Musculoskeltetal drugs Flashcards
Osteoporosis
Over Activity of Osteoclast
Increase the risk of FX
loss in bone density
BMP peaks around?
80 y/o
Osteoblast
Bone-building cells
Osteoclast
Break down bones
Resorption
Breaking down the bone, let the calcium out
Osteopenia
Low BMP
Calcium for men 51-70
1000mg a day
Calcium
Builds bones
Calcium for everyone over 70
1200mg
Vitamin D
D5, sun to convert vitamin D to be useable
Smoking
affects and decreases vitamin d absorption
Alcohol
Decreases calcium absorption
Hormone Therapy
no longer recommended to treat
used to prevent
Osteoporosis drugs
Bisphosphonates
SERMS (Selective Estrogen Receptor Modulators)
Bisphosphonates
inhibits resorptions of bones by inhibiting osteoclast activity
Should not be taken with NSAIDs, aspirin, antacids
Bisphosphonates side effects
Gi distress
esophageal inflammation
difficultly swallowing
reflux
ulcers
Sit or stand 30 mins after taking (harsh on esophagus)
Bisphosphonates contraindications
esophageal abnormalities
delayed emptying of the stomach
inability to sit or stand for 30 mins
Bisphosphonates meds
Alendronate (Fosamax)- taken daily or weekly
Ibandronate Sodium (Boniva)- Orally monthly or IV every 3 months
Risedronate (Actonel)- taken orally daily or weekly
Zoledronic Acid (Reclast)- administered IV yearly (for treatment)
SERMs
Acts like estrogen on certain parts of the body while not affecting other parts (it does not affect endometrium)
increase bone mineral density decreases bone turnover and redices vertebral FX
Raloxifene (Evista)- Orally daily
SERMs side effects
the benefit of decreasing incidence of breast cancer
Vitamin D Function
Regulates calcium and phosphorus metabolism
Needed to absorb calcium from GI tract
SERMs contraindications
history of DVT
use with caution in cardiac patients
Take with calcium and Vitamin D
Vitamin D
taken orally
Hypervitaminosis D
Hypercalcemia
Anorexia
v/ n
RDA
600 IU- 19- 70 daily
800 IU- 70+ daily
Calcium
Electrolyte
Normal Serum range- 8.6 to 10.2
Calcium Function
promote normal nerce and muscle activity
aids in heart contractions
maintains normal cellular permeability
promotes blood clotting
promotes bone and teeth formation
Hypocalcemia
less than 8.6mg/dl
signs and symptoms
bone fx
anxiety
irritability
tetany
decreased cardiac output
EKG changes
dysrhythmias
Calcium Admin for Hypocalcemia
to correct deficit or prevent osteoporosis
oral (calcium with salt)
IV (calcium chloride or calcium gluconate)
Hypercalcemia
more than 10.2mg/dl
Signs and symptoms
fatigue
muscle weakness
depressed reflexes
confusion
impaired memory
GI distress
N/ V/ D
EKG changes
dysrhythmias
kidney stones
Hypercalcemia TX
treat underlying cause
flush excess with IV fluids
Acetaminophen
Not an NSAID
Action- inhibits prostaglandin synthesis
Hepatotoxic
Uses
muscle aches
pain
fever
Max dose 4g/ daily
if taken frequently/ 2g a day
Acetaminophen Effects
rash
headache
insomnia
Gi distress
Acetaminophen Toxic effects
hepatoxicity
renal failure
thrombocytopenia
hemolytic anemia
agranulocytosis
leukopenia
neutropenia
Opioid Analgesics
Use- moderate to severe pain
Possess antidiarrheal effects
opioid analgesic action site
Acts on CNS
suppress pain impulsis
suppress respiration and coughing by acting on respiratory and cough centers in the medulla
Opioid analgesic contraindications/ side effects
Head Injury
Side effects
N/ V
constipation
decrease in blood pressure
orthostatic hypotension
respiratory depression
urinary retention
antitussive effects
Drug tolerance
withdraw symptoms (after stopping)
twitching
increased pulse
increased hr
Morphine
opiod analgesic
PO, IV, IM
Morphine side effects
drowsiness
dizziness
euphoria
confusion
depression
miosis
blurred vision
GI distress
flatulence
constipation
orthostatic hypotension
weakness
urinary retention
respiratory depression
Meperidine
One of the first synthetic opioids
IV, IM, PO
less constipation
preferred during pregnancy
can decrease bp
Hydromorphone (Dilaudid)
semisynthehetic opioid similar to morphine
analgesic effect is 6 times more potent than morphine with fewer hypnotic effects
faster onset shorter duration
PO, Rectal, IM, IV
Hydromorphone side effects
drowsiness
dizziness
confusion
orthostatic hypotension
weakness
constipation
miosis
tolerance
dependence
respiratory depression
urinary retention
Combination Drugs
Hydrocondone and Ibuprofen
Acetaminophen and condeine
decreases the risk of dependency
Patient controlled analgesia (PCA)
Morphine is commonly used
predetermined safety limits
loading dose
locked mechanism
near-constant analgesic level
Transdermal Opioid Analgesics
around-the-clock pain control
fentanyl
more potent than morphine
exercise caution when prescribing fentanyl for patients with less than 100 pounds
adjuvant therapies
typically used along with a nonopioid and opioid
examples
anticonvulsants
antidepressants
corticosteroids
antidysrhythmics
local anesthetics
Opioid Agonists- Antagonsist examples
pentazocine
butorphanol tartrate
budprenorphine
nalbuphine hydrochloride
not given for cancer pain
safe for use during labor
safety during early pregnancy not established
Opioid antagonsits action
blocks receptor and displaces opioid
opioid antagonists use
antidote for opiate overdonses
reverse effects of opiates, including respiratory depression, depression, hypotension
opioid meds
naloxone (Narcan)
IV, IM
naltrexone hydrochloride (ReVia)
PO, IM
opioid antagonist’s side effects/ adverse reactions
sweating
flushing
agitation
dyspnea
hypo/hyperthyroidism
tachycardia
N/ V
elevated PTT
bleeding
reversal of analgesiaia
Monitor vitals and bleeding continuously.
Non-opioid analgesic
less potent than opioids
used to treat mild to moderate pain
some OTC, some prescription
Acute Pain
sudden onset, treatable, less than a month
Chronic Pain
Persistent pain that lasts longer than treatment time, longer than 3 to 6 months
Cancer Pain
pain related to cancer
Somatic Pain
pain from injury to the bone
Superficial Pain
pain in the mucous membrane/ skin
Vascular Pain
pain to the vessels/ poor circulation
Visceral Pain
Pain in the organs
