ATI section 10: Medication for the Musculoskeletal System

Question 1

Bisphosphonates

Answer 1

-dronate, dronic

-Therapeutic Use
Prevention and tx of osteoporosis
Paget’s disease
Hypercacemia related to malignancy

-Precautions/Interactions
Contraindicated during lactation
Clients who have esophageal stricture or difficulty swallowing may only use zoledronate
Absorption is decreased when taken with calcium supplements, antacids, OJ, and caffeine

-Side/Adverse Effects
Musculoskeletal pain
Esophagitis and GI discomfort
Jaw pain with zoledronate

-Nursing Interventions and Client Education
Administer medication in the morning on an empty stomach
Instruct client to consume at least 8 oz water
Client must remain upright (sitting or standing) for 30 min after taking medication
Consume adequate amounts of vitamin D

Question 2

Antirheumatics

DMARDs

Answer 2

• Methotrexate, Hydroxychloroquine, Etanercept, Infliximab, Adalimumab
• Interrupt complex immune responses, preventing disease progression

Question 3

Antirheumatics

Glucocorticoids

Answer 3

• Prednisone, Prednisolone

- Decrease inflammation by suppressing leukocyte and fibroblasts, and reversing capillary permeability

Question 4

Antirheumatics

NSAIDs

Answer 4

• Ibuprofen, Diclofenac, Indomethacin, Naproxen, Celeboxib

- Inhibit prostaglandin synthesis resulting in decreased inflammatory responses

Question 5

DMARDs

Answer 5

-Therapeutic use
Slow joint degeneration and progression of rheumatoid arthritis

-Precautions/Interactions
Methotrexate: Contraindicated in pregnancy, kidney or liver failure, psoriasis, alcohol use disorder, or hematologic discards

-Side/Adverse Effects
Methotrexate: increased risk of infection, bone marrow suppression, GI ulceration
Hydroxychloroquine: retinal damage (blindness)

-Nursing Interventions and Client Education
Instruct client about measures to prevent infection
Monitor liver function
Instruct client to use reliable contraception
Instruct client that initial effects may take several months
Administer with food
Instruct clients taking hydroxychloroquine about the critical importance of retinal

Question 6

Glucocorticoids

Answer 6

-Therapeutic use
Provide symptomatic relief of inflammation and pain

-Precautions/Interactions
Contraindicated in systemic fungal infection
Do not administer live virus vaccines during therapy
Should only be used for short duration

-Side/Adverse effects
Risk of infection
Osteoporosis
Adrenal suppression
Fluid retention
GI discomfort
Hyperglycemia
Hypokalemia

-Nursing Interventions and Client Education
Do not skip doses
Monitor BP
Monitor F&E balance and weight
Monitor for signs of bleeding, GI discomfort
Teach clients to take calcium supplements and maintain vitamin D levels
Give with food
Never stop abruptly
Provide immunoprotection

Question 7

NSAIDs

Answer 7

-Therapeutic Use
Provide rapid, symptomatic, relief of inflammation and pain

-Precautions/Interactions
Hypersensitivity to aspirin or other NSAIDs
May increase the risk of MI and stroke

-Side/Adverse Effects
GI discomfort
Renal impairment
Photosensitivity

-Nursing Interventions and Client Education
Administer with food and a full glass of water
Avoid lying down for 30 min after administration
Instruct client to use only as needed for symptoms to reduce risk of GI ulceration
Instruct client to use sunscreen

Question 8

Antigout Medications

Allopurinol

Answer 8

-Therapeutic Use

Chronic gouty arthritis

Question 9

Antigout Medications

Colchicine

Answer 9

-Therapeutic use

Acute gouty arthritis

Question 10

Antigout Medications

Answer 10

-Precautions/Interactions
Use caution in clients who have renal, cardiac, or GI dysfunction
Should not be combined with theophylline

-Side/Adverse Effects
GI distress
Hepatitis

-Nursing Interventions and ClienT Education
Instruct client to avoid foods high in purines to reduce uric acid
Monitor CBC and uric acid levels
Instruct clients to avoid aspirin
Administer with meals