Musculosk Flashcards
Alendronate (Fosomax) Class/Use
Bisphosphonate
Prevention and treatment of
* Postmenopausal osteoporosis
* Glucocorticoid-related osteoporosis
* Age-related osteoporosis in men
Alendronate (Fosomax) Adverse Reaction
- Esophagitis
- Gastrointestinal disturbances (nausea and vomiting, abdominal pain)
- Muscle and joint pain
- Eye pain and vision changes
Alendronate (Fosomax) Interventions
- Give drug with 6–8 oz. of water.
- For 30 minutes after taking drug, have clients:
- Remain in upright position.
- Avoid eating or drinking anything other than water.
- Avoid giving calcium supplement or antacid.
- Give analgesic for muscle and joint pain.
- Monitor clients for changes in vision.
Alendronate (Fosomax) Administration
- Give drug 30 minutes before breakfast with a full glass of water.
- Have client sit or stand for 30 minutes after administration.
- Avoid giving calcium-containing drugs/supplements within 30 minutes of administration.
Alendronate (Fosomax) Teaching
Instruct clients to report changes in swallowing or vision to provider.
Alendronate (Fosomax) Contraindications
- Esophageal strictures/disorders or difficulty swallowing
- Clients unable to sit up for 30 minutes after administration
- Renal insufficiency
- Hypocalcemia
Alendronate (Fosomax) Interactions
- Calcium supplements and dairy products decrease absorption when given within 30 minutes of each other.
Citrate/Carbonate (Citracel and Tums) Class/Use
Calcium Supplements
* Hypocalcemia
* Clients who have, or are at risk for, experiencing a calcium deficiency
* Adolescents
* Women who are pregnant, breastfeeding, or postmenopausal
* Men and women at risk for osteoporosis due to age or lactose intolerance
* Gastric hyperacidity
Citrate/Carbonate (Citracel and Tums) Adverse Drug Reactions
- Hypercalcemia
- More likely to occur when taking large amounts of vitamin D
- More likely to occur with long-term therapy
- Nausea, vomiting, and constipation—may occur as adverse effects or secondary to calcium toxicity
- Kidney stones—in clients with hypercalcemia or a history of kidney stones
Citrate/Carbonate (Citracel and Tums) Interventions
- Monitor serum calcium periodically.
- Monitor clients for signs of decreased gastric and intestinal motility.
- Monitor clients for urine output in excess of intake.
- Monitor clients for signs of decreased gastric and intestinal motility.
- Monitor clients for flank pain and blood in urine.
Citrate/Carbonate (Citracel and Tums) Administration
- Can be given orally or intravenously.
- Give calcium supplements 1 hr before or 1 to 2 hr after glucocorticoids, thyroid supplements, and tetracycline and quinolone antibiotics.
- Give calcium-based antacids 1 hr after meals and at bedtime.
- Chewable tablets should be chewed before swallowing.
- Give clients glass of water after swallowing.
Citrate/Carbonate (Citracel and Tums) Teaching
Teach clients signs of hypercalcemia (constipation, nausea and vomiting, increased urine output, depression).
Instruct clients to report flank pain or blood in urine to provider.
* Don’t take more than 600 mg at one time.
Citrate/Carbonate (Citracel and Tums) Contraindications
Hypercalcemia
Kidney stones
Low phosphate levels
Cardiac dysrhythmias
Citrate/Carbonate (Citracel and Tums) Interactions
Thiazide diuretics cause decreased excretion of calcium, which may result in hypercalcemia.
Avoid taking calcium with foods such as cereals, rhubarb, and spinach.
Methotrexate Class and Use
Non-biologic DMARD
Decrease joint inflammation and subsequently joint damage.
Methotrexate Adverse Drug Reaction
Bone marrow suppression (decreased platelets, red and white blood cells)
* Increased risk of infection
* Liver damage
* Gastrointestinal ulceration
* Pulmonary fibrosis
* Dizziness and headache
* Nausea and vomiting
Methotrexate Interventions
Monitor for decreased platelets, red and white blood cell counts.
* Monitor for signs and symptoms of infection.
* Monitor liver function tests and observe for jaundice.
* Monitor for gastrointestinal bleeding (with methotrexate).
* Monitor for respiratory distress and decreased oxygenation
* Monitor for abdominal pain, diarrhea, nausea and vomiting
Methotrexate Administration
Give methotrexate once a week via route prescribed (oral, subcutaneous, or intramuscular).
* Folic acid supplement may be prescribed to decrease risk of toxicity.
Methotrexate Teaching
Report abnormal bleeding, bruising, or petechiae (pinpoint areas of blood under the skin). Report ulcerations of the mouth or tongue.
* Report signs and symptoms of infection immediately.
* Avoid ingesting alcohol.
* Report yellowing of the skin and eyes immediately.
* Report blood in vomitus or stools.
* Report difficulty breathing or shortness of breath.
* Drink adequate amounts (2L) of water daily to ensure excretion of drug.
* Avoid breastfeeding while on this drug.
Methotrexate Contraindications
Teratogenic (methotrexate)
* Liver insufficiency or hepatitis
* Renal insufficiency
Methotrexate Interactions
Concurrent use of methotrexate and digoxin may reduce digoxin level
Concurrent use of methotrexate and NSAIDs, salicylates, and sulfonamides may cause toxicity.
Caffeine may reduce the effectiveness of methotrexate Concurrent use of warfarin may increase the risk for bleeding
Alcohol use may increase risk of hepatotoxicity.
Prednisone Class and Use
Glucocorticoid
Symptomatic relief of pain and inflammation for a wide variety of disorders
* Delay progression of some disorders, such as rheumatoid arthritis
Prednisone Adverse Drug Reaction
Suppression of adrenal function
* Hyperglycemia
* Peptic ulcer disease, gastrointestinal discomfort
* Infection
* Fluid and electrolyte imbalances
* Bone loss
* Cataracts (long-term therapy)
Prednisone Interventions
Recommend larger dosage during times of illness and stress.
* Monitor blood glucose levels, especially for clients who have diabetes mellitus.
* Adjust dosages of insulin/hypoglycemic drugs accordingly.
* Recommend the lowest possible effective dose and alternate-day dosing.
* Observe for gastrointestinal bleeding (bloody vomitus as well as black, tarry stools).
* Give drug with food or meals.
* Observe for signs of infection
* Monitor for generalized weakness (hypokalemia).
* Monitor for Cushing-like effects: abdominal fat, buffalo hump, and moon face.
* Determine schedule for regular ophthalmologic examinations.
