get antibiotics to the site of the infection that is in the bone?
yes
what is the primary method of treatment for acute osteomyelitis?
primary method of treatment for acute osteomyelitis is aggressive and prolonged IV antibiotic therapy
is it important to teach pt about adverse and toxic reactions that can come from prolonged usage of IV antibiotics to treat acute osteomyelitis?
yes
what are the 2 types of toxicity that aggressive and prolonged IV antibiotics used to treat acute osteomyelitis can cause? (NO)
2 types of toxicity that aggressive and prolonged IV antibiotics used to treat acute osteomyelitis can cause:
1. nephrotoxicity
2. ototoxicity
what can aggressive and prolonged IV antibiotics used to treat acute osteomyelitis impair the function of? (R)
aggressive and prolonged IV antibiotics used to treat acute osteomyelitis impair renal function
what kind of rupture can prolonged IV antibiotics used to treat acute osteomyelitis cause? (T)
prolonged IV antibiotics used to treat acute osteomyelitis can cause tendon rupture
what is the antibiotic class can cause tendon rupture? (F)
floxacin
when giving pt prolonged IV antibiotics used to treat acute osteomyelitis, what are the 2 levels that need to be measured? (PT)
when giving pt prolonged IV antibiotics used to treat acute osteomyelitis, the 2 levels that must be measured are:
1. peak levels
2. trough levels
when giving pt prolonged IV antibiotics used to treat acute osteomyelitis, what do the peak and trough levels tell us?
peak and trough levels tell us how much meds are in the bloodstream
trough level =
how much med is in the blood right before the next dose
peak level =
peak level is drawn when the pt has the highest amount of med in their blood
gout is a recurrent attack of acute _______________ (A)
gout is a recurrent attack arthritis
when giving pt prolonged IV antibiotics used to treat acute osteomyelitis, what are the 2 things that this can cause? (YC)
when giving pt prolonged IV antibiotics used to treat acute osteomyelitis, this can cause:
1. yeast infections
2. C. diff
is c. diff very common in pt that is on prolonged IV antibiotics for treatment of acute osteomyelitis?
yes
gout is a recurrent attack of acute arthritis with increased level of what serum? (U)
gout is a recurrent attack of acute arthritis with increased level of serum uric acid
what are the 2 types of gout? (PS)
2 types of gout:
1. primary gout
2. secondary gout
if pt has primary gout, what kind of error do they have? (H)
if pt has primary gout, they have a hereditary error
if pt has primary gout, what metabolism do they have a hereditary error for? (P)
if pt has primary gout, they have a hereditary error for purine metabolism
if pt has primary gout, they have a hereditary error for purine metabolism. what does this lead to an overproduction or retention of? (U)
hereditary error for purine metabolism will lead to an overproduction or retention of uric acid
of cases are due to primary gout?
90%
90% of people with primary gout belong to what pt population?
primary gout typically occurs in middle aged men
secondary gout may be related to another acquired ________________ (D)
secondary gout may be related to another acquired disorder
secondary gout may also be a result of medication that inhibit the secretion of what? (U)
secondary gout may also be a result of medication that inhibit the secretion or uric acid
what can meds that cause an increase in cell death also cause an increase in? (U)
meds that cause an increase in cell death can also cause an increase in uric acid production
what is the primary problem of gout?
primarily problem of gout is that there is too much uric acid in the blood
is gout recurrent and inflammatory?
yes
what does serum uric acid crystallize into?
uric acid crystallizes into sodium urate
what causes pain in gout?
pain in gout occurs when serum uric acid crystallizes into sodium urate
what is it called when these sodium urate crystals get deposited into one area? (T)
when sodium urate crystals get deposited into one area is called as tophites
are tophites large amount of crystals getting deposited into 1 area?
yes
where are the 3 primary locations where crystals can deposited? (JBK)
3 primary locations where crystals can get deposited are:
1. joints
2. bones
3. kidneys
hyperuricemia AKA
too much uric acid
hyperuricemia can occur from increased synthesis of what?
hyperuricemia can occur from increased purine synthesis
hyperuricemia can occur from decreased excretion of what? (R)
hyperuricemia can occur from decreased renal excretion
what is uric acid the end product of? (P)
uric acid is the end product of purine catabolism
what is uric acid primarily excreted by?
uric acid is primarily excreted by the kidneys
sodium urate crystallization can increase by ____________ (F)
sodium urate crystallization can increase by fasting
is alcohol problematic for people with gout?
yes
what does alcohol inhibit the secretion of? (U)
alcohol inhibits the secretion of uric acid
when treating gout, what are the 2 things that we need to in regard to uric acid?
when treating gout, we need to either:
1. increase getting rid of the uric acid
2. need to stop the growth of uric acid
what are the 3 things that gout can make joints look like? (DCR)
3 things that gout can make joints look like:
1. dusky
2. cyanotic
3. red
do gout make joints tender?
yes
75% of gouty attacks occur where?
75% of gouty attacks occur in the big toe
what is the onset of gout attacks?
gout attacks have a rapid onset
in chronic gout, can multiple joints be involved?
yes
in chronic gout, what are there visible deposits of?
in chronic gout, there are visible deposits of sodium urate crystals (tophi)
what are the 3 primary drugs used to treat an acute gouty attack? (NGC)
3 primary drugs used to treat an acute gouty attack:
1. NSAIDs
2. glucocorticoids
3. colchicine
what drug is considered to be the first choice to treat an acute gouty attack? (N)
NSAIDs are considered to be the first choice to treat an acute gouty attack
when treating acute gouty attack, are we aiming at relieving the pts symptoms?
yes
when treating acute gouty attack, what are we aiming to lower?
when treating acute gouty attack, we are aiming to lower uric acid levels
what do NSAIDs suppress when treating an acute gouty attack? (I)
NSAIDs suppress inflammation when treating an acute gouty attack
do NSAIDs help relieve the symptoms of an acute gouty attack?
yes
are glucocorticoids effective for an acute gouty attack?
yes
what are the 3 most common NSAIDs used to treat an acute gouty attack? (IND)
3 most common NSAIDs to treat an acute gouty attack:
1. indomethacin
2. naproxen
3. diclofenac sodium
what is the most common glucocorticoid used to treat an acute gouty attack? (P)
most common glucocorticoid used to treat an acute gouty attack is prednisone
what are glucocorticoids the most effective at relieving when it comes to an acute gouty attack? (P)
glucocorticoids are the most effective at relieving pain when it comes to an acute gouty attack
in which pts should you avoid use glucocorticoids to treat an acute gouty attack? (H)
avoid using glucocorticoids in pts that are hyperglycemic
are glucocorticoids a good drug choice to treat an acute gouty treatment for pts that are hypersensitive or unresponsive to NSAIDs?
yes
what kind of agent is colchicine? (A)
colchicine is an anti-inflammatory agent
is colchicine now reserved for pts that are unresponsive or intolerant to safer agents for the treatment of acute gouty attacks?
yes
colchicine is not effective against what other type of disorders? (A)
colchicine is not effective against other anti-inflammatory disorders
what is the key use of colchicine? what does it treat?
cholchicine treats acute gouty attacks
colchicine can ______________ the incidence of acute gouty attacks (R)
colchicine can reduce the incidence of acute gouty attacks
what can colchicine do to impending acute gouty attacks? (A)
colchicine can abort impending acute gouty attacks
what is the most significant adverse effect of colchicine? (G)
most significant adverse effect of colchicine is GI effects
what are the 3 drug interactions that colchicine has? (SPI)
3 drug interactions that colchicine has:
1. statins
2. p-glycoprotein inhibitors
3. inhibitors of CYP3A4
what is the most important drug interaction to be mindful of with colchicine? (S)
most important drug interaction to be mindful of with colchicine is statins
does colchicine mesh well with other drugs?
no
in which 2 pt population is colchicine contraindicated in? (OP)
colchicine is contraindicated in:
1. older adults
2. pregnant women
can pts with cardiac, hepatic, renal, and GI disease take colchicine?
no
what are the 4 drugs used to treat hyperuricemia? (AFPP)
4 drugs used to treat hyperuricemia:
1. allopurinol
2. febuxostat
3. probencid
4. pegloticase
when treating hyperuricemia, what do allopurinol and febuxostat?
allopurinol and febuxostat inhibit uric acid formation
when treating hyperuricemia, what does probenecid increase?
probenecid increase uric acid excretion
when treating hyperuricemia, what does pegloticase convert uric acid into? (A)
pegloticase converts uric acid into allantoin
what is allantoin?
allantoin is a compound that is readily excreted by the kidneys
what do the drugs that are used to treat hyperuricemia promote the dissolution of?
drugs that are used to treat hyperuricemia promote the dissolution of urate crystals
do drugs that are used to treat hyperuricemia have anti-inflammatory or analgesic properties?
no, drugs that are used to treat hyperuricemia have no anti-inflammatory or analgesic properties
because the drugs that are used to treat hyperuricemia have no anti-inflammatory or analgesic properties, what are these drugs not useful in treating?
drugs that are used to treat hyperuricemia are not useful in treating acute gouty attacks
what does allopurinol reduce?
allopurinol reduces blood uric acid levels
what enzyme does allopurinol inhibit? (XO)
allopurinol inhibits xanthine oxidase
what is the enzyme xanthine oxidase required for? (U)
the enzyme xanthine oxidase is required for the uric acid formation
allopurinol is generally well ________________
allopurinol is generally well tolerated
what is a rare adverse effect that allopurinol can cause? (hint: syndrome)
allopurinol can cause hypersensitivity syndrome
what does the hypersensitivity syndrome that allopurinol can result in?
hypersensitivity syndrome that allopurinol causes can result in a breakout rash
what attack can the initial therapy of allopurinol cause?
initial therapy of allopurinol can cause acute gouty attack
what can occur if allopurinol is used for longer than 3 years? (C)
if allopurinol is used for longer than 3 years, cataracts can occur
what does febuxostat reduce?
febuxostat reduces blood uric acid levels
what does febuxostat have the same MOA as? (A)
febuxostat has the same MOA as allopurinol
what tubules does probenecid act on? (R)
probenecid acts on renal tubules
when probenecid acts on renal tubules, what reabsorption will get inhibited?
when probenecid acts on renal tubules, reabsorption of uric acid will get inhibited
can probenecid exacerbate acute gouty attacks?
yes
what drug can you add with probenecid for relief? (I --> it's a NSAID)
you can add indomethacin with probenecid for relief
what must pt drink lots of while taking probenecid?
pt must drink lots of water while taking probenecid
does pt need to take probenecid with food?
yes
what is the primary drug interaction that probenecid has? (A)
probenecid has a drug interaction with aspirin
how is pegloticase administered? (I)
pegloticase is administered via IV
pegloticase is indicated for __________ gout (C)
pegloticase is indicated for chronic gout
pegloticase is used as the __________ resort (L)
pegloticase is used as the last result
can pegloticase cause severe adverse effects?
yes
is pegloticase really expensive?
yes
is it hard to tolerate the IV infusion of pegloticase?
yes
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