MSK and Endocrine Drugs

Question 1

Ibandronate, Alendronate

Answer 1

Biophosphonates used in the treatment and prevention of osteoporosis.
Work by inhibiting bone resorption and decreasing osteoclast activity,
ADRs: Esophageal Ulcer, Atypical Femoral Fractures, Osteonecrosis of Jaw, Ocular problems
[take on empty stomach, no food]

Question 2

Calcitonin

Answer 2

hormone secreted by thyroid, used in treatment of Paget’s and osteoporosis.
Works by moving the calcium to the bone, lowering serum calcium.
Not as effective as the other osteoporosis drugs.

Question 3

Raloxifene

Answer 3

a selective estrogen receptor modifer, like estrogen but safer.
estrogen bone agonist
estrogen breast and uterus antagonist
–> protects against those cancers
ADRs: thromboembolism, stroke

Question 4

Teriparatide (Forteo)

Answer 4

used in the treatment of osteoporosis
Creates bone formation with osteoblasts. Is a form of PTH.
ADRs: orthostatic hypotension, cramping
osteosarcoma in animals
nursing considerations: given with an injector device

Question 5

Denosumab (Prolia, Xgeva)

Answer 5

monoclonal antibody used for treatment of osteoporosis.
Decreases the formation and function of osteoclasts, which decreases bone resorption, and increases bone strength and density.
ADRs: pain, hypocalcemia, pancreatitis
nursing considerations: administer subQ, 1x month

Question 6

Ocreotide (Sandostatin)

Answer 6

Somastatin Analog
a natural Growth Hormone inhibiting hormone, so it decreases GH release

Question 7

Pegvisomant (Somavert)

Answer 7

Growth Hormone Receptor Antagonist, used for the treatment of Acromegaly, thought to be the most effective

Question 8

Desmopressin (DDAVP)

Answer 8

not as intense vasoconstrictor effect as Vasopressin, like Anti Diuretic Hormone
ADRs; water intoxication, and excessive vasoconstriction

Question 9

Levothyroxine Sodium

Answer 9

synthetic T4, the drug of choice for Hypothyroidism
a lot of the T4 converts to T3

IV Levothyroxine is used to treat Myxedema Coma
nursing considerations: narrow therapeutic range, take on an empty stomach b4 breakfast, will take one month to reach therapeutic levels

Question 10

Methimazole (Tapazole)

Answer 10

Thionamide used to inhibit the synthesis of thyroid hormones
*does not destroy the existing stores of thyroid hormone, so takes 3-12 weeks to come into effect
ADRs: Hypothyroidism, Agranulocytosis, monitor WBC and sore throat and fever

Question 11

Propylthiouracil (PTU)

Answer 11

a thionamide that is safer to use in pregnancy

Question 12

Propanolol (Inderal)

Answer 12

beta 1 and 2 blocker used in treatment of hyperthyroidism

Question 13

Methotrexate

Answer 13

fast acting (3-6 weeks) DMARD for treatment of arthritis
-slows disease progression and reduces joint destruction
-also is a chemotherapy drug that kills fast growing cells
-reduces B and T lymphocytes
-in small doses works as an immunosuppressant agent, helpful in treatment of autoimmune diseases
ADRs: Steven Johnson syndrome, Seizure, hepatotoxicity, nephrotoxicity, pneumonitis, bone marrow suppression, GI ulceration,

Question 14

Sulfasalazine (Azulfidine)

Answer 14

originally used for treatment of IBD, ow used for Rheumatoid Arthritis
-anti inflammatory and immunosuppressant
-slows disease progression and reduces joint destruction
ADR: GI side effects, dermatologic,

Question 15

Hydroxychloroquine (Plaquenil)

Answer 15

preffered DMARD for pts with mild symtoms
also an antimalarial agent
usually given in combo with Methotrexate
(not effective in slowing disease progression when given by itself)
ADR:retinal damage can lead to blindness, need EYE EXAM prior to treatment

Question 16

Adalimumad (Humira)

Answer 16

tumor necrosis factor blocker
(neutralizes TNF which is part of pathology of rheumatoid arthritis)
ADRs: sepsis, invasive fungal infections, hematologic disorders, hepatoxicitiy

Question 17

Etanercept (Enbrel)

Answer 17

tumor necrosis factor blocker
(neutralizes TNF which is part of pathology of rheumatoid arthritis)
ADRs: sepsis, invasive fungal infections, hematologic disorders, hepatoxicitiy

Question 18

Imfliximab (Remicade)

Answer 18

tumor necrosis factor blocker

Question 19

Indomehtacin (Indocin)

Answer 19

NSAID used for termination of acute gout attacks
(NSAIDS are first line)

Question 20

Naproxen (Naprosyn)

Answer 20

NSAID used for termination of acute gout attacks
(NSAIDS are first line)

Question 21

Colchicine

Answer 21

anti-inflammatory agent specific for Gout
it inhibits the migration of leukocytes to the inflamed site
used to be first line, but now NSAIDS are more effective
ADRs: GI side effects

Question 22

Allopurinol

Answer 22

drug used to decrease uric acid levels for gout
it is the preferred agent, it inhibits uric acid formation
-used prophylactically
nursing considerations: pt needs to increase fluid intake

Question 23

Febuxostat

Answer 23

drug used to decreased uric acid levels for treatment of gout
an alternative to Allopurinol (just as effective)

Question 24

Probenecid

Answer 24

increases the rate of uric acid excretion by inhibiting uric acid reabsorption
-used in the treatment of gout
-used for chronic gout, not for acute attacks
nursing considerations: should not be taken during the first 2-3 weeks of an acute attack because it will prolong the inflammatory process

Question 25

Baclofen (lioresal)

Answer 25

for the treatment of muscle spasticity
-centrally acting, acts within the spinal cord
suppresses the hyperactive reflexes in the regulation of muscle movement
-no direct on skeletal muscles (so it doesn’t decrease muscle strength)
ADRS: CNS depressant, also an abrupt withdrawal can trigger hallucinations and paranoid ideations
nursing considerations: can be delivered Intrathecally directly to the cerebral spinal fluid (also available PO)

Question 26

Dantrolene (Dantrium)

Answer 26

direct acting agent on skeletal muscle to relieve spasticity
it is a skeletal muscle relaxant
ADRs: muscle weakness, hepatotoxicity, drowsiness

Question 27

Cyclobenzaprine (flexeril)

Answer 27

centrally acting drug used in the treatment of muscle spasms (not spasticity)
-reduces tonic somatic muscle activity at level of brainstem
ADRs: CNS depressant, anticholinergic effects, serotonin syndrome , cardiac rhythm disturbances

Question 28

Ketoconazole (Nizoral)

Answer 28

an antifungal agent used to suppress the adrenal gland release of corticosteroids (used in treatment of cushings syndrome), inhibits synthesis

Question 29

Hydrocortisone

Answer 29

drug of choice for Addisons disease
-synthetic steroid
-contains both glucocorticoid and mineralocorticoid
nursing considerations:
-may need to adjust dosing during times of stress
-administered orally for chronic, or IV for acute adrenal insufficiency
-do not stop abruptly

Question 30

Fludrocortisone

Answer 30

similar to just administering aldosterone
-just a mineralocorticoid agent used for treatment of Addisons disease
-indicated if pt has sodium loss and hypotension
-usually given along with a hydrocortisone agent
ADR: edema and fluid overload