[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
2
Q
RA can result in
A
joint stiffness, pain, swelling, and deformity.
3
Q
Goal of drug therapy for RA?
A
Decrease joint pain and inflammation and prevent disabling deformities
4
Q
What is Osteoporosis?
A
Progressive disease that results in reduced bone mass, decrease bone density, and increased risk for fractures
5
Q
Three main types of drugs to treat RA?
A
NSAIDS
Glucocorticoids
Disease-modifying antirheumatic drugs (DMARDS)
6
Q
What are DMARDS?
A
Immunosuppressive drugs that decrease joint inflammation and joint dmage. Delay progression of RA
7
Q
You initially give DMARDS with NSAIDS because
A
onset of DMARDS therapeutic effect may take weeks
8
Q
Categories of DMARDs?
A
Nonbiologic (traditional) and biologic DMARDS
9
Q
What are the four main drugs to prevent or treat osteoporosis?
A
Selective Estrogen REceptor Modulators (SERMs)
Biphosphonates
Calcitonin
Calcium Supplements
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
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
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.
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
14
Q
SERMs: ADR of SERM drugs relate primarily to
A
activation of estrogen receptors
15
Q
SERMs: Serious adverse effects of Raloxifene are
A
increased risk of stroke, pulmonary embolism, and deep vein thrombosis
16
Q
SERMs: Clients may have what due to blockage of estrogen receptors in other tissue
A
Hot flashes
17
Q
SERMs: Women pregnant or breastfeeding should not take this because
A
They are teratogenic and can damage a developing fetus.
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
19
Q
SERMs: Interventions, Raloxifene can cause fluctuations in certain components of blood such as
A
cholesterol, hormones, and fibrinogen.
20
Q
SERMs: Admisteration includes
A
taking orally and on a daily basis. Clients cna take them with or without food
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
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
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
24
Q
SERMs: Interactions: Because of increased risk for estrogen-supported cancers, concurrent admiistration of what is not recommended?
A
Estrogen.
25
Biphosphonates: Therapeutic use is for
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
26
Biphosphonates: Prototype and Other Drugs
Prototype is Alendronsate (Fosamax) with Bone REsorption Inhibitor Class
Risedronate (Actonel)
Ibandronate (Boniva)
27
Biphosphonates: Expected Pharmacologic Action is
Drecrease bone resorption by inhibiting activity of osteoclasts
28
Biphosphonates: Adverse drug reactions include
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
29
Biphosphonates: Client Instructions
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
30
Biphosphonates: Contraindications include
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
31
Biphosphonates: Contraindications. give cautions to those who have other
upper GI disorders, active infection, liver disease, or heart failure
32
Biphosphonates: Interactions
Calcium supplement and dairy products decrease absorption of biphosphates so do not give them within 30 minutes of administration
33
Calcitonin: Unlike SERMs, biphosphonates and calcium supplements, this cannot prevent
osteoporisis
34
Calcitonin: Therapeutic uses are for
treating established postmenopausal osteoporsis, as well as hypercalcemia secondary to hyperparathyroidism and Pagets disease
35
Calcitonin: Prototype and Other Drugs
Calcitonin-Salmon (Miacalcin, Calcimar) which is a Hypocalcemic
36
Calcitonin: Expected Pharmacologic Action
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
37
Calcitonin: Adverse Drug Reactions: Anaphylaxis can occur in clients with allergy to
Salmon protein or gelatin diluent
38
Calcitonin: Adverse Drug Reactions: Becauses calcitonin increased real excretion of calcium...
hypocalcemia can occur if excretion exceeds intake.
39
Calcitonin: Adverse Drug Reactions: Clients taking nasal form may experience
nasal dryness and irritation with therapy along with headaches
40
Calcitonin: Adverse Drug Reactions: Clients taking injectable form may experience
injection site reactions, N/V, Polyuria.
41
Calcitonin: Adverse Drug Reactions: Experience decrease in therapeutic effect if
they take calcitonin over long period of time
42
Calcitonin: Interventions: What happens here?
If taken Intranasally, assess the nostrils prior to administration.
Monitor for Hypocalcemia like muscle spasms or tingling of fingers or toes.
43
Calcitonin: Interventions: When treating with calcitonin-salmon, provide diet high in
calcium and vitamin d to prevent hypocalcemia from occurin g
44
Calcitonin: Interventions Safety Alert
Anaphylatic shock can occur in clients allergic to salmon or other fish
Perform allergy test prior to therapy
45
Calcitonin: Administration: Instructions
Intranasal: Hold nasal pump in upright manner. Spray in one nostril and alternate on daily basis.
Subcutaneous: Rotate injection sites
46
Calcitonin: Administration: Precautions for Parenteral Calcitonin?
Keep from light and keep it in a refrigerator
47
Calcitonin:Client Instructions:
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
48
Calcitonin: Contraiindications and Precautions:
COntraindications include clients who are allergic to salmon or other fish protein
49
Calcitonin: Interactions
Those taking lithium may experience decrease in serum lithium levels.
Previous treatment with biphosphonates may decrease bodys response to calcitonin.
50
Calcium Supplements: Therapeutic uses include
Hypocalcemia and clients who either have a calcium deficiency or at risk of experiencing a calcium deficiency
51
Calcium Supplments: What is the primary component of several antacids that treat gastric hyperacidity?
Calcium Carbonate
52
Calcium Supplments: Prototype and OTher Drugs: Drug Classification
Mineral and Electrolyte Supplements
53
Calcium Supplments: Prototype and OTher Drugs: Two Prototypes are
Calcium Citrate (Citacal), which is used for calcium replacement as dietary supplements
Calcium Carbonate (Tums) but is primary on the market as an antacid
54
Calcium Supplements: Expected Pharmacologic Action: They are expected to provide
Non-dietary source of Calcium. Calcium effective in neutralizing gastric acid.
Often use with Vitamin D because it enhances absorption of calcium from intestine
55
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
Hypercalcemia
56
Calcium Supplements: Adverse Drug Reactions: Signs of hypercalcemia include
N/V, Constipation, Increased urine output, DEpression
57
Calcium Supplements: Interventions: Periodically check
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
Calcium Supplements: Administration: Given either
orally or IV.
59
Calcium Supplements: Administration: You give thois when?
One-2 hours after glucocorticoids, thyroid supplements and tetracycline and quinoline antibiotics
60
Calcium Supplements: Administration: Give Calcium based antacids when
one hour after meals, with full glass of water to increase solubility. Administer same process again at bedtime
61
Calcium Supplements: Client Instructions: Clients who take this are at risk for
hypercalcemia, and should teach them the signs and symptoms. Also report N/V, increased urine output and depression
62
Calcium Supplements: Client Instructions: To prevent constipation, encourage
use of diet high in fiber,r and increase water consumption
63
Calcium Supplements: Client Instructions: Instruct client to take the supplemental calcium drug at what time
1 hour before or 1-2 hours after glucocorticoids, thyroid supplements, and tatracycline and quinolone antibiotics
64
Calcium Supplements: Client Instructions: Instruct to take calcium-based antacids when?
1 hour after measl and at bedtime
65
Calcium Supplements: Client Instructions: Teach them how to take pill
Chew tablet before swallowing, drink a glass full of water and no more than 600 miligrams at one time
66
Calcium Supplements: Conraindications and Precautions: Contraindicated for clients who jave
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
Calcium Supplements: Conraindications and Precautions: Clients with low phosphate level can experience
greater decrease if given supplemental calcium due to inverse relationship between calcium and phosphorus
68
Calcium Supplements: Conraindications and Precautions: Contraindicated for patients who have
cardiac dysrhythmias
69
Calcium Supplements: Interactions: What does Glucocorticoids do?
Decreases absorption of clacium supplement
70
Calcium Supplements: Interactions: What does calcium supplement do to thyroid hormone, tetracycline or quinolone antibiotics?
Decreases absorption of all these drugs
71
Calcium Supplements: Interactions: Clients on thiazide diuretics and calcium supplements are more likely to develop hypercalcemia because
decreased excretion of calcium.
72
Nonbiologic DMARDs are
antimetabolite drugs, which exert their immunosuppressive effect by interfering with normal B and T Lymphocyte activity
73
DMARD I - Prototype:
Methotrexate (Arava)
74
DMARD I - Prototype: Since RA is an autoimmune disorder where antibodies attack aclients own tissue, DMARDS given to
suppress immune response
75
DMARD I - Expected Phahrmacologic Action:
Immunosuppression. Can slow or stop progression of RA.
76
DMARD I - Adverse Drug Reactions: Signs include
Dizziness, Headaches, Blurred Vision and N/V.
77
DMARD I - Adverse Drug Reactions: Are Hepatotoxic, meaning
they cause liver damage
78
DMARD I - Adverse Drug Reactions: Bone marrow suppression causes
decrease in platelets and red and WBCs. Icnreased risk for infection.
79
DMARD I - Adverse Drug Reactions: Contrainidcated in what for women?
Pregnancy
80
DMARD I - Interventions: Since it causes bone marrow suppression, monitor
RBC, WBC, and Platelets. If normal, still assess for signs and symptoms of infection
81
DMARD I - Interventions: Since it messes with liver, monitor for
liver dysfunction and observe for jaundice.
82
DMARD I - Administration: Can only administer how often?
Once a week.
83
DMARD I - Administration: Can be given how?
Orally, subcutaneously , or IM
84
DMARD I - Administration: Dosage?
Start at low level and increase as needed to provide maximum response.
85
DMARD I - Administration: Giving daily can cause
serious side effects of immunosuppression.
86
DMARD I - Client Instructions: Water level?
2 L per day to assist kidneys in excreting drugs reducing risk of renal damage.
87
DMARD I - Client Instructions: Client should report what?
Yellowing of skin or eyes and signs or symptoms of infection such as fatigue, chills, fever
88
DMARD I - Client Instructions: Fertility issues
Should be aware of this.
89
DMARD I - Client Instructions (Safety Alert)
Should avoid ingesting alcohol. Toxic to the liver.
90
DMARD I - COntraindications and Precautions: Take caution in giving to those with
bacterial or viral infections. Can also cause GI ulceration.
91
DMARD I - Interactions: Digoxin
May reduce serum digoxin levels
92
DMARD I - Interactions: NSAIDs, Salicylates or Sulfonammides
cause toxicity of these drugs
93
DMARD I - Interactions: Caffeine
may reduce effectiveness of amthotrexate
94
DMARD I - Interactions: Warfarin
may increase risk for bleeding
95
DMARD I - Interactions: alcohol
increases cient risk of hepatotoxicity
96
DMARD II - Prototype:
Entancercept (Enbrel)
97
DMARD II - Expected Pharmacologic Action: Primary action is
inactivation of tumor necrosis factor (TNF) resulting in reduce dinflammation and immunosuppression.
98
DMARD II - Expected Pharmacologic Action: What are these drugs? and prevent what?
Tumor NEcrosis Factor and are drugs that bind with naturally occuring tumor necrosis factor, preventing them from attaching to cells
99
DMARD II - Expected Pharmacologic Action: PRevents it from
stimulating an inflammatory reaction in joints of clients with RA.
100
DMARD II - Expected Pharmacologic Action: IF given with methotrexate,
effect enhanced
101
DMARD II - Adverse Drug REactions: BEcause TNF helps fight against infections, suppression causes
clients susceptibility to infection to increase
102
DMARD II - Adverse Drug REactions: Other side effects include
Dizzines, pharyngitis, upper respiratory infection, abdominal pain.
103
DMARD II - Adverse Drug REactions: HF can occur in those with
previous history .
104
DMARD II - Adverse Drug REactions: TB
TB can be reactivated
105
DMARD II - Interventions: Monitor for
signs of infection. REaction at site occurs in 37% of those receiving this.
106
DMARD II - Administration: DMARD II - Administration: This is given how often adn how
Subcutaneous injection once weekly
107
DMARD II - Client Instructions: Tell client to report signs of
infection immediately along with skin rash
108
DMARD II - Client Instructions: TNF and Vaccines
You now are at risk for acquiring or transmitting infections.
109
DMARD II - Conraindications and Precautions: Contraindicated for those who have
acive infection, hematologi cidsease or malignancy
110
DMARD II - Client Instructions: Not apporpriat for those who have
autoimmune demyelinating idsorders
111
DMARD II - Interactions: Chemotherapeutic Drugs
Cause bone marrow suppression which results in decrease in platelets and RBC and WBCs
112
DMARD II - Client Instructions: Anakinra
Increased risk of infection
113
Cholinesterase Inhibitors - Prototype:
Neostigmine (Prostigmin)
114
Cholinesterase Inhibitors - Theapeutic Use:
Given to patients with myasthenia grais to improve muscle strength and endurance
115
Cholinesterase Inhibitors - Side Effects/Interventions/Patients Instructions for : Increased intenstial motility
Monitor for execessive diarrhea indicating toxicity
Inform patients to notify provider of excessive diarrhea
116
Cholinesterase Inhibitors - Side Effects/Interventions/Patients Instructions for : Increased Salviation
Monitor for excessive salivtion indicating toxicity
Informed that its side effect, but not to report
117
Cholinesterase Inhibitors - Side Effects/Interventions/Patients Instructions for : Bradycardia
Monitor all signs at beginning and notify if below 60 bpm
Teach how to take pulse
118
Cholinesterase Inhibitors - Side Effects/Interventions/Patients Instructions for : Muscle WEakness and Respiraotry Paralysis (Indicates toxicity or inadequate dose)
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
Cholinesterase Inhibitors - Take drug with ..
small food and to eat 45-1 hour after taking drug
120
Cholinesterase Inhibitors : Instruct patients to take drug when?
At same time every day
121
Cholinesterase Inhibitors: Contraindications include obstruction of
bowel or urinary tract
122
Cholinesterase Inhibitors: Precautions
Seizure Disorder
Hyperthyroidism
Peptic Ulcer Disease
Asthma
123
Cholinesterase Inhibitors: Interactions
Neuromuscular blocking againsts interefere.
Decrease effects of nondepolarizing neuromuscular blocking agent.
Enhance effects of depolaizing neuromuscular blockings agents
124
Cholinesterase Inhibitors: Administration
Take 1 hour before meals to strengthen muscles while eating. Take as same time.
IF weakness, adjust administration schedule
125
Neuromuscular Blocking Agents - Prototype:
Succinylcholine (Anectine)
126
Neuromuscular Blocking Agents - Therapeutic Use
Used during anesthesia to pormote relaxation
During electroconvulsive thehrapy to control seizures
COntrols spontaneous respirations and suppreses gag reflex
127
Neuromuscular Blocking Agents - S.E./Intervention/Patient Instructions: Postoperative Muscle Pain
Administer mild analgesic
Explain that muscle pain is expected
128
Neuromuscular Blocking Agents - S.E./Intervention/Patient Instructions: Hyperkalemia
Monitor potassium closely
129
Neuromuscular Blocking Agents - S.E./Intervention/Patient Instructions: Hypotension
Monitor BP regularly anf give antihistamine for extremely low blood pressures
130
Neuromuscular Blocking Agents - S.E./Intervention/Patient Instructions: Bradycardia and CArdiac Arrest / Respiratory Arrest
PRovide continuous cardiac and resp monitoring
If intubateed and on neuromuscular blocking agent, explain paralysis is temproary
131
Neuromuscular Blocking Agents - S.E./Intervention/Patient Instructions: Malignant Hypertheremia
Immediatelt discontinue succinycholine , cool patient, administer dantrolene
132
Neuromuscular Blocking Agents - Contraindications: Risk for
Hyperkalemia
133
Neuromuscular Blocking Agents - Precautions:
Electrolyte Imablance
Myasthenia Gravis
Respiratory Depression
134
Neuromuscular Blocking Agents - Interactions:
Nondepolarizing neuromucular blocking agent
135
Neuromuscular Blocking Agents - Interactions: Aminoglycoside and Tetracycline antibiotics
enhance effects when its a nondepoliaring neuromuscular blocking agent. If its depolarizing, it enhances effects
136
Neuromuscular Blocking Agents - Interactions: Cholinesterase Inhibitors
decreases effects when its a nondepoliaring neuromuscular blocking agent. If its depolarizing, it enhances effects
137
Neuromuscular Blocking Agents - Administration
Usually given IV. For short procedures and dose based on weight
138
Neuromuscular Blocking Agents - Administration: For prolonged paralysis, drug titrated by
infusion rate
