MOBILITY MEDS Flashcards
What is the MOA of NSAIDs
blocks prostaglandin via Cox 1 and Cox 2
What is the first generation of NSAIDs
Ibuprofen (Advil) and Naproxen (Aleve)
What is the 2nd generation of NSAIDs
Celecoxib (Celebrex) —> slightly more GI protection (related to Sulfa)
What is another 1st generation of NSAIDs
ASA (Aspirin) —> prevention of MI/stroke inhibiting platelet aggregation (CI: <18yrs can develop Reye’s Syndrome
How does NSAIDs affect RA?
treat symptoms, rapid onset, often used with DMARDS (does not slow disease progression), higher doses than OTC recommendations
What are the adverse effects when Cox 1 is in inhibited?
gastric erosion/ulcertion
bleeding tendecies
renal impairment
What are the adverse effects when inhibiting Cox 2?
ONLY IN CELEBREX
- renal impairment
- promotion of MI and stroke (secondary to suppressing vasodilation)
What is a rare adverse effect with Ibuprofen?
Steven Johnson Syndrome —> blistering of the skin and mucous membranes
What are the nursing considerations of NSAIDs?
- best administered with food
- monitor kidney function
- monitor for adverse effects of HTN
- monitor for signs of bleeding
- CI: ALL NSAIDs —> PREGNANCY
What is the MOA of Prednisone (Deltasone —> Corticosteroids)?
mimics cortisol, potent anti-inflammatory and immunosuppressant, works rapidly (short term)
What are the indications for Prednisone?
treat autoimmune disorders —> eg. RA
What is the therapeutic effet of Prednisone?
suppression of the inflammatory and immune responses in autoimmune disorders
What does cortisol do to the body?
hormone produced by adrenal glands
- reduces inflammation
- increases blood sugar
- increases blood pressure
What is the adverse effects of Prednisone?
- fluid retention
- hypokalemia
- mood swings, pyschological and behavioural changes
- weight gain
- hyperglycemia
- increased risk of infection
- slow wound healing, bruising
- peptic ulcers
- osteoporosis
What are the contraindications and precautions of Prednisone?
active infection, existing peptic ulcer, hypersensitivity
NOTE: should not be taken for long term (can cause adrenal suppression) —> taper dose overtime
What are the nursing considerations and assessments of prednisone?
monitor I/Os
monitor serum electrolytes and glucose
monitor for improvement of disorder symptoms
assess for edema, daily weight, auscultate lungs, skin lungs
administer with meals —> prevent GI irritation
pts should increase foods with calcium and potassium
NOTE: adrenal insufficiency —> anorexia, N/V, weakness, fatigue, dyspnea, low blood pressure, hypoglycemia, Pts should not skip doses
What is the MOA of Methotrexate (Rhematrex)
- interferes w/ folic acid metabolism –> inhibiting DNA synthesis and cells reproduction
- immunosuppressive –> suppresses T/B lymphocyte activity
- kills rapidly dividing cells
What is the classification of Methotrexate (Rhematrex)?
Disease modifying antirheumatic drug (DMARD)
What cells rapidly divide?
skin, nails, hair, GI mucosa, bone marrow, reproductive cells
What are the indication for Methotrexate (Rhematrex)?
RA, psoriasis, diff. types of cancer
What is the therapeutic effect of Methotrexate (Rhematrex)?
slows the disease progression of RA
- fast-acting –> therapeutic effects seen within 3-6 weeks
What are the adverse effects of Methotrexate (Rhematrex)?
- hepatic fibrosis
- bone marrow suppression –> risk for bleeding, infection, anemia
- GI ulceration
- pneumonitis
What are the CI and precautions of Methotrexate (Rhematrex)?
- hypersensitivity
- immunosuppression
- hepatic impairment
- pregnancy/breast feeding
Precautions: renal impairment, active infection
What are the nursing considerations and assessments for Methotrexate (Rhematrex)?
assess:
- vital signs
- GI –> monitor for diarrhea, pain, stomatitis
- signs of pulmonary toxicity (dry cough - early sign !!)
monitor:
- signs of bone marrow suppression (bleeding gums, bruising, petechiae, melena, hematuria, hematemesis, fatigue, SOB)
- I/Os, weight
- liver enzymes, CBC
Nursing consideration: administer antiemetic prophylactically
What are the classifications of Infliximab (Remicade)?
DMARD, tumor necrosis factor antagonist (TNF)
What is the role of TNF in RA?
promotes infiltration of neutrophils and macrophages –> resulting in inflammation and joint destruction
What is the MOA of Infliximab (Remicade)?
neutralizes TNF (immune mediator in RA) –> suppresses inflammation
What are the indications for Infliximab (Remicade)?
active RA, active crohn’s disease, psoriasis, ankylosing spondylitis
What is the therapeutic effect of Infliximab (Remicade)?
decreased pain/swelling, decreased rate of joint destruction, and improved physical function
What are the adverse effects of Infliximab (Remicade)?
- increased risk of serious infections –> M. tuberculosis, fungal infection, opportunistic infections
- usage of diabetes, HIV, concurrent immunosuppressant drug will increase the risk of developing an infection while being on this drug
- heart failure
What are the CI of Infliximab (Remicade)?
- hypersensitivity to Infliximab
- active infection
Precautions:
- pts with a history of tuberculosis, or recurrent infections
What are the nursing considerations and assessments for Infliximab (Remicade)?
Assess:
- infusion reaction (continuous monitoring of IV site)
- monitor CBC frequently –> neutropenia
- s/s of infection (fever chills)
- edema, weight gain, SOB, crackles –> heart failure
Nursing consideration: often used in combo w/ Methotrexate, IV administered
What is the classification of Allopurinol (Zyloprim)?
Xanthine oxidase inhibitor
What is the MOA of Allopurinol (Zyloprim)?
inhibits the enzyme, Xanthine oxidase (needed for uric acid formation) –> reduces uric acid production in the body
What is the indication for Allopurinol (Zyloprim)?
gout
What is the therapeutic effect of Allopurinol (Zyloprim)?
- dissolve urate crystals
- prevent new crystal formation
- prevent disease progression
- reduce the frequency of attacks
- improve quality of life
What are the adverse effects of Allopurinol (Zyloprim)?
well tolerated
- hypersensitivity (rash, fever, liver/kidney dysfunction)
- mild GI upset
- may initially worsen gout attack
- kidney stones (increase risk)
What are the CI of Allopurinol (Zyloprim)?
caution in pts w/ kidney dysfunction
What are nursing considerations and assessments of Allopurinol (Zyloprim)?
discontinue immediately if signs of hypersensitivity, encourage fluid intake
What is the normal function of calcium?
nervous system, msk system, cardiovascular system
bone: structural integrity of bone
Where is calcium usually found in diet?
dairy, non dairy vegetables, calcium fortified processed foods
Which group do not get enough of calcium to meet their DRI?
postmenopausal women –> put on supplements
Where is calcium stored?
98% in bone
- bones are continuously remodeling (resorption and new bone formation)
How is calcium absorbed and excreted?
small intestine (vit. D increases absorption), kidneys excrete left over calcium
What are the adverse effects of too much calcium?
Hypercalcemia –> 3-4g over a long of periods of time, mostly in those receiving large amounts of vitamin D
- GI disturbances (N/V, constipation)
- renal dysfunction (polyuria, nephrolithiasis)
- CNS effects (lethargy, depression)
- change in skeletal muscle tone
- cardiac dysrhythmias
- risk of vascular calcification, MI, stroke
What are the nursing considerations of calcium?
variety of supplements –> consider the amount of elemental calcium and the pts dietary intake
- administration
What is the function of vitamin D?
increases plasma calcium levels
- increase calcium resorption from bone
- decrease calcium excretion by the kidneys
- increase calcium absorption from the intestine
How do we get vitamin D?
sunlight (produced naturally), vitamin D2 (found in plants) used in medicine, supplements, and fortification of foods
What is the adverse effect of vitamin D?
hypercalcemia
What is the classification of Alendronate (Fosamax)?
Bisphosphonate
What is the MOA of Alendronate (Fosamax)?
reduces the number and activity of osteoclasts
What are the indications for Alendronate (Fosamax)?
osteoporosis in postmenopausal women, glucocorticosteroids induced OP, OP in men
What are the therapeutic effect of Alendronate (Fosamax)?
reversal of the progression of OP with decreased fractures
NOTE: often used for less than 5yrs –> effects can last 10 yrs
What are the adverse effects of Alendronate (Fosamax)?
- esophagitis (occurs with prolonged contact w/ esophageal mucosa if the drug fails to pass completely into the esophagus)
- MSK pain (can occur with initial dose/month after –> not a reason to stop) – notify the prescriber to manage time
- RARE: ocular inflammation, atypical femur fractures (increase with long term use
What are the nursing considerations of Alendronate (Fosamax)?
- administration: morning, empty stomach, before breakfast, with only water, no food or drinks for 30 mins after (maximize bioavailability)
- minimize risk of esophageal injury: full glass of water, remain upright (sitting/standing) at least 30 mins, avoid chewing or sucking on alendronate tablets
