Musculoskeletal Medications Flashcards
What drug therapy can be used for Rheumatoid Arthritis (RA)?
non-steroidal anti-inflammatory drugs (NSAIDs), Glucocorticoids, disease modifying anti-rhematic drugs (DMARDs)
methotrexate (Rheumatrexate): class
Nonbiological (Traditional) DMARD
methotrexate (Rheumatrexate): Use
decrease inflammation/ joint pain
methotrexate (Rheumatrexate): EPA
immunosuppression, takes weeks to take effect
methotrexate (Rheumatrexate): ADR
dizzy, headache, blurred vision, N/V, hepatotoxic, renal damage, infection, bone arrow suppression, GI bleeding, pulmonary fibrosis
methotrexate (Rheumatrexate): RN Interventions
monitor lab values, take contraceptives, hydrate 2L a day, report adverse reactions, monitor respiratory status
methotrexate (Rheumatrexate): contraindications
Teratogenic. Caution in w/ peptic ulcer disease, ulcerative colitis. Infections. Liver disease, heavy ETOH use.
Med Interactions: Warfarin, Digoxin, NSAIDs
Caffeine can reduce effectiveness!
etanercept (Enbrel): class
biological DMARDs
biological DMARDs
etanercepts (Enbrel), infliximab (Remicade), adalimumab (Humira)
etanercept (Enbrel): use
decrease joint inflammation and subsequent damage, once weekly
etanercept (Enbrel): EPA
inactivates tumor necrosis factor (TNF)
etanercept (Enbrel): ADR
immunosuppression, pancytopenia, heart failure, dizzy, abdominal pain, psoriasis
etanercept (Enbrel): RN Interventions
monitor for infection, monitor for heart failure, TB test prior to start of therapy, monitor lab values
etanercept (Enbrel): contraindications
NO live vaccines, active infection, hematological disorders, malignancy, interacts with chemotherapeutics = bone marrow suppression, do not give with Anikinra (Kineret)
What medications treat osteoporosis?
SERMs, Bisphosphonates, calcitonin, calcium supplements
raloxifene(Evista): class
Selective Estrogen Receptor Modulators (SERMs)
raloxifene(Evista): Use
bone reabsorption inhibitor, postmenopausal osteoporosis, reducing risk of estrogen receptor-positive breast cancer
raloxifene(Evista): EPA
activate estrogen receptors in some tissue and blocks receptors in others (breast)
raloxifene(Evista): ADR
increased risk of stroke, PE, DVT, Hot flashes
raloxifene(Evista): Contraindications
teratogenic, do not give with history of PE/DVT, caution with HLD, and concurrent estrogen use
raloxifene(Evista): RN Interventions
monitor and report s/sx of thrombi-emboli, encourage calcium and vitamin D intake, do weight bearing activates, educate on hot flashes
alendronate (Fosamax): class
bisphosphonates
bisphosphonate medications
alendronate (fosamax), risedronate (actonel), ibandronate (Boniva)
alendronate (fosamax): use
postmenopausal, age-related and glucocorticoid osteoporosis
alendronate (fosamax): EPA
bone reabsorption inhibitor, inhibits osteoclast activity - decrease bone absorption
alendronate (fosamax): ADR
GI distress, muscle and joint pain
alendronate (fosamax): contraindications
esophageal disorders, renal insufficiency, hypocalcemia, calcium supplements & dairy reduce absorption
alendronate (fosamax): RN Interventions
monitor for esophagitis, take with full glass of water, sit at a 90 degree angle for 30 minutes, 30 minutes prior to other food, report vision changes
calcitonin-salmon (Miacalcin, Calcimar): class
Hypocalcemic: Calcitonin
calcitonin-salmon (Miacalcin, Calcimar): Use
treats established postmenopausal osteoporosis, hypercalcemia, hyperparathyroidism, Paget’s disease
calcitonin-salmon (Miacalcin, Calcimar): EPA
inhibits actions of osteoclasts, increase excretion of calcium
calcitonin-salmon (Miacalcin, Calcimar): ADR
allergy to salmon protein or gelatin diluent, hypocalcemia, nasal dryness and irritation, headache, epistaxis, N/V, polyuria
calcitonin-salmon (Miacalcin, Calcimar): contraindications
allergy to salmon/fish proteins, interaction with lithium, may have lower effectiveness if bisphosphonate previously taken
calcitonin-salmon (Miacalcin, Calcimar): RN Interventions
inspect nares, diet high in calcium and vitamin D, intradermal allergy test, keep some forms in fridge and protected from light, s/sx hypocalcemia, regular bone density testing
What is Hypocalcemia and what does it present as?
calcium level lower than 9.0
CATS: convulsions, arrhythmias, tetany, stridor and spasms
What is Hypercalcemia and what does it present as?
calcium level higher than 10.5
Moans, bones, stones, groans, other: N/V, constipation, pancreatitis, weakness, bone pain, fractures, polyuria, nephrocalcinosis, confusion, poor concentration, secondary hypertension, short QT
calcium citrate (Citracal) or calcium carbonate (Tums): class
calcium supplements
calcium citrate (Citracal) or calcium carbonate (Tums): use
calcium replacement, antacid
calcium citrate (Citracal) or calcium carbonate (Tums): EPA
provide calcium, acts as a base
calcium citrate (Citracal) or calcium carbonate (Tums): ADR
hypercalcemia, N/V constipation, polyuria, depression, renal stones
calcium citrate (Citracal) or calcium carbonate (Tums): contraindications
Avoid in hypercalcemia OR hypophosphatemia. Caution w/ kidney stones, cardiac dysrhythmias, slow gastric motility.
Interactions: above meds. Digoxin, thiazide diuretics. Some foods.
calcium citrate (Citracal) or calcium carbonate (Tums): RN Interventions
monitor calcium levels, give IV Slowly, administer 1 hr before or 2 hrs after other medications, do not take more than 600mg at a time, chew and take with water
