Lewis 68 - Musculoskeletal Problems

Question 1

MOA/Class

Prednisone, methylprednisolone

Answer 1

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

Question 2

Side Effects

Prednisone, methylprednisolone

Answer 2

Growth suppression, elevated blood glucose, weight gain
GI upset (tolerated best in AM with food/milk)
Osteoporosis (long-term use)

Tucker 36

Question 3

Nursing Considerations

Prednisone, methylprednisolone

Answer 3

Taper dose when stopping to prevent adrenal insufficiency

Tucker 36

Question 4

Indications

Prednisone, methylprednisolone

Answer 4

Used to gain control of inflammatory musculoskeletal conditions.

Tucker 36

Question 5

MOA/Class

ibuprofen, naproxen, ketorolac, indomethacin, celecoxib

Answer 5

Inhibit cyclooxygenase thus inhibiting inflammatory symptoms

NSAID

Tucker 16

Question 6

Side Effects

ibuprofen, naproxen, ketorolac, indomethacin, celecoxib

Answer 6

GI upset/ulcers/bleeding, risk for thrombotic events

Tucker 16

Question 7

Nursing Considerations

ibuprofen, naproxen, ketorolac, indomethacin, celecoxib

Answer 7

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

Question 8

Indications

ibuprofen, naproxen, ketorolac, indomethacin, celecoxib

Answer 8

Pain due to inflammation

Tucker 16

Question 9

MOA/Class

cyclobenzaprine, tizanidine

Answer 9

Acts on the brainstem to decrease muscle spasms

Centrally-acting muscle relaxant

Tucker 25

Question 10

Side Effects

cyclobenzaprine, tizanidine

Answer 10

CNS depression; may have some anticholinergic effects

Tucker 25

Question 11

Nursing Considerations

cyclobenzaprine, tizanidine

Answer 11

Do not combine with alcohol or other CNS depressants.

Tucker 25

Question 12

Indications

cyclobenzaprine, tizanidine

Answer 12

Short-term/intermittent treatment of acute muscle spasms/injuries.

Tucker 25

Question 13

MOA/Class

duloxetine

Answer 13

Inhibits serotonin and norepinephrine reuptake in the CNS

SNRI

Tucker 21

Question 14

Side Effects

duloxetine

Answer 14

Serotonin syndrome, neuroleptic malignant syndrome, Stevens-Johnson syndrome
Hepatotoxicity, drowsiness, constipation, dry mouth

Tucker 21

Question 15

Nursing Considerations

duloxetine

Answer 15

Do not use within 14 days of MAOI medications
Taper dose to discontinue

Tucker 21

Question 16

Indications

duloxetine

Answer 16

Antidepressant and nerve pain management

Tucker 21

Question 17

MOA/Class

gabapentin

Answer 17

Unknown

Analgesic/anticonvulsant

Tucker 23

Question 18

Side effects

gabapentin

Answer 18

Confusion, drowsiness, fatigue, ataxia

Tucker 23

Question 19

Nursing Considerations

gabapentin

Answer 19

Increased risk of CNS depression when combined with alcohol

Tucker 23

Question 20

Indications

gabapentin

Answer 20

Used for neuropathic pain and mood stabilization

Tucker 23

Question 21

MOA/Class

tramadol

Answer 21

Binds to opioid and norepinphrine receptors to block pain signals.

Centrally-acting opioid serotonin/norepinephrine reuptake inhibitor

Tucker 26

Question 22

Side Effects

tramadol

Answer 22

Dizziness, headache, constipation, serotonin syndrome, seizures

Tucker 26

Question 23

Nursing Considerations

tramadol

Answer 23

Fluid and fiber to prevent constipation
(Analgesic effect is weaker than most opioids, but stronger than codeine)

Tucker 26

Question 24

Indications

tramadol

Answer 24

Moderate pain

Tucker 26

Question 25

# MOA/Class diazepam

Answer 25

Binds to GABA receptors to depress CNS activity and relax muscles. | Benzodiazepine ## Footnote Tucker 20

Question 26

# Side Effects diazepam

Answer 26

Drowsiness, vertigo, “hangover effect” ## Footnote Tucker 20

Question 27

# Nursing Considerations diazepam

Answer 27

Antidote: flumazenil Avoid alcohol and other CNS depressants Grapefruit increases effect/toxicity ## Footnote Tucker 20

Question 28

# Indications diazepam

Answer 28

Anxiety, muscle spasms, seizure management / status epilepticus ## Footnote Tucker 20

Question 29

# MOA/Class alendronate, zolendronate acid

Answer 29

Slows bone resorption (degeneration) ## Footnote Tucker 37

Question 30

# Side Effects alendronate, zolendronate acid

Answer 30

GI and musculoskeletal pain, constipation, esophageal burns ## Footnote Tucker 37

Question 31

# Nursing Considerations alendronate, zolendronate acid

Answer 31

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. ## Footnote Tucker 37

Question 32

# Indications alendronate, zolendronate acid

Answer 32

osteoporosis, Paget's disease, multiple myeloma, hypercalcemia ## Footnote Tucker 37

Question 33

# MOA/Class calcitonin

Answer 33

Mimics naturally thyroid-produced calcitonin Inhibits osteoclasts (bone degeneration) | Calcimimetic ## Footnote Tucker 37

Question 34

# Side Effects calcitonin

Answer 34

Flushing, nausea, diarrhea, decreased appetite ## Footnote Tucker 37

Question 35

# Nursing Considerations calcitonin

Answer 35

Contraindicated with salmon allergy Usually administered as a nasal spray - one spray daily; alternating nostrils. ## Footnote Tucker 37

Question 36

# Indications calcitonin

Answer 36

osteoporosis, Paget's disease, multiple myeloma, hypercalcemia ## Footnote Tucker 37

Question 37

# MOA/Class raloxifene

Answer 37

Stimulates estrogen receptors in bones | Selective estrogen receptor modifier ## Footnote Tucker 40

Question 38

# Side Effects raloxifene

Answer 38

Hot flashes, leg cramps, increased risk for VTE, teratogenic ## Footnote Tucker 40

Question 39

# Nursing Considerations raloxifene

Answer 39

Contraindicated in pregnancy, during menopause, or with history of thrombotic disorder ## Footnote Tucker 40

Question 40

# Indications raloxifene

Answer 40

osteoporosis, reduction of breast cancer in post-menopausal patients ## Footnote Tucker 40