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NRSG 106: Pharmacology > [Exam 1] Module 3: The Musculoskeletal System > Flashcards

[Exam 1] Module 3: The Musculoskeletal System Flashcards

1
Q

What is Rheumatoid Arthritis?

A

An inflammatory, systemic autoimmune disease of the joints and surrounding structures. Primarily affects synovial joints but can occur in any area with connective tissue

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2
Q

RA can result in

A

joint stiffness, pain, swelling, and deformity.

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3
Q

Goal of drug therapy for RA?

A

Decrease joint pain and inflammation and prevent disabling deformities

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4
Q

What is Osteoporosis?

A

Progressive disease that results in reduced bone mass, decrease bone density, and increased risk for fractures

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5
Q

Three main types of drugs to treat RA?

A

NSAIDS
Glucocorticoids

Disease-modifying antirheumatic drugs (DMARDS)

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6
Q

What are DMARDS?

A

Immunosuppressive drugs that decrease joint inflammation and joint dmage. Delay progression of RA

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7
Q

You initially give DMARDS with NSAIDS because

A

onset of DMARDS therapeutic effect may take weeks

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8
Q

Categories of DMARDs?

A

Nonbiologic (traditional) and biologic DMARDS

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9
Q

What are the four main drugs to prevent or treat osteoporosis?

A

Selective Estrogen REceptor Modulators (SERMs)

Biphosphonates

Calcitonin

Calcium Supplements

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10
Q

SERMs: Primary therapeutic use is

A

the prevention and treatment of postmenopausal osteoporosis.

Also for women at risk for estrogen-dependent or receptor positive cancer and had treatment for estrogen-dependent or receptor positive cancer

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11
Q

SERMs: Prototype Drugs?

A

Raloxifene (Evista) which is a Bone Resportion Inhibitor.

Tamoxifen (Nolvadex) was the first serm, but other used because it poses less risk of uterine cancer

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12
Q

SERMs: Expected Pharmacologic Action

A

Activate estrogen receptors in some tissues and block receptors in other tissues.

Decreases bone resorption and bone loss, maintaining bone mideral density.

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13
Q

SERMs and Expected Pharmacologic Action: Raloxifene blocks

A

access o estrogen receptors in breast tissue, making it valueable for clients with estrogen-dependent or positive cancer.

Raloxifene does not activate receptors in endometrium, while other SERMs do

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14
Q

SERMs: ADR of SERM drugs relate primarily to

A

activation of estrogen receptors

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15
Q

SERMs: Serious adverse effects of Raloxifene are

A

increased risk of stroke, pulmonary embolism, and deep vein thrombosis

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16
Q

SERMs: Clients may have what due to blockage of estrogen receptors in other tissue

A

Hot flashes

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17
Q

SERMs: Women pregnant or breastfeeding should not take this because

A

They are teratogenic and can damage a developing fetus.

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18
Q

SERMs: Interventions include monitoring

A

BMD

Observe for development of thrombo-emboli in either the lower legs or lungs such as leg cramps and difficulty breathing

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19
Q

SERMs: Interventions, Raloxifene can cause fluctuations in certain components of blood such as

A

cholesterol, hormones, and fibrinogen.

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20
Q

SERMs: Admisteration includes

A

taking orally and on a daily basis. Clients cna take them with or without food

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21
Q

SERMs: Client Instructions include

A

Consume Adequate amount of Calcium and Vitamin D

Perform daily weight bearing exercises

Avoid getting pregnant

If premenopausal and using raloxifene to prevent breast cancer, warn of hot flashes

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22
Q

SERMs: Client Instructions: Patients must report pain in the lower extremities, particualrly in calves or chest pain with difficulty breathing because it may indicate

A

a blood clot has formed in the leg and or traveled to the lungs

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23
Q

SERMs: Contraindications include

A

Having Raloxifene and Tamoxifen not be taken in pregnant women .

Client who develops DVT cannot take the drug .

Make sure those with elevated serum lipids use SERMS with caution

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24
Q

SERMs: Interactions: Because of increased risk for estrogen-supported cancers, concurrent admiistration of what is not recommended?

A

Estrogen.

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25
Q

Biphosphonates: Therapeutic use is for

A

prevention and treatment of postmenopausal osteoporosis in women, age-related osteoporisis in men, and glucocortioid related osteoporissi in clients who were on that long-term therapy

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26
Q

Biphosphonates: Prototype and Other Drugs

A

Prototype is Alendronsate (Fosamax) with Bone REsorption Inhibitor Class

Risedronate (Actonel)

Ibandronate (Boniva)

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27
Q

Biphosphonates: Expected Pharmacologic Action is

A

Drecrease bone resorption by inhibiting activity of osteoclasts

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28
Q

Biphosphonates: Adverse drug reactions include

A

GI Disturbances like Esophagitis, N/V, and Abdominal Pain

Muscle and Joint Pain may occur, managed by mild analgesic

Eye Pain and Vision Changes may occur

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29
Q

Biphosphonates: Client Instructions

A

Take with full glass of water, then sit or stand for 30 minutes , avoiding eating or drinking anything other than water for 30 minutes

Avoid taking calcium supplement or antaciad

Take mild analgesic for muscle or joint pain

Tell provider about difficulty swallowing or changes in vision

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30
Q

Biphosphonates: Contraindications include

A

Those with Esophageal Strictures or difficulty swallowing

Dont give to those who are unable to stand/sit for 30 minutes or those with hypocalcemia or renal insufficiency

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31
Q

Biphosphonates: Contraindications. give cautions to those who have other

A

upper GI disorders, active infection, liver disease, or heart failure

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32
Q

Biphosphonates: Interactions

A

Calcium supplement and dairy products decrease absorption of biphosphates so do not give them within 30 minutes of administration

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33
Q

Calcitonin: Unlike SERMs, biphosphonates and calcium supplements, this cannot prevent

A

osteoporisis

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34
Q

Calcitonin: Therapeutic uses are for

A

treating established postmenopausal osteoporsis, as well as hypercalcemia secondary to hyperparathyroidism and Pagets disease

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35
Q

Calcitonin: Prototype and Other Drugs

A

Calcitonin-Salmon (Miacalcin, Calcimar) which is a Hypocalcemic

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36
Q

Calcitonin: Expected Pharmacologic Action

A

Decrease Bone Resorption by inhibiting action of osteoclasts and increasing excretion of Calcium

Also valueable in decreasing serum calcium in clients who are experiecing hypercalcemia

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37
Q

Calcitonin: Adverse Drug Reactions: Anaphylaxis can occur in clients with allergy to

A

Salmon protein or gelatin diluent

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38
Q

Calcitonin: Adverse Drug Reactions: Becauses calcitonin increased real excretion of calcium…

A

hypocalcemia can occur if excretion exceeds intake.

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39
Q

Calcitonin: Adverse Drug Reactions: Clients taking nasal form may experience

A

nasal dryness and irritation with therapy along with headaches

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40
Q

Calcitonin: Adverse Drug Reactions: Clients taking injectable form may experience

A

injection site reactions, N/V, Polyuria.

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41
Q

Calcitonin: Adverse Drug Reactions: Experience decrease in therapeutic effect if

A

they take calcitonin over long period of time

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42
Q

Calcitonin: Interventions: What happens here?

A

If taken Intranasally, assess the nostrils prior to administration.

Monitor for Hypocalcemia like muscle spasms or tingling of fingers or toes.

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43
Q

Calcitonin: Interventions: When treating with calcitonin-salmon, provide diet high in

A

calcium and vitamin d to prevent hypocalcemia from occurin g

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44
Q

Calcitonin: Interventions Safety Alert

A

Anaphylatic shock can occur in clients allergic to salmon or other fish

Perform allergy test prior to therapy

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45
Q

Calcitonin: Administration: Instructions

A

Intranasal: Hold nasal pump in upright manner. Spray in one nostril and alternate on daily basis.

Subcutaneous: Rotate injection sites

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46
Q

Calcitonin: Administration: Precautions for Parenteral Calcitonin?

A

Keep from light and keep it in a refrigerator

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47
Q

Calcitonin:Client Instructions:

A

Intranasally: Prime the pump for each new container prior to first use. Alternate nostril daily.

Notify immediately if rash or itching occurs.

Encourage consumption of diet high in calcium and vitamin D.

May lose effectiveness after a year or more

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48
Q

Calcitonin: Contraiindications and Precautions:

A

COntraindications include clients who are allergic to salmon or other fish protein

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49
Q

Calcitonin: Interactions

A

Those taking lithium may experience decrease in serum lithium levels.

Previous treatment with biphosphonates may decrease bodys response to calcitonin.

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50
Q

Calcium Supplements: Therapeutic uses include

A

Hypocalcemia and clients who either have a calcium deficiency or at risk of experiencing a calcium deficiency

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51
Q

Calcium Supplments: What is the primary component of several antacids that treat gastric hyperacidity?

A

Calcium Carbonate

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52
Q

Calcium Supplments: Prototype and OTher Drugs: Drug Classification

A

Mineral and Electrolyte Supplements

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53
Q

Calcium Supplments: Prototype and OTher Drugs: Two Prototypes are

A

Calcium Citrate (Citacal), which is used for calcium replacement as dietary supplements

Calcium Carbonate (Tums) but is primary on the market as an antacid

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54
Q

Calcium Supplements: Expected Pharmacologic Action: They are expected to provide

A

Non-dietary source of Calcium. Calcium effective in neutralizing gastric acid.

Often use with Vitamin D because it enhances absorption of calcium from intestine

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55
Q

Calcium Supplements: Adverse Drug Reactions: Clients who take calcium supplement or antacid on llong term basis or take vitamin D along with it are at risk for

A

Hypercalcemia

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56
Q

Calcium Supplements: Adverse Drug Reactions: Signs of hypercalcemia include

A

N/V, Constipation, Increased urine output, DEpression

57
Q

Calcium Supplements: Interventions: Periodically check

A

serum calcium and monitor for signs of decreased gastric and intesinal motility such as N/V and constipation.

Also monitor for urine output excess , flank pain, or blood in urine

58
Q

Calcium Supplements: Administration: Given either

A

orally or IV.

59
Q

Calcium Supplements: Administration: You give thois when?

A

One-2 hours after glucocorticoids, thyroid supplements and tetracycline and quinoline antibiotics

60
Q

Calcium Supplements: Administration: Give Calcium based antacids when

A

one hour after meals, with full glass of water to increase solubility. Administer same process again at bedtime

61
Q

Calcium Supplements: Client Instructions: Clients who take this are at risk for

A

hypercalcemia, and should teach them the signs and symptoms. Also report N/V, increased urine output and depression

62
Q

Calcium Supplements: Client Instructions: To prevent constipation, encourage

A

use of diet high in fiber,r and increase water consumption

63
Q

Calcium Supplements: Client Instructions: Instruct client to take the supplemental calcium drug at what time

A

1 hour before or 1-2 hours after glucocorticoids, thyroid supplements, and tatracycline and quinolone antibiotics

64
Q

Calcium Supplements: Client Instructions: Instruct to take calcium-based antacids when?

A

1 hour after measl and at bedtime

65
Q

Calcium Supplements: Client Instructions: Teach them how to take pill

A

Chew tablet before swallowing, drink a glass full of water and no more than 600 miligrams at one time

66
Q

Calcium Supplements: Conraindications and Precautions: Contraindicated for clients who jave

A

hypercalcemia or a low phosphate level . Calcium can icnrease to toxic level if supplemental calcium is given to cleint who have clacium level above expected range

67
Q

Calcium Supplements: Conraindications and Precautions: Clients with low phosphate level can experience

A

greater decrease if given supplemental calcium due to inverse relationship between calcium and phosphorus

68
Q

Calcium Supplements: Conraindications and Precautions: Contraindicated for patients who have

A

cardiac dysrhythmias

69
Q

Calcium Supplements: Interactions: What does Glucocorticoids do?

A

Decreases absorption of clacium supplement

70
Q

Calcium Supplements: Interactions: What does calcium supplement do to thyroid hormone, tetracycline or quinolone antibiotics?

A

Decreases absorption of all these drugs

71
Q

Calcium Supplements: Interactions: Clients on thiazide diuretics and calcium supplements are more likely to develop hypercalcemia because

A

decreased excretion of calcium.

72
Q

Nonbiologic DMARDs are

A

antimetabolite drugs, which exert their immunosuppressive effect by interfering with normal B and T Lymphocyte activity

73
Q

DMARD I - Prototype:

A

Methotrexate (Arava)

74
Q

DMARD I - Prototype: Since RA is an autoimmune disorder where antibodies attack aclients own tissue, DMARDS given to

A

suppress immune response

75
Q

DMARD I - Expected Phahrmacologic Action:

A

Immunosuppression. Can slow or stop progression of RA.

76
Q

DMARD I - Adverse Drug Reactions: Signs include

A

Dizziness, Headaches, Blurred Vision and N/V.

77
Q

DMARD I - Adverse Drug Reactions: Are Hepatotoxic, meaning

A

they cause liver damage

78
Q

DMARD I - Adverse Drug Reactions: Bone marrow suppression causes

A

decrease in platelets and red and WBCs. Icnreased risk for infection.

79
Q

DMARD I - Adverse Drug Reactions: Contrainidcated in what for women?

A

Pregnancy

80
Q

DMARD I - Interventions: Since it causes bone marrow suppression, monitor

A

RBC, WBC, and Platelets. If normal, still assess for signs and symptoms of infection

81
Q

DMARD I - Interventions: Since it messes with liver, monitor for

A

liver dysfunction and observe for jaundice.

82
Q

DMARD I - Administration: Can only administer how often?

A

Once a week.

83
Q

DMARD I - Administration: Can be given how?

A

Orally, subcutaneously , or IM

84
Q

DMARD I - Administration: Dosage?

A

Start at low level and increase as needed to provide maximum response.

85
Q

DMARD I - Administration: Giving daily can cause

A

serious side effects of immunosuppression.

86
Q

DMARD I - Client Instructions: Water level?

A

2 L per day to assist kidneys in excreting drugs reducing risk of renal damage.

87
Q

DMARD I - Client Instructions: Client should report what?

A

Yellowing of skin or eyes and signs or symptoms of infection such as fatigue, chills, fever

88
Q

DMARD I - Client Instructions: Fertility issues

A

Should be aware of this.

89
Q

DMARD I - Client Instructions (Safety Alert)

A

Should avoid ingesting alcohol. Toxic to the liver.

90
Q

DMARD I - COntraindications and Precautions: Take caution in giving to those with

A

bacterial or viral infections. Can also cause GI ulceration.

91
Q

DMARD I - Interactions: Digoxin

A

May reduce serum digoxin levels

92
Q

DMARD I - Interactions: NSAIDs, Salicylates or Sulfonammides

A

cause toxicity of these drugs

93
Q

DMARD I - Interactions: Caffeine

A

may reduce effectiveness of amthotrexate

94
Q

DMARD I - Interactions: Warfarin

A

may increase risk for bleeding

95
Q

DMARD I - Interactions: alcohol

A

increases cient risk of hepatotoxicity

96
Q

DMARD II - Prototype:

A

Entancercept (Enbrel)

97
Q

DMARD II - Expected Pharmacologic Action: Primary action is

A

inactivation of tumor necrosis factor (TNF) resulting in reduce dinflammation and immunosuppression.

98
Q

DMARD II - Expected Pharmacologic Action: What are these drugs? and prevent what?

A

Tumor NEcrosis Factor and are drugs that bind with naturally occuring tumor necrosis factor, preventing them from attaching to cells

99
Q

DMARD II - Expected Pharmacologic Action: PRevents it from

A

stimulating an inflammatory reaction in joints of clients with RA.

100
Q

DMARD II - Expected Pharmacologic Action: IF given with methotrexate,

A

effect enhanced

101
Q

DMARD II - Adverse Drug REactions: BEcause TNF helps fight against infections, suppression causes

A

clients susceptibility to infection to increase

102
Q

DMARD II - Adverse Drug REactions: Other side effects include

A

Dizzines, pharyngitis, upper respiratory infection, abdominal pain.

103
Q

DMARD II - Adverse Drug REactions: HF can occur in those with

A

previous history .

104
Q

DMARD II - Adverse Drug REactions: TB

A

TB can be reactivated

105
Q

DMARD II - Interventions: Monitor for

A

signs of infection. REaction at site occurs in 37% of those receiving this.

106
Q

DMARD II - Administration: DMARD II - Administration: This is given how often adn how

A

Subcutaneous injection once weekly

107
Q

DMARD II - Client Instructions: Tell client to report signs of

A

infection immediately along with skin rash

108
Q

DMARD II - Client Instructions: TNF and Vaccines

A

You now are at risk for acquiring or transmitting infections.

109
Q

DMARD II - Conraindications and Precautions: Contraindicated for those who have

A

acive infection, hematologi cidsease or malignancy

110
Q

DMARD II - Client Instructions: Not apporpriat for those who have

A

autoimmune demyelinating idsorders

111
Q

DMARD II - Interactions: Chemotherapeutic Drugs

A

Cause bone marrow suppression which results in decrease in platelets and RBC and WBCs

112
Q

DMARD II - Client Instructions: Anakinra

A

Increased risk of infection

113
Q

Cholinesterase Inhibitors - Prototype:

A

Neostigmine (Prostigmin)

114
Q

Cholinesterase Inhibitors - Theapeutic Use:

A

Given to patients with myasthenia grais to improve muscle strength and endurance

115
Q

Cholinesterase Inhibitors - Side Effects/Interventions/Patients Instructions for : Increased intenstial motility

A

Monitor for execessive diarrhea indicating toxicity

Inform patients to notify provider of excessive diarrhea

116
Q

Cholinesterase Inhibitors - Side Effects/Interventions/Patients Instructions for : Increased Salviation

A

Monitor for excessive salivtion indicating toxicity

Informed that its side effect, but not to report

117
Q

Cholinesterase Inhibitors - Side Effects/Interventions/Patients Instructions for : Bradycardia

A

Monitor all signs at beginning and notify if below 60 bpm

Teach how to take pulse

118
Q

Cholinesterase Inhibitors - Side Effects/Interventions/Patients Instructions for : Muscle WEakness and Respiraotry Paralysis (Indicates toxicity or inadequate dose)

A

Have Atropine ready to treat within 1 hour of neostigmine. Monitor ability to swallow.

Instruct to immediately instruct provider if occurs within 1 hour of taking

119
Q

Cholinesterase Inhibitors - Take drug with ..

A

small food and to eat 45-1 hour after taking drug

120
Q

Cholinesterase Inhibitors : Instruct patients to take drug when?

A

At same time every day

121
Q

Cholinesterase Inhibitors: Contraindications include obstruction of

A

bowel or urinary tract

122
Q

Cholinesterase Inhibitors: Precautions

A

Seizure Disorder

Hyperthyroidism

Peptic Ulcer Disease

Asthma

123
Q

Cholinesterase Inhibitors: Interactions

A

Neuromuscular blocking againsts interefere.

Decrease effects of nondepolarizing neuromuscular blocking agent.

Enhance effects of depolaizing neuromuscular blockings agents

124
Q

Cholinesterase Inhibitors: Administration

A

Take 1 hour before meals to strengthen muscles while eating. Take as same time.

IF weakness, adjust administration schedule

125
Q

Neuromuscular Blocking Agents - Prototype:

A

Succinylcholine (Anectine)

126
Q

Neuromuscular Blocking Agents - Therapeutic Use

A

Used during anesthesia to pormote relaxation

During electroconvulsive thehrapy to control seizures

COntrols spontaneous respirations and suppreses gag reflex

127
Q

Neuromuscular Blocking Agents - S.E./Intervention/Patient Instructions: Postoperative Muscle Pain

A

Administer mild analgesic

Explain that muscle pain is expected

128
Q

Neuromuscular Blocking Agents - S.E./Intervention/Patient Instructions: Hyperkalemia

A

Monitor potassium closely

129
Q

Neuromuscular Blocking Agents - S.E./Intervention/Patient Instructions: Hypotension

A

Monitor BP regularly anf give antihistamine for extremely low blood pressures

130
Q

Neuromuscular Blocking Agents - S.E./Intervention/Patient Instructions: Bradycardia and CArdiac Arrest / Respiratory Arrest

A

PRovide continuous cardiac and resp monitoring

If intubateed and on neuromuscular blocking agent, explain paralysis is temproary

131
Q

Neuromuscular Blocking Agents - S.E./Intervention/Patient Instructions: Malignant Hypertheremia

A

Immediatelt discontinue succinycholine , cool patient, administer dantrolene

132
Q

Neuromuscular Blocking Agents - Contraindications: Risk for

A

Hyperkalemia

133
Q

Neuromuscular Blocking Agents - Precautions:

A

Electrolyte Imablance
Myasthenia Gravis

Respiratory Depression

134
Q

Neuromuscular Blocking Agents - Interactions:

A

Nondepolarizing neuromucular blocking agent

135
Q

Neuromuscular Blocking Agents - Interactions: Aminoglycoside and Tetracycline antibiotics

A

enhance effects when its a nondepoliaring neuromuscular blocking agent. If its depolarizing, it enhances effects

136
Q

Neuromuscular Blocking Agents - Interactions: Cholinesterase Inhibitors

A

decreases effects when its a nondepoliaring neuromuscular blocking agent. If its depolarizing, it enhances effects

137
Q

Neuromuscular Blocking Agents - Administration

A

Usually given IV. For short procedures and dose based on weight

138
Q

Neuromuscular Blocking Agents - Administration: For prolonged paralysis, drug titrated by

A

infusion rate

NRSG 106: Pharmacology (14 decks)

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