Bone Medications Flashcards
Rheumatoid Arthritis
- pharmacological management provides symptomatic relief and some delay in disorder progression
- disease-modifying antirheumatic drugs (DMARDs)
- glucocorticoids and nonsteroidal anti-inflammatory drugs (NSAIDs) ma be used individually or in combination to treat this chronic disease
Disease-Modifying Antirheumatic Drugs (DMARDs) I
1) slow joint degeneration and progression of rheumatoid arthritis
2) DMARD I: major nonbiologic DMARDs
- methotrexate (Rheumatrex)
- hydroxychloroquine (Plaquenil)
- sulfasalazine (Azulfidine)
- minocycline (Minocin)
DMARD II: Major Biologic DMARDs
1) etanercept (Enbrel)
2) infliximab (Remicade)
3) adalimumab (Humira)
DMARD III: Major Nonbiologic DMARDs
1) gold salts
2) penicillamine (Cuprimine)
3) azathioprine (Imuran)
DMARDs: Complications
1) hepatic dysfunction
2) GI ulceration
3) Death
4) congenital abnormalities
5) bone marrow suppression
6) toxicity
DMARDs: nursing interventions
1) monitor liver function test
2) monitor CBC and platelet counts
3) monitor renal function including BUN and creatinine
4) monitor for bleeding, bruising, or fever
DMARDs: client education
1) observe for anorexia, abdominal fullness, and jaundice. Notify provider if symptoms occur.
2) take medications with food or full glass of water
3) recognize manifestations of GI ulcers
4) avoid use during pregnancy
5) monitor for and notify provider of indications of infection
Glucocorticoids
- provide symptomatic relief of inflammation and pain
- prednisone (Deltasone)
Glucocorticoids: complications
1) increased risk for infection
2) osteoporosis
3) adrenal suppression
4) fluid retention
5) GI ulceration
6) hyperglycemia
7) hypokalemia
Glucocorticoids: nursing interventions
1) monitor for signs of infectin
2) monitor for sings of fluid excess
3) monitor blood glucose level
4) monitor potassium levels
Glucocorticoids: client education
1) notify provider if symptoms of infection occur
2) do not discontinue medication suddenly
3) notify provider if symptoms of ulcer occur
4) recognize symptoms of hyperglycemia
5) eat low-sodium, high-potassium diet
Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
provide rapid symptomatic relief of inflammation and pain
- aspirin
- ibuprofin
- indomethacin (Indocin)
- naproxen (Naprosyn)
NSAIDs: complications
1) GI upset
2) GI bleeding
3) bone marrow depression
4) anemia
5) thrombocytopenia
NSAIDs: nursing interventions
1) assess for contraindications: hypersensitivity, GI disorders, pregnancy, anticoagulant therapy
2) assess for signs of toxicity: tinnitus, decreased hearing, nausea, vomiting, confusion, lethargy
3) discontinue use 24-48 hr before surgery
4) monitor CBC including WBC, RBC, platelets, and H&H for sings of blood dyscrasias or bone marrow
NSAIDs: client education
1) drink a full glass of water with medication
2) notify provider of signs of bleeding, bruising, tinnitus, or GI irritation
3) avoid alcohol while on NSAIDs
Bone Disorders: medications
1) medications that affect bones:
- prevention and treatment of osteoporosis
- prevention of fractures
2) medication classifications:
- calcium supplements
- selective estrogen receptor modulators
- bisphosphonates
- calcitonin
Calcium Supplements
1) maintenance of normal musculoskeletal, neurological and cardiovascular function
2) oral calcium supplements
- hypocalcemia
- deficiencies of parathyroid hormone, vitamin D, or dietary calcium
3) oral dietary supplements
- adolescents
- older adults
- women who are postmenopausal, pregnant, or breastfeeding
Calcium Supplements: client education
1) take calcium supplement at least 1 hr apart from glucocorticoids, tetracyclines, thyroid hormones
2) chewable tablets provide more consistent bioavailability
3) recommended doses of oral calcium vary depending on specific calcium preparation
4) follow provider prescription
Selective Estrogen Receptor Modulators
1) works as endogenous estrogen in bone, lipid metabolism, and blood coagulation
2) decreased bone resorption:
- slowing bone loss
- preserving bone mineral density
- prevents and treats postmenopausal osteoporosis
3) works as antagonist to estrogen on breast and endometrial tissue to protect against breast cancer
Selective Estrogen Receptor Modulators:
Raloxifene (Evista)
complications
1) increases risk for PE and DVT
2) hot flashes
Selective Estrogen Receptor Modulators: client education
1) consume adequate amounts of calcium and vitamin D
2) take medication with or without food once a day
3) undergo a bone density scan every 12-18 months
4) perform weight-bearing exercises daily
Bisphosphonates
1) decrease number and action of osteoclasts
2) inhibits bone resorption
3) prophylaxis and treatment of postmenopausal osteoporosis
4) medications:
- alendronate sodium (Fosamax)
- ibandronate sodium (Boniva)
- risedronate (Actonel)
- alendronate (Reclast)
Bisphosphonates: complications
1) esophagitis
2) nausea
3) diarrhea or constipation
4) musculoskeletal pain
5) blurred vision
6) osteonecrosis of jaw with IV infusion
Bisphosphonates: client education
1) take first thing in morning after getting out of bed
2) take oral medication on empty stomach
3) drink at least 8 oz water with tablets, at least 2 oz water with liquid
4) sit or ambulate for 30 min after taking medication
5) avoid calcium-containing foods/liquids/medications within 2 hr of taking alendronate
6) avoid chewing or sucking on tablet
7) perform weight-bearing exercises daily
8) notify provider of difficulty swallowing, painful swallowing, or new/worsening heartburn
9) if dose is skipped, wait until next day to take next dose. do not take skipped dose
10) tablets are prescribed once a day or once a week. liquid is prescribed once a week
11) have bone density scan every 12-18 months
12) have serum calcium level monitored. expected range 9.0-10.5 mg/dL
Calcitonin
1) decreases bone resorption by inhibiting activity of osteoclasts in osteoporosis
2) increases renal calcium excretion by inhibiting tubular resorption
3) calcitonin (Forical, Miacalcin)
Calcitonin: complications
1) nausea
2) with intranasal route–nasal dryness and irritation
Calcitonin: nursing interventions
1) calcitonin-salmon most commonly given by nasal spray
- can also be given IM or SC
- rotate injection sites to prevent inflammation
2) keep container in upright position
3) teach clients to alternate nostrils daily
4) check for Chvostek’s or Trousseau’s signs to monitor for hypocalcemia.
5) monitor client’s bone density scans periodically
6) encourage clients to consume diet high in calcium and vitamin D
