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Pharmacology > Drugs For Bone And Joint Disorders > Flashcards

Drugs For Bone And Joint Disorders Flashcards

1
Q

What is Rheumatoid Arthritis?

A

A chronic, progressive autoimmune disease that causes inflammation in the joints.

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2
Q

What are three types of drugs that are used in the treatment of Rheumatoid Arthritis? What is the pharmacological goal of these drugs?

A

NSAIDs, corticosteroids, and DMARDs are used to treat RA.

The goal is to manage inflammation, reduce pain, and maximize physical abilities.

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3
Q

The nurse educator knows that the student nurses understand contraindications and adverse effects of Calcitriol when they list which options?

A

Contraindications:
- Hypercalcemia
- Vitamin D Toxicity

A/E:
- GI (N/V, dry mouth, metallic taste, constipation)
- Hypercalcemia

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4
Q

What are the adverse effects of Calcitonin Salmon?

A
  • Flushing of the face/hands/rash
  • Hypocalcemia
  • Nasal dryness
  • Site reaction
  • Anaphylaxis (need to do intradermal testing)
  • Decreased therapeutic effects over time
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5
Q

What are the adverse effects of alendronate?

A
  • Hypocalcemia
  • GI: n/v, constipation, esophagitis, esophageal ulceration
  • Osteonecrosis of the jaw
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6
Q

What are the adverse effects of raloxifene?

A
  • Increased risk of thromboembolic events (PE and DVT)
  • Hot flashes
  • Endometrial Cancer
  • Box Warning: Thromboembolism
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7
Q

When educating the patient about methotrexate or hydroxychloroquine, the nurse knows that they should warn them about which adverse effects?

A
  • Liver damage
  • Bone marrow suppression
  • GI ulcers
  • Pulmonary fibrosis
  • Eye damage
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8
Q

The registered nurse knows that the student nurses are competent about contraindications and precautions regarding methotrexate when they list which options?

A
  • Active infection
  • Liver/renal insufficiency
  • Visual field damage
  • Allergy
  • Pregnancy/lactation
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9
Q

An antihypercalcemic agent is _________. It works in the body by __________. The appropriate routes are available _____, _____, and _____.

A
  1. Calcitonin Salmon
  2. Acts like calcitonin that the thyroid gland secretes, inhibits bone resorption, decreases Ca levels while increasing excretion of phosphate, calcium, and sodium from kidneys.
  3. Routes: SC, IM, and Intranasal
    - if using intranasal, alternate nostrils.
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10
Q

The patient tells the nurse they’ve been taking alendronate in the morning with breakfast and her multivitamin. What should the nurse educate the client about related to drug interactions?

A
  • Need to take on an empty stomach
  • Need to take 30 minutes before other medications
  • Take it with a full glass of water
  • Remain upright for 30 minutes and avoid drinking or eating anything other than water after taking the medication
  • Diet needs vitamin d, calcium, and phosphates
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11
Q

What are the contraindications of raloxifene?

A
  • Allergy
  • History of Thromboembolism
  • Pregnancy/Lactation
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12
Q

Why are DMARDs chosen for treatment of RA? What are some important details the nurse and client should be aware of regarding DMARDs?

A

Chosen because:
- they reduce mortality rates
- improve s/s
- enhance quality of life
- aggressively affect inflammation process

Details to be aware of:
- they are very toxic and need monitoring
- takes several months to reach therapeutic effects, so it’s usually taken with an NSAID
- usually started within 3 months of an RA diagnosis

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13
Q

What are the contraindications for etanercept?

A
  • Pregnancy/Lactation
  • Active Infection
  • TB
  • Allergy
  • Cancer
  • Hepatitis
  • Myelosuppression
  • Demyelinating Disorders like MS
  • Allergy to Chinese Hamster Ovary Products
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14
Q

The nurse is educating the patient with RA about etanercept, what adverse effects will the nurse educate on?

A
  • Box Warning: medication may activate latent TB and there’s increased risk of fatal infections, lymphoma, and etc.
  • increased risk for infections
  • increased injection site reactions
  • CV: MI, HF, hypotension
  • May cause demyelinating disorders like MS
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15
Q

What are the contraindications with Calcium Citrate and Calcium Bicarbonate?

A
  • Cardiac Dysrhythmias
  • Kidney Stones
  • Hypercalcemia
  • Low Phosphate Levels
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16
Q

The adverse effects of Calcium Supplements include?

A
  • Hypercalcemia (N/V, constipation, polyuria, depression)
  • Constipation
  • Kidney Stones
  • IV: pain, hypotension, sensations of heat waves, fainting, dysrhythmias
17
Q

DMARDs I (Nonbiologics)

What are the 2 prototypes and how does this drug aid in the treatment of RA?

A

Prototypes: methotrexate and hydroxychloroquine

MOA:
- interferes with production of lymphocytes or antibodies that stimulate the immune response
- slows/stops progression of RA
- affects process of inflammation and normal metabolic processes
- results in immunosuppression

18
Q

The 84-year-old female client states that she has been taking an antacid with methotrexate and NSAIDs. What should the nurse provide education on regarding drug-drug interactions?

A
  • Antacids prevent absorption of methotrexate and should be taken 2 hours before or after other medications.
  • Hepatotoxic drugs should be avoided or used with caution.
  • Alcohol should also be avoided to decrease the risk of hepatotoxicity.
19
Q

The patient asks the nurse about taking etanercept and receiving the Nasal Flu Vaccine. What should the nurse educate this client on when it comes to drug interactions?

A

While taking etanercept patients should avoid:
- Other immunosuppressant drugs
- Live Vaccines: MMR, Nasal Flu, and Varicella

Both can cause more immunosuppression

20
Q

DMARDS III (Nonbiologic & Biologic)

What is used in this category of DMARDs and how does this drug work? Why are DMARDS III not used very often?

A

Gold therapy is used and can be known as Chrysotherapy.

Gold is taken up by macrophages which inhibits phagocytosis and decreases tissue damage.

DMARDS III are not used very often because they are the most toxic.

21
Q

Which 4 main classes of drugs are used to treat Osteoporosis? Which age group should be targeted for treatment? And what are the goals of these classes?

A

4 Main Classes:
1. Calcium Supplements
2. Calcitonin
3. Bisphosphonates
4. Selective Estrogen Receptor Modifiers (SERMs)

School-aged children should be targeted.

Goals are to prevent excessive loss of calcium and prevent fractures.

22
Q

Calcium Supplements

What are the 2 prototypes for this drug class? What is the action of the drug and appropriate routes?

A

Prototypes: calcium bicarbonate and calcium citrate

MOA: increase or restore serum calcium levels

Routes: IV and PO

23
Q

The patient asks, “so how much am I supposed to take when it comes to my calcium supplement, and why do I need to take vitamin D?”

A

Calcium Supplement: 1000-1200 mg/day

Need to take Vitamin D because it enhances absorption of calcium in the intestines.

24
Q

The 54-year-old patient is currently using calcium supplements. She tells the nurse that she’s been eating a grand amount of spinach and whole-grain bread. The nurse knows that they must re-educate this patient about drug interactions. What will be included in re-education?

A

Food Interactions:
- Zinc-rich foods can decrease Calcium absorption (spinach, Swiss chard, whole grain bread, and cereals).

Drugs:
- Calcium decreases the absorption of thyroid hormones and some Antibiotics
- Calcium supplements should be taken 1 hour before or 2 hours after other medications.

25
Q

Vitamin D can also be known as _____? and it works in the body by _____. The appropriate routes are ___ and ___.

A

Calcitriol

MOA: increases Ca levels, decreases elevated phosphorus, and decreases bone resorption.

Routes: PO and IV

26
Q

The patient asks the nurse if she can still eat salmon while taking calcitonin. The nurse re-educates her on contraindications.

A

She can still eat salmon as long as she does not have an allergy to salmon, fish protein, or the drug itself.

If lactating, the drug will stop lactation and may cause hypocalcemia in babies.

27
Q

Bisphosphonates

What is the prototype? How does this drug work and what are the appropriate routes?

A

Prototype: Alendronate

MOA: decreases bone resorption by decreasing actions of osteoclast.

Routes: PO

28
Q

SERMS

What is the prototype and how does this drug work?

A

Prototype: Raloxifene

MOA:
- activates estrogen receptors in endometrial tissue and bone
- decreases bone resorption/loss
- blocks access to estrogen receptors in breast tissue

29
Q

The patient asks, “is there anything else I should know about while taking methotrexate?”. The nurse should inform the client about 4 important actions which include?

A
  1. Need to have a routine eye exam
  2. Drink 8-12 8oz glasses of water daily
  3. Methotrexate is a category X drug and patients should be on contraceptives. If they d/c the drug, they need to wait 6 months before trying to conceive.
  4. Should be taking a folic acid supplement weekly.
30
Q

DMARDS II (Biologics)

What is the prototype and how does this drug work?

A

Prototype: etanercept

MOA:
- inactivates tumor necrosis factor
- TNF can’t attach to cells on synovial joints
- results in immunosuppression and reduced inflammation

Pharmacology (16 decks)

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