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pharm 2 > Musculosk > Flashcards

Musculosk Flashcards

1
Q

Alendronate (Fosomax) Class/Use

A

Bisphosphonate
Prevention and treatment of
* Postmenopausal osteoporosis
* Glucocorticoid-related osteoporosis
* Age-related osteoporosis in men

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2
Q

Alendronate (Fosomax) Adverse Reaction

A
  • Esophagitis
  • Gastrointestinal disturbances (nausea and vomiting, abdominal pain)
  • Muscle and joint pain
  • Eye pain and vision changes
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3
Q

Alendronate (Fosomax) Interventions

A
  • 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.
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4
Q

Alendronate (Fosomax) Administration

A
  • 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.
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5
Q

Alendronate (Fosomax) Teaching

A

Instruct clients to report changes in swallowing or vision to provider.

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6
Q

Alendronate (Fosomax) Contraindications

A
  • Esophageal strictures/disorders or difficulty swallowing
  • Clients unable to sit up for 30 minutes after administration
  • Renal insufficiency
  • Hypocalcemia
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7
Q

Alendronate (Fosomax) Interactions

A
  • Calcium supplements and dairy products decrease absorption when given within 30 minutes of each other.
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8
Q

Citrate/Carbonate (Citracel and Tums) Class/Use

A

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

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9
Q

Citrate/Carbonate (Citracel and Tums) Adverse Drug Reactions

A
  • 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
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10
Q

Citrate/Carbonate (Citracel and Tums) Interventions

A
  • 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.
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11
Q

Citrate/Carbonate (Citracel and Tums) Administration

A
  • 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.
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12
Q

Citrate/Carbonate (Citracel and Tums) Teaching

A

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.

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13
Q

Citrate/Carbonate (Citracel and Tums) Contraindications

A

Hypercalcemia
Kidney stones
Low phosphate levels
Cardiac dysrhythmias

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14
Q

Citrate/Carbonate (Citracel and Tums) Interactions

A

Thiazide diuretics cause decreased excretion of calcium, which may result in hypercalcemia.
Avoid taking calcium with foods such as cereals, rhubarb, and spinach.

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15
Q

Methotrexate Class and Use

A

Non-biologic DMARD
Decrease joint inflammation and subsequently joint damage.

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16
Q

Methotrexate Adverse Drug Reaction

A

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

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17
Q

Methotrexate Interventions

A

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

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18
Q

Methotrexate Administration

A

Give methotrexate once a week via route prescribed (oral, subcutaneous, or intramuscular).
* Folic acid supplement may be prescribed to decrease risk of toxicity.

19
Q

Methotrexate Teaching

A

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.

20
Q

Methotrexate Contraindications

A

Teratogenic (methotrexate)
* Liver insufficiency or hepatitis
* Renal insufficiency

21
Q

Methotrexate Interactions

A

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.

22
Q

Prednisone Class and Use

A

Glucocorticoid
Symptomatic relief of pain and inflammation for a wide variety of disorders
* Delay progression of some disorders, such as rheumatoid arthritis

23
Q

Prednisone Adverse Drug Reaction

A

Suppression of adrenal function
* Hyperglycemia
* Peptic ulcer disease, gastrointestinal discomfort
* Infection
* Fluid and electrolyte imbalances
* Bone loss
* Cataracts (long-term therapy)

24
Q

Prednisone Interventions

A

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.

25
Q

Prednisone Administration

A

For long-term use (10 days or more), take in the morning using alternate-day dosing.
* Taper the dose slowly when symptoms are controlled to establish the lowest possible oral dose.
* For short-term oral use, the largest dose is given on the 1st day with progressively smaller doses for each of the next 8 days.

26
Q

Prednisone Teaching

A
  • Taper the dose before discontinuing it.
  • Report polyphagia, polydipsia, and polyuria.
  • Report muscle pain or weakness.
  • Avoid taking NSAIDs.
  • Take the drug with food or meals.
  • Report signs of infection, such as a sore throat.
  • Report weakness (hypokalemia).
  • Understand that long-term therapy may cause some changes in fat distribution throughout the body.
  • Take the drug on alternate days for long-term therapy.
  • Perform weight-bearing exercise daily.
  • Consume adequate calcium and vitamin D.
  • Report blurred vision and loss of color acuity.
27
Q

Prednisone Precautions

A

Heart failure
* Peptic ulcer disease
* Diabetes mellitus
* Hypertension
* Kidney dysfunction
* Myasthenia gravis
* Osteoporosis

28
Q

Prednisone Interactions

A

furosemide (Lasix), increase risk of hypoka- lemia.
* The risk of digoxin-induced dysrhythmias increases with digoxin.
* NSAIDs increase risk of gastrointestinal bleeding and ulceration.
* Effects of insulin and oral hypoglycemics decrease in clients who have diabetes.
* Prednisone prevents the body from responding to vaccines
* Live vaccine administration increases risk for decreased antibody response and increased risk of adverse effects

29
Q

Celecoxib (Celebrex) Class/Use

A

2nd generation NSAID (Cox 2 only inhibitor)
Inflammation suppression
Analgesia for mild to moderate pain

30
Q

Celecoxib (Celebrex) Adverse Drug Reactions

A

Gastric upset, heartburn, nausea, diarrhea, gastric ulceration
* Kidney dysfunction
* Cardiovascular and cerebrovascular events

31
Q

Celecoxib (Celebrex) Interventions

A

Monitor for and report gastric upset, heartburn, nausea, diarrhea, or GI bleeding.
* Test for and treat Helicobacter pylori infection prior to long-term therapy.
* Monitor intake and output; watch for low urine output and fluid retention.
* Monitor for rapid rises in BUN and creatinine.
* Recommend the drug for short periods and in low doses only.
* Monitor for signs of myocardial infarction and cerebrovascular accident.

32
Q

Celecoxib (Celebrex) Administration

A

Give 2 hr before or after magnesium- or aluminum-based antacids.

33
Q

Celecoxib (Celebrex) Teaching

A

Take with food, milk, or 8 oz of water to minimize gastrointestinal effects.
* Avoid alcohol.
* Take low-dose aspirin once daily to reduce the risk of heart attack and stroke.

34
Q

Celecoxib (Celebrex) Contraindications

A

Pregnancy risk (third trimester); can cause premature closure of the ductus arteriosus
* Severe hepatic impairment
* Advanced kidney disease
* Gastrointestinal bleeding

35
Q

Celecoxib (Celebrex) Interactions

A

Diuretic effects of furosemide (Lasix) decrease.
* Anticoagulant effects of warfarin (Coumadin) increase.
* Glucocorticoids and alcohol increase the risk of bleeding.
* Antihypertensive effects of ACE inhibitors decrease.

36
Q

*Allopurinol Class/Use

A

Antihyperuricemic
Gouty arthritis - reduces inflammation
Hyperuricemia due to chronic tophaceous gout. Often affects big toe first

37
Q

Allopurinol Notes

A

Metallic taste in mouth
sore throat, bruising vision changes
hypersensitivity syndrome (rash, fever)
GI disturbances
Lots of water
Minimize exposure to sunlight
Interactions: Warfarin (lower dose) and theophylline (inc risk of toxicity)

38
Q

Glucosamine Class/Use

A

Complementary Therapy
Stimulates cells to make cartilage and synovial fluid
● Suppresses inflammation of the joints and cartilage
degradation
● Treats osteoarthritis of the knee, hip, and wrist

39
Q

Glucosamine Adverse Effects

A

Mild GI upset - nausea, heartburn

40
Q

Glucosamine Precautions

A

shell fish allergy

41
Q

Glucosamine Interactions

A

anticoags and antiplatelets - inc risk of bleeding

42
Q

*Cyclobenzaprine Class/Use

A

Muscle relaxant - used in arthritis
Act in the CNS to enhance GABA and produce sedative effects and depress spasticity of muscles.

43
Q

NSAIDS (Ibuprofen, aspirin, Advil, Motrin) Class/Use

A

NSAID (Cox 1 and Cox 2 Inhibitor
anti-inflammatory
pain reliever

44
Q

NSAID Notes

A

GI upset
Aspirin inc bleeding risk
renal dysfunction
Take with food or milk
no alcohol (GI)
Teratogenic
peptic ulcer dx

pharm 2 (5 decks)

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