Bone Medications

Question 1

Rheumatoid Arthritis

Answer 1

• 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

Question 2

Disease-Modifying Antirheumatic Drugs (DMARDs) I

Answer 2

1) slow joint degeneration and progression of rheumatoid arthritis
2) DMARD I: major nonbiologic DMARDs
- methotrexate (Rheumatrex)
- hydroxychloroquine (Plaquenil)
- sulfasalazine (Azulfidine)
- minocycline (Minocin)

Question 3

DMARD II: Major Biologic DMARDs

Answer 3

1) etanercept (Enbrel)
2) infliximab (Remicade)
3) adalimumab (Humira)

Question 4

DMARD III: Major Nonbiologic DMARDs

Answer 4

1) gold salts
2) penicillamine (Cuprimine)
3) azathioprine (Imuran)

Question 5

DMARDs: Complications

Answer 5

1) hepatic dysfunction
2) GI ulceration
3) Death
4) congenital abnormalities
5) bone marrow suppression
6) toxicity

Question 6

DMARDs: nursing interventions

Answer 6

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

Question 7

DMARDs: client education

Answer 7

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

Question 8

Glucocorticoids

Answer 8

• provide symptomatic relief of inflammation and pain

- prednisone (Deltasone)

Question 9

Glucocorticoids: complications

Answer 9

1) increased risk for infection
2) osteoporosis
3) adrenal suppression
4) fluid retention
5) GI ulceration
6) hyperglycemia
7) hypokalemia

Question 10

Glucocorticoids: nursing interventions

Answer 10

1) monitor for signs of infectin
2) monitor for sings of fluid excess
3) monitor blood glucose level
4) monitor potassium levels

Question 11

Glucocorticoids: client education

Answer 11

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

Question 12

Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

Answer 12

provide rapid symptomatic relief of inflammation and pain

• aspirin
• ibuprofin
• indomethacin (Indocin)
• naproxen (Naprosyn)

Question 13

NSAIDs: complications

Answer 13

1) GI upset
2) GI bleeding
3) bone marrow depression
4) anemia
5) thrombocytopenia

Question 14

NSAIDs: nursing interventions

Answer 14

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

Question 15

NSAIDs: client education

Answer 15

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

Question 16

Bone Disorders: medications

Answer 16

1) medications that affect bones:
- prevention and treatment of osteoporosis
- prevention of fractures
2) medication classifications:
- calcium supplements
- selective estrogen receptor modulators
- bisphosphonates
- calcitonin

Question 17

Calcium Supplements

Answer 17

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

Question 18

Calcium Supplements: client education

Answer 18

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

Question 19

Selective Estrogen Receptor Modulators

Answer 19

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

Question 20

Selective Estrogen Receptor Modulators:
Raloxifene (Evista)
complications

Answer 20

1) increases risk for PE and DVT

2) hot flashes

Question 21

Selective Estrogen Receptor Modulators: client education

Answer 21

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

Question 22

Bisphosphonates

Answer 22

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)

Question 23

Bisphosphonates: complications

Answer 23

1) esophagitis
2) nausea
3) diarrhea or constipation
4) musculoskeletal pain
5) blurred vision
6) osteonecrosis of jaw with IV infusion

Question 24

Bisphosphonates: client education

Answer 24

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

Question 25

Calcitonin

Answer 25

1) decreases bone resorption by inhibiting activity of osteoclasts in osteoporosis
2) increases renal calcium excretion by inhibiting tubular resorption
3) calcitonin (Forical, Miacalcin)

Question 26

Calcitonin: complications

Answer 26

1) nausea

2) with intranasal route–nasal dryness and irritation

Question 27

Calcitonin: nursing interventions

Answer 27

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