Joint/Bone

Question 1

Immunosuppressant/Antirheumatic #1

+ methotrexate (Rheumatrex)

Answer 1

INDICATIONS: Rheumatoid arthritis, psoriasis, cancers.

MODE OF ACTION: Inhibits folic acid metabolism, which prevents cell reproduction. This causes death of rapidly replicating cells. Also has immunosuppressive effect.

SIDE EFFECTS: INFECTION, hepatotoxicity, bone marrow suppression, GI upset.

KEY POINTS: Notify provider right away for any signs of infection. Monitor liver infection, CBC levels.

Question 2

Immunosuppressant/Antirheumatic #2

+ cyclosporine (Sandimmune)

Answer 2

INDICATIONS: Ulcerative colitis, autoimmune diseases (rheumatoid arthritis, psoriasis). Also used in the prevention of graft vs. host disease in transplant patients.

MODE OF ACTION: Inhibits normal immune response by blocking interleukin-2.

SIDE EFFECTS: INFECTIONS, hepatotoxicity, nephrotoxicity, GI upset, hirsutism.

KEY POINTS: Notify provider right away for any signs of infection. Monitor liver function, renal function.

Question 3

Selective Estrogen Receptor Modulator

+ raloxifene (Evista)

Answer 3

INDICATIONS: Postmenopausal osteoporosis. Also reduces risk of breast cancer.

MODE OF ACTION: Binds to estrogen receptors, decreasing bone resorption.

SODE EFFECTS: Increased risk for embolic event (PE, DVT, stroke), hot flashes, leg cramps.

KEY POITNS: Encourage increased intake of calcium and vitamin D, weight bearing exercises. Monitor bone density.

Question 4

Biphosphonates

+ alendronate (Fosamax)

Answer 4

INDICATIONS: Postmenopausal osteoporosis, Paget’s disease.

MODE OF ACTION: Prevents bone resorption by inhibiting osteoclast activity.

SIDE EFFECTS: ESOPHAGITIS, GI upset, muscle pain, visual disturbances.

KEY POINTS: TAKE ON EMPTY STOMACH IN THE MORNING WITH AT LAST 8 OZ OF WATER. SIT UPRIGHT (OR AMBULATE) FOR 30 MINUTES AFTER TAKING MEDICATION (to prevent esophageal ulceration). Encourage intake of calcium and vitamin D, weight bearing exercises. Monitor bone density.

Question 5

Calcitonin

+ calcitonin-salmon (Fortical)

Answer 5

INDICATIONS: Postmenopausal osteoporosis and hypercalcemia.

MODE OF ACTION: Prevents bone resorption by inhibiting osteoclast activity.

SIDE EFFECTS: GI upset, nasal irritation/dryness (if given via intranasal route).

KEY POINTS: Encourage intake of calcium and vitamin D, weight bearing exercises. Monitor bone density.