Musculoskeletal Drugs

Question 1

Calcium Supplements Prototype

Answer 1

calcium citrate (Citracal), calcium carbonate (Tums)

Question 2

Calcium Supplements Therapeutic Uses

Answer 2

Calcium replacement, antacid

Question 3

Calcium Supplements Administration

Answer 3

PO or Iv slowly

Question 4

Calcium Supplements EPA

Answer 4

• provide calcium
• act as a base

Question 5

Calcium Supplements ADRs

Answer 5

hypercalcemia = N/V, constipation, polyuria, depression, renal stones

Question 6

Calcium Supplements Contraindications and Interactions

Answer 6

Avoid in hypercalcemia OR hypophosphatemia. Caution with kidney stones, cardiac dysrhythmias, slow genetic motility
Interactions: Digoxin, thiazide diuretics. Some foods

Question 7

Calcium Supplements RN Interventions and Client Education

Answer 7

Monitor serum calcium levels
Monitor for and educate client about s/sx of hypercalcemia
Administer supplement ca+ 1hr before or 2hrs after
Glucocorticoids
Thyroid supplements
Tetracycline and quinolone antibiotics
Do not take more than 600mg at a time
Chew tablet, take w/ 8ox of water

Question 8

Hypocalcemic: Calcitonin Prototype

Answer 8

calcitonin-salmon (Miacalcin, Calcimar)

Question 9

Calcitonin Therapeutic Uses

Answer 9

treats established postmenopausal osteoporosis. Also hypercalcemia, and hyperparathyroidism. Paget’s disease

Question 10

Calcitonin Administration

Answer 10

IM, subQ, intranasal

Question 11

Calcitonin EPA

Answer 11

inhibits actions of osteoclasts. Increases excretion of calcium

Question 12

calcitonin ADRs

Answer 12

allergy to salmon protein or gelatin diluent. Hypocalcemia. Nasal dryness and irritation. HA, epistaxis
- Injection site rxns, N/V, polyuria

Question 13

Calcitonin RN interventions and client education

Answer 13

Prior nasal administration, inspect nares (irritation and ulceration)
Diet - high in calcium and vitamin D
Prior to therapy initiation - intradermal allergy test
Erythema w/in 15 min
Antihistamines, epi, O2 available
Keep parenteral forms in fridge, protect from light
Nasal form - prime pump
Educate client on s/sx of hypocalcemia
May need regular bone density testing

Question 14

Calcitonin Contraindications and Interactions

Answer 14

Allergy to salmon/fish proteins
Interactions with lithium
If taken bisphosphate previously may have lower effectiveness

Question 15

Bisphosphonates Prototype and Other Drug Names

Answer 15

alendronate (Fosamax)
Others: risedronate (Actonel), ibandronate (Boniva)

Question 16

Bisphosphonates Therapeutic Uses

Answer 16

postmenopausal, age-related, and glucocorticoid osteoporosis

Question 17

Bisphosphonates Administration

Answer 17

PO for alendronate

Question 18

Bisphosphonates EPA

Answer 18

directly inhibits activity of osteoclasts = decreased bone absorption

Question 19

Bisphosphonates ADRs

Answer 19

GI disturbances (N/V, abd pain, esophagitis). Muscle and joint pain

Question 20

Bisphosphonates Contraindications and Interactions

Answer 20

Esophageal disorders. Renal insufficiency. Hypocalcemia
Calcium supplements and dairy reduce absorption!!!

Question 21

Bisphosphonates RN interventions and client education

Answer 21

Monitor for S/sx of esophagitis = reflux, pain with swallowing and dysphagia
Must take with a full glass of water (risk for esophageal ulcers). 90 degree angle for 30 minutes
Give 30 min prior to other meds, food, drink
Monitor for muscle/joint pain = mild analgesic
Educate client to report vision changes (rare ADR)

Question 22

Selective Estrogen Receptor Modulators (SERMs) Prototype

Answer 22

raloxifene (Evista)

Question 23

SERMs therapeutic uses

Answer 23

postmenopausal osteoporosis. Also for reducing risk of estrogen receptor-positive breast cancer

Question 24

SERMS administration

Answer 24

PO daily

Question 25

SERMs EPA

Answer 25

activate estrogen receptor in some tissue and blocks receptors in others (breasts)

Question 26

SERMs ADRs

Answer 26

increased risk of stroke, PE, DVT, hot flashes

Question 27

SERMs RN intervention and client education

Answer 27

Monitor for and educate pt to call provider if s/sx of thrombo-emboli SOB, chest pain, pain/cramping in extremities, unilateral extremity swelling, redness in extremity Encourage calcium and vit D intake Encourage weight bearing activities If using for breast cancer prevention, educate on hot flashes

Question 28

SERMs contraindications and interactions

Answer 28

Teratogenic! Including breastfeeding. Counsel on contraception Do not give to pt that have hx of PE/DVT if it develops need to discontinue Caution w/ HLD, concurrent estrogen use

Question 29

Biologic DMARDS Prototype and other names

Answer 29

etanercept (Enbrel) Others: infliximab (Remicade), adalimumab (Humira)

Question 30

Biological DMARDs Therapeutic Uses

Answer 30

decrease joint inflammation and subsequent damage

Question 31

Biological DMARDS Administration

Answer 31

subQ once weekly

Question 32

Biological DMARDS EPA

Answer 32

inactivates tumor necrosis factor (TNF)

Question 33

Biological DMARDS ADRs

Answer 33

immunosuppression, pancytopenia, heart failure, dizziness, abdominal pain, psoriasis

Question 34

Biological DMARDS RN intervention and client education

Answer 34

Monitor for s/sx of infection Monitor injection site Monitor for s/sx of heart failure SOB, edema, cough - pink frothy sputum TB test prior to therapy initiation Monitor lab values

Question 35

Biological DMARDS contraindications and interactions

Answer 35

No live vaccines! contraindicated: active infection, hematological disorders, malignancy Interactions: chemotherapeutics = bone marrow suppression. Do not give with Anikinra (Kineret)

Question 36

Nonbiological (Traditional) DMARDs Prototype

Answer 36

methotrexate (Rheumatrexate)

Question 37

Nonbiological DMARDS therapeutic uses

Answer 37

decrease inflammation/joint damage

Question 38

Nonbiological DMARDS EPA

Answer 38

immunosuppression

Question 39

Nonbiological DMARDS Administration

Answer 39

PO, IV, subQ Once a week

Question 40

Nonbiological DMARDS ADRs

Answer 40

dizziness, HA, blurred vision, N/V, hepatotoxic, renal damage, infection, bone marrow suppression (decreased blood cells), GI bleeding, pulmonary fibrosis

Question 41

Nonbiological DMARDS RN intervention and client education

Answer 41

Monitor lab values - CBC, platelets, creatine, LFT Monitor respiratory status Educate pt to call provider immediately for Jaundice, s/sx of, infection, Shortness of breath, Abnormal bleeding. Clients of childbearing age should take contraceptive Educate client to hydrate - 2L per day

Question 42

Nonbiological DMARDS contraindications and interactions

Answer 42

Teratogenic Caution in people with peptic ulcer disease, ulcerative colitis Infections. Liver disease, heavy ETOH use Med interactions: warfarin, digoxin, NSAIDS Caffeine can reduce effectiveness