Musculoskeletal

Question 1

DMARD1

Answer 1

methotrexate (rheumatrex, trexal)

considered folic acid antagonist

Question 2

Methotrexate

Answer 2

 can slow or stop progression of RA
 oral or SQ once a week for RA
 Considered first choice DMARD
 high doses are used to treat some breast, skin, head/neck, and lymphoma or leukemia type cancers

Question 3

Methotrexate

NI

Answer 3

• Relatively safe and low cost.
• Hepatotoxicity & Bone Marrow Suppression are the main side effects: assess liver function prior and during. BMS-need to know about symptoms of infection.
a. Cbc, lft, jaundice
b. Call if developing mouth sores (folic acid deficiency)
• Higher risk of cardiac event in anyone with RA
• AE: some studies show patients on this drug are more likely to develop melanoma and lymphoma
• AE: potential higher risk of GI ulceration w/ some DMARD I drugs:
a. GI bleed
b. Take with food
c. Enteric coated

given PO, SQ, or IM once weekly

Question 4

DMARDII

Answer 4

etanercept (enbril), adalimumab (humira)

like a sponge for TNF

Question 5

Etanercept (enbril)

NI

Answer 5

o like a sponge for TNF (Enbrel)
• AE: Infections and reactivated infections
a. If have had tB, Hepatitis, shingles, etc it could reactivate.
b. Should avoid live vaccine: varicella, MMR
• AE: severe allergies: such as SJS, toxic epidermal necrolysis (most extreme SJS) , and erythema multiforme
• AE: HF
a. SOB, Edema in legs, echo-baseline and throughout, affecting ejection fraction?
pancytopenia

Question 6

SERMS (selective estrogen receptor modulators)

Answer 6

Raloxifene (Evista)

Prevention and tx of postmenopausal osteoP

Question 7

Raloxifene

Answer 7

Causes hypocalcemia, need to be on supplements

High risk for : PE, DVT,

hot flashes
Pregnancy x

Question 8

biphosphanates

Answer 8

alendronate (fosamax), -dronate

reverse lost bone and reduce future risk in higher risk patients

Question 9

Alendronate (fosamax)

Ni

Answer 9

Causes hypocalcemia, need to be on a supplement

Esophagitis is number one side effect, to the point of ulceration and bleeding to death.

Must sit up for at least 30 mins after taking. *
Must take on empty stomach*
notify provider if you experience GI issues.

Question 10

Calcitonin

Answer 10

Salmon calcitonin

Question 11

calcitonin NI

Answer 11

• AE: nasal dryness and irritation: (given nasally) alternate nares between doses
• AE: Hypocalcemia: stopping breakdown, trying to push calcium back into the bone. (all osteoporosis med do this), encourage calcium intake.
• AE: may lose therapeutic use after several years d/t antibodies
• Given intranasally, SQ or IM

Question 12

Ca supplements

Answer 12

give with vitamin d.
hypercalcemia not generally and issue
Kidney stones more prevalent: drink lots of water.

Question 13

Cholinesterase inhibitors

Answer 13

Cholinergic agent:

Neostigmine (prostigmin)

Question 14

Neostigmine therapeutic use

Answer 14

Myasthenia gravis (improves muscle strength and endurance)

used to reverse nondepolarizing neuromuscular blocking agents.

Question 15

Neostigmine NI

Answer 15

toxic doses do the opposite to contraction and cause muscle weakness and respiratory paralysis within one hour of administration:

SLUDGEMM

Question 16

SLUDGEMM

Answer 16

Salivation
Lacrimation
Urination
Defecation
GI distress
Emesis
Miosis
Muscle spasm

Question 17

Neuromuscular blocking agents

Answer 17

Succinylcholine:

depolarizing NMBD

Question 18

succinylcholine NI

Answer 18

Malignant Hyerperthermia
Must have sedative before
Hyperkalemia
hypotension
bradycardia
cardiac and respiratory arrest

Question 19

succinylcholine antidote

Answer 19

Dantrolene

Question 20

Pancuronium

Answer 20

nondepolarizing NMBD

Last longer, for longer surgeries

Question 21

Pancuronium antidote

Answer 21

neostigmine