Pharmacology for mobility: musculoskeletal Flashcards
NSAIDS MOA
Block prostaglandin via Cox1 and Cox2
Indications for NSAIDS
Inflammation, pain, fever
First generation NSAIDS
Ibuprofen (Advil) and Naproxen (Aleve)
Second generation NSAIDS
Celecoxib (Celebrex)
Slightly more GI protection
Related to Sulfa
ASA description
Aspirin
Prevention of MI/ stroke via interrupting platelet aggregation
Contraindicated in <18 yrs → Reye’s Syndrome
Harmful effects of inhibition of COX-1
Gastric erosion and ulceration
Bleeding tendencies
Renal impairment
Harmful effects of inhibition of COX-2
Renal impairment
Promotion of MI and stroke (secondary to suppressing vasodilation)
Nursing considerations for NSAIDs
Best administered with food
Monitor kidney function
Monitor for adverse effects of HTN
Monitor for signs of bleeding
All NSAIDs contraindicated in pregnancy
Steven Johnson Syndrome description
Blistering of the skin and mucous membranes
What does cortisol do?
Reduces inflammation
Increases blood sugar
Increases blood pressure
Prednisone (Deltasone) classification
Corticosteroid also called steroids or glucocorticoids
MOA of prednisone (Deltasone)
Mimics Cortisol (a hormone produced by our adrenal glands)
Potent anti-inflammatory and immunosuppressant
Works rapidly and is often only used for a short period of time
Indication for prednisone
Used to treat autoimmune disorders (like rheumatoid arthritis)
Therapeutic effects of prednisone
Suppression of the inflammatory and immune responses in autoimmune disorders
Adverse effects of prednisone (Deltasone)
Fluid retention
Hypokalemia
High blood pressure
Mood swings, psychological and behavioural changes
Weight gain
Hyperglycemia
Increased risk of infection
Slow wound healing, bruising
Peptic ulcers
Osteoporosis
Contraindications and precautions of prednisone
Presence of active infection should not take (prednisone will mask symptoms of infection)
Peptic ulcer
Hypersensitivity
Should not be taken long term → will cause adrenal suppression so taper dose over time
Nursing considerations and assessment of prednisone
Monitor intake/ output
Assess for: edema, weigh daily, auscultate lungs, skin assessment
Monitor serum electrolytes and glucose
Administer with meals to prevent GI irritation
Stopping doses abruptly can cause adrenal insufficiency → anorexia, nausea/ vomiting, weakness, fatigue, dyspnea, low blood pressure, hypoglycemia. Patients should not skip doses
Patient should increase foods with calcium and potassium
Monitor for improvement of disorder symptoms
What does the nurse identify as possible complications of glucocorticoid therapy? Select all that apply:
a. Impaired carbohydrate and glucose tolerance
b. Increased production of glucocorticoids from the adrenals
c. Predisposition to gastrointestinal ulceration
d. Decrease in serum sodium and glucose levels
e. Increase in plaque development in coronary arteries
a. Impaired carbohydrate and glucose tolerance
c. Predisposition to gastrointestinal ulceration
methotrexate (Rheumatrex) classification
Disease Modifying Antirheumatic Drug (DMARD)
methotrexate (Rheumatrex) MOA
Interferes with folic acid metabolism → inhibits DNA synthesis and cells reproduction, also immunosuppressive → suppresses T and B lymphocyte activity
Kills rapidly dividing cells (skin, nails, hair, GI mucosa, bone marrow, reproductive cells)
Indications for methotrexate (Rheumatrex)
Rheumatoid arthritis, psoriasis, different types of cancer
methotrexate (Rheumatrex) therapeutic effects
Slow disease progression
Fast acting, therapeutic effects seen within 3-6 weeks
Contraindications for methotrexate (Rheumatrex)
Hypersensitivity
Immunosuppression
Hepatic impairment
Pregnancy/ breast feeding
Precautions for methotrexate (Rheumatrex)
Renal impairment
Active infection
Adverse effects for methotrexate (Rheumatrex)
Hepatic fibrosis
Bone marrow suppression (risk for bleeding, infection, anemia)
GI ulceration
Pneumonitis
Nursing considerations for methotrexate (Rheumatrex)
Assess vital signs
GI assessment (monitor for diarrhea, pain, stomatitis)
Signs of bone marrow suppression → bleeding gums, bruising, petechiae, melon, hematuria, hematemesis, fatigue shortness of breath
Intake/ output, weights
Assess for signs of pulmonary toxicity (dry cough is an early sign)
Administer antiemetic prophylactically
Liver enzymes, CBC
Tumour necrosis factor
In rheumatoid arthritis, tumour necrosis factor (TNF) plays a large role in promoting infiltration of neutrophils and macrophages which results in inflammation and joint destruction
Infliximab (Remicade) classification
Disease Modifying Antirheumatic Drug (DMARD)
Tumor Necrosis Factor Antagonist
Infliximab (Remicade) MOA
Neutralizes TNF, an immune mediator in RA, thereby suppressing inflammation
Infliximab (Remicade) indications
Active rheumatoid arthritis, active Crohn’s disease, psoriasis, ankylosing spondylitis
Therapeutic effect of infliximab (Remicade)
Decreased pain and swelling, decreased rate of joint destruction and improved physical function
Additional info of infliximab (Remicade)
Often used in combination with Methotrexate
IV administered
Adverse effects of infliximab (Remicade)
Immunosuppression → increased risk of serious infections (especially infections caused by M. Tuberculosis), fungal infections, and opportunistic infections
-Because TNF normally plays a role in response to infection, drugs that neutralize this factor, risk of infection increases
-Diabetes, HIV, and concurrent immunosuppressant drug use will increase the developing an infection while on the drug
Heart failure
Contraindications of infliximab (Remicade)
Hypersensitivity to Infliximab
Active infection
Use cautiously in patients with a history of tuberculosis, patients with recurrent infections
Nursing considerations for infliximab (Remicade)
Infusion reaction
- Continuous monitoring of IV site
- Minor vs Severe
Infection
- Signs of new onset
- Fever/ chills
Neutropenia
- CBC monitored frequently
Heart failure
- Edema, weight gain, SOB, crackles
A nurse teaches a patient who is to start taking infliximab (Remicade) for rheumatoid arthritis. Which of these cardiac findings should the nurse instruct the patient to report as a complication of this treatment?
a. Calf pain
b. Pedal edema
c. Cool, pale toes
d. Clubbed fingernails
b. Pedal edema
A patient is taking methotrexate (Rheumatrex) for rheumatoid arthritis. Which therapeutic action should a nurse expect if the medication is having the desired effect?
a. Selective inhibition of cyclooxyrgenase
b. Neutralization of tumour necrosis factor
c. Inhibition of T-cell activation
d. Suppression of T and B lymphocytes
d. Suppression of T and B lymphocytes
Allopurinol (Zyloprim) classification
Xanthine Oxidase Inhibitor
Allopurinol (Zyloprim) MOA
Xanthine oxidase is an enzyme required for uric acid formation. By inhibiting this enzyme, thereby reducing the production of uric acid in the body
Indication for allopurinol (Zyloprim)
Gout
Therapeutic effect of allopurinol (Zyloprim)
Dissolve uric crystals, prevent new crystal formation, prevent disease progression, reduce frequency of attacks, improve quality of life
Adverse effects of allopurinol (Zyloprim)
Generally, well tolerated
Hypersensitivity → rash, fever, liver and kidney dysfunction
Mild GI upset
May initially worsen gout attack
Kidney stones
Contraindications of allopurinol (Zyloprim)
Use with caution in patients with kidney dysfunction
Discontinue immediately if signs of hypersensitivity
Encourage fluid intake
Normal function of calcium
Nervous system
MSK system
Cardiovascular system
Where is vitamin D and calcium absorbed?
In the small intestine
Hypercalcemia
3-4g a day over long periods of time
Most likely in those also receiving large amounts of vitamin D
GI disturbance: N/ V/ constipation
Renal dysfunction (polyuria, nephrolithiasis)
CNS effects (lethargy, depression)
Cardiac dysrhythmias
Risk of vascular calcification, MI and stroke
Role of vitamin D for calcium
Increases plasma calcium levels
- Increases calcium reabsorption from bone
- Decreases calcium excretion by the kidney
- Increases calcium absorption from the intestine
Produced naturally in humans when our skin is exposed to sunlight
Vitamin D2 is a form of vitamin D that occurs in plants and is used for medications and supplements and to fortify foods
Alendronate (Fosamax) classification
Bisphonate
Alendronate (Fosamax) MOA
Reduces the number and activity of osteoclasts
Contraindications for alendronate (Fosamax)
OP in postmenopausal women, GIOP, OP in men
Therapeutic effects of alendronate (Fosamax)
Strengthens bone and reduces risks of fractures associated with osteoporosis
Adverse effects of alendronate (Fosamax)
Esophagitis: occurs with prolonged contact with the esophageal mucosa if the drug fails to pass completely into the esophagus
MSK pain: can occur with initial dose or month after. Not a reason to stop - notify the prescriber and manage the pain. Often resolves with time
RARE: ocular inflammation, atypical femur fractures
Administration of alendronate (Fosamax)
Maximize bioavailability (morning, empty stomach, before breakfast, with only water, no food or drink for 30 mins after)
Minimize risk of esophageal injury:
Take with a full glass of water
Remain upright (sitting or standing) for at least 30 mins
Avoid chewing or sucking on alendronate tablets
