E4 326 - musculoskeletal - pharm

Question 1

what class is Aldendronate

Answer 1

biphosphates

Question 2

biphosphates MOA

Answer 2

Binds permanently to surface of bones to inhibit osteoclast activity

Question 3

Aldendronate indication

Answer 3

osteoporosis

Question 4

Aldendronate SE

Answer 4

N/V/D
Esophageal ulceration

(Treatment of osteoporosis)

Question 5

Aldendronate nursing considerations

Answer 5

do not lay down after taking d/t ulceration risk

do not take calcium (or other food/drinks) with this bc will lower bioavailability)

given 1x/wk

(Treat osteoporosis)

Question 6

what class is Raloxifene

Answer 6

Selective estrogen receptor modulators (SERMs)

Question 7

Selective estrogen receptor modulators (SERMs) MOA

Answer 7

Mimics estrogen by increasing bone density, inhibits bone resorption

Question 8

Raloxifene indications

Answer 8

Preventing or treating postmenopausal osteoporosis

Question 9

Raloxifene SE

Answer 9

Hot flashes
Leg problems
Stroke risk

(Preventing or treating postmenopausal osteoporosis)

Question 10

Raloxifene nursing considerations

Answer 10

Safer than a hormone replacement, less affective the biphos

BBW: stroke risk

Need to take adequate calcium & vit D for this to work

Discontinue at least 72 hrs before planned procedures

Do not smoke or drink

Do not take if pregnant

(Used as prevention and treatment post-menopausal osteoporosis)

Question 11

what class is Calcitonin Salmon

Answer 11

calcitonin

Question 12

Calcitonin Salmon MOA

Answer 12

Inhibits bone removal by osteoclasts

Question 13

Calcitonin Salmon indication

Answer 13

Treatment of osteoporosis

Question 14

Calcitonin Salmon SE

Answer 14

Nasal irritation

Question 15

Calcitonin Salmon nursing consideration

Answer 15

Have to take for 5 years to see long term benefit

Slows done bone loss and increases spinal bone density

Given intranasal

Question 16

what class is Methotrexate

Answer 16

DMARD ; antineoplastic, anti-rheumatic

Question 17

Methotrexate MOA

Answer 17

Immunosuppressive -> interferes w/ folic acid metabolism

Question 18

Methotrexate indication

Answer 18

RA

Question 19

Methotrexate SE

Answer 19

GI
Bone marrow suppression
Shortened life expectancy

Question 20

Methotrexate nursing consideration

Answer 20

Need folic acid replacement

1x/wk or deadly

Hepatotoxic -> monitor liver enzymes

Monitor RBCs & WBCs

11 BBW
-no alcohol
-teratogenic (need BC)
-high infection risk
-liver & kidney disease
-aplastic anemia w/ NSAID use

Question 21

what class is Hydroxychloroquine

Answer 21

DMARD; antimalarial, anti rheumatic

Question 22

Hydroxychloroquine MOA

Answer 22

Unknown but anti inflammatory processes

Question 23

Hydroxychloroquine indications

Answer 23

RA

Question 24

Hydroxychloroquine SE

Answer 24

Retinopathy

Question 25

Hydroxychloroquine nursing considerations

Answer 25

Less side effects than methotrexate, Slow progression of RA when used in combo w/ other DMARDs

Question 26

what class is Biologic Agents

Answer 26

New generation DMARDs

Question 27

Biologic Agents MOA

Answer 27

Targets part of the immune system that triggers inflammation that causes joint and tissue damage

Question 28

Biologic Agents indication

Answer 28

RA

Question 29

Biologic Agents SE

Answer 29

Increase risk of severe skin or lung infections, skin cancers, serious allergic rx

Question 30

Biologic Agents nursing considerations

Answer 30

Usually given w/ methotrexate

Question 31

what class is Allopurinol

Answer 31

Xanthine oxidase inhibitor

Question 32

Xanthine oxidase inhibitor MOA

Answer 32

Inhibits the xanthine oxidase enzyme, which prevents uric acid production

Question 33

Allopurinol indications

Answer 33

Gout related to excess uric acid production

Question 34

Allopurinol SE

Answer 34

Agranulocytosis aplastic anemia fatal skin reaction -> can cause Steven Johnson syndrome which can leads to **TENs**

Question 35

Allopurinol nursing considerations

Answer 35

Prevention drug **May cause hypoglycemia -> watch sugars** **If on warfarin, monitor INR closely** **Onset is 2-6 weeks** Monitor WBC & RBCs

Question 36

what class is Colchicine

Answer 36

anti gout

Question 37

Colchicine MOA

Answer 37

Reduces inflammatory response to the deposits or urate crystals in joint tissue

Question 38

Colchicine indications

Answer 38

2nd line gout therapy

Question 39

Colchicine SE

Answer 39

GI bleeding Urinary bleeding

Question 40

Colchicine nursing considerations

Answer 40

Powerful inhibitor of cell mitosis and **can cause short term leukopenia** **If have flu like sx / vomiting stop immediately because sign of toxicity** **Contraindicated for any person with severe renal, gastrointestinal, hepatic disorders, cardiac disorders or bleeding disorders**

Question 41

what class is probenecid

Answer 41

Uricosuric agent

Question 42

Uricosuric agent MOA

Answer 42

Inhibits reabsorption of uric acid in kidneys promoting excretion

Question 43

probenecid indications

Answer 43

Treats hyperuricemia w/ gout

Question 44

probenecid SE

Answer 44

GI upset Dizziness or headache Kidney/liver impairment Lots of drug interactions

Question 45

probenecid nursing considerations

Answer 45

Take w/ food and plenty of fluids Lots of drug interactions

Question 46

why is hormone therapy no longer used for osteoporosis

Answer 46

d/t risk of blood clots, breast cancer, & other cancers

Question 47

osteomyelitis pharm

Answer 47

abx fro 4-6 weeks-> nafcillin, cefazolin, vancomycin

Question 48

pharm for OA

Answer 48

manage pain & reduce swelling mild to mod: acetaminophen, topical capsaicin, nsaids mod to sev: rx nsaids, nsaids + colchinine, Tylenol + tramadol, opioids, steroid injections

Question 49

how do NSAIDs work

Answer 49

by reducing production of prostaglandins which promote inflammation, pain and fever

Question 50

what drugs are NSAIDs

Answer 50

aspirin ibuprofen naproxen ketorolac celecoxib

Question 51

NSAIDs facts

Answer 51

-use lowest effective dose -can affect kidney function -risk for GI bleed -contraindicated for pts w/ PUD -use w/ caution if pmh of GI bleeds or on anticoags

Question 52

goal of pharm for RA

Answer 52

-relieve pain and swelling -slow or stop progression of disease -long term drug therapy (NSAIDs, short term glucocorticoids, DMARDS)

Question 53

what is the steroid of choice for RA + facts

Answer 53

-prednisone -rapid suppression of inflammation -only use when sx cannot be controlled by NSAIDs -used with DMARD

Question 54

what is the drug of choice for gout

Answer 54

NSAIDs bc of anti inflammatory