Lewis 68 - Musculoskeletal Problems Flashcards
MOA/Class
Prednisone, methylprednisolone
Steroids stabilize leukocytes (WBCs) preventing the release of intracellular chemical/inflammatory mediators
Restore/increase bronchial responsiveness to beta-adrenergic receptor stimulation
Systemic glucocorticoid/corticosteroid
Tucker 36
Side Effects
Prednisone, methylprednisolone
Growth suppression, elevated blood glucose, weight gain
GI upset (tolerated best in AM with food/milk)
Osteoporosis (long-term use)
Tucker 36
Nursing Considerations
Prednisone, methylprednisolone
Taper dose when stopping to prevent adrenal insufficiency
Tucker 36
Indications
Prednisone, methylprednisolone
Used to gain control of inflammatory musculoskeletal conditions.
Tucker 36
MOA/Class
ibuprofen, naproxen, ketorolac, indomethacin, celecoxib
Inhibit cyclooxygenase thus inhibiting inflammatory symptoms
NSAID
Tucker 16
Side Effects
ibuprofen, naproxen, ketorolac, indomethacin, celecoxib
GI upset/ulcers/bleeding, risk for thrombotic events
Tucker 16
Nursing Considerations
ibuprofen, naproxen, ketorolac, indomethacin, celecoxib
Monitor renal (and hepatic) function
Increased bleeding risk when combined with alcohol, anticoagulants, some herbals
Take with food
Misoprostol can help decrease risk for ulcers with chronic NSAID use
Stop NSAIDs several days prior to surgery/dental work
Celcoxib has less risk of GI irritation as it is a COX-2 inhibitor.
Tucker 16
Indications
ibuprofen, naproxen, ketorolac, indomethacin, celecoxib
Pain due to inflammation
Tucker 16
MOA/Class
cyclobenzaprine, tizanidine
Acts on the brainstem to decrease muscle spasms
Centrally-acting muscle relaxant
Tucker 25
Side Effects
cyclobenzaprine, tizanidine
CNS depression; may have some anticholinergic effects
Tucker 25
Nursing Considerations
cyclobenzaprine, tizanidine
Do not combine with alcohol or other CNS depressants.
Tucker 25
Indications
cyclobenzaprine, tizanidine
Short-term/intermittent treatment of acute muscle spasms/injuries.
Tucker 25
MOA/Class
duloxetine
Inhibits serotonin and norepinephrine reuptake in the CNS
SNRI
Tucker 21
Side Effects
duloxetine
Serotonin syndrome, neuroleptic malignant syndrome, Stevens-Johnson syndrome
Hepatotoxicity, drowsiness, constipation, dry mouth
Tucker 21
Nursing Considerations
duloxetine
Do not use within 14 days of MAOI medications
Taper dose to discontinue
Tucker 21
Indications
duloxetine
Antidepressant and nerve pain management
Tucker 21
MOA/Class
gabapentin
Unknown
Analgesic/anticonvulsant
Tucker 23
Side effects
gabapentin
Confusion, drowsiness, fatigue, ataxia
Tucker 23
Nursing Considerations
gabapentin
Increased risk of CNS depression when combined with alcohol
Tucker 23
Indications
gabapentin
Used for neuropathic pain and mood stabilization
Tucker 23
MOA/Class
tramadol
Binds to opioid and norepinphrine receptors to block pain signals.
Centrally-acting opioid serotonin/norepinephrine reuptake inhibitor
Tucker 26
Side Effects
tramadol
Dizziness, headache, constipation, serotonin syndrome, seizures
Tucker 26
Nursing Considerations
tramadol
Fluid and fiber to prevent constipation
(Analgesic effect is weaker than most opioids, but stronger than codeine)
Tucker 26
Indications
tramadol
Moderate pain
Tucker 26
MOA/Class
diazepam
Binds to GABA receptors to depress CNS activity and relax muscles.
Benzodiazepine
Tucker 20
Side Effects
diazepam
Drowsiness, vertigo, “hangover effect”
Tucker 20
Nursing Considerations
diazepam
Antidote: flumazenil
Avoid alcohol and other CNS depressants
Grapefruit increases effect/toxicity
Tucker 20
Indications
diazepam
Anxiety, muscle spasms, seizure management / status epilepticus
Tucker 20
MOA/Class
alendronate, zolendronate acid
Slows bone resorption (degeneration)
Tucker 37
Side Effects
alendronate, zolendronate acid
GI and musculoskeletal pain, constipation, esophageal burns
Tucker 37
Nursing Considerations
alendronate, zolendronate acid
Take on an empty stomach 30-60 minutes before food. Adminsitered with a full glass of water. Remain upright 30 minutes after administration.
Ensure adequate calcium intake during therapy.
Tucker 37
Indications
alendronate, zolendronate acid
osteoporosis, Paget’s disease, multiple myeloma, hypercalcemia
Tucker 37
MOA/Class
calcitonin
Mimics naturally thyroid-produced calcitonin
Inhibits osteoclasts (bone degeneration)
Calcimimetic
Tucker 37
Side Effects
calcitonin
Flushing, nausea, diarrhea, decreased appetite
Tucker 37
Nursing Considerations
calcitonin
Contraindicated with salmon allergy
Usually administered as a nasal spray - one spray daily; alternating nostrils.
Tucker 37
Indications
calcitonin
osteoporosis, Paget’s disease, multiple myeloma, hypercalcemia
Tucker 37
MOA/Class
raloxifene
Stimulates estrogen receptors in bones
Selective estrogen receptor modifier
Tucker 40
Side Effects
raloxifene
Hot flashes, leg cramps, increased risk for VTE, teratogenic
Tucker 40
Nursing Considerations
raloxifene
Contraindicated in pregnancy, during menopause, or with history of thrombotic disorder
Tucker 40
Indications
raloxifene
osteoporosis, reduction of breast cancer in post-menopausal patients
Tucker 40
