Musculoskeletal

Question 1

Calcium

Answer 1

Given on empty stomach cause if given with food binds to phosphate and excreted in faeces

Question 2

Cytotoxic drugs

Answer 2

Decrease proliferation of cells within immune system

Monitor WBC notify if below 4000 or platelets below 75000.
Monitor kidney and liver function tests, give with food, increase fluids for hydration and output
monitor intake/output
Monitor for bleeding

Education- avoid situations that can expose to infection, report signs of infection, use contraception, avoid aspirin/ibuprofen, menses may stop

Question 3

Uricosurics (probenecid)

Answer 3

Block tubular reabsorption of uric acid promoting secretion

Assess for hypersensitivity, take with meal/milk, administer sodium bicarb to alkaline urine, no aspirin

Side effects- nausea, vomiting, headaches, dizziness, hepatic necrosis, renal colic, bone marrow depression, anaphylaxis

Contraindications- aspirin (interferes with drug action)

Education- no aspirin, drink 3 ltr water (minimise kidney stones), take with meals

Question 4

Allopurinol

Answer 4

Anti gout, antihyperurecimics

Prevents attacks of gouty arthritis and neuropathy

Dose- 100mg 2-3 times daily

Use cautiously in rental impairment and dehydration

Acts on purine metabolism, xanthine oxidase inhibitor lowers plasma uric acid levels and facilitates mobilisation of tophi

Nursing considerations- Drink 3 ltr water, assess BUN and creative levels prior to treatment, administer with meals, monitor FBC (bone marrow depression), discontinue if develops a rash, monitor BGL if diabetic (can cause hypos), assess for joint pain

Education- stop if rash develops, painful ruination, blood in urine, swelling of lips, take with meals, drink 3-4 ltr water

Side effects- CNS- drowsiness
CVS- hypotension, hypertension, flushing, bradycardia, heart failure
Skin- rash
GI- nausea, diarrhoea, vomiting, hepatitis
Urinary- renal failure, haematuria
Haem- bone marrow depression

Interactions- Use with warfarin and oral hypoglycaemics increases effects of these drugs

Question 5

Colchicine

Answer 5

Interrupts cycle of urate crystal deposits and inflammation response

Oral doses on empty stomach, evaluate for adverse effects

Education- drink 3-4 ltr water, report adverse effects, no alcohol

Side effects- abdo cramps, diarrhoea, nausea, vomiting, bone marrow suppression, DIC

Contraindication- GI disease, kidney disease, hepatic disease, cardiac

Question 6

Calcitonin

Answer 6

Prevents further bone loss and increases bone mass, pain relief, derived from salmon and humans

Protein so may cause anaphylaxis, alternate nostrils daily,

Contraindicated- salmon allergy, breast feeding

Side effects- nausea, vomiting, anorexia, runny nose, flushing of palms and soles feet

Education- take in evening to minimise side effects, warm to room temperature before use, consume adequate calcium and Vit D

Question 7

Fluoride

Answer 7

Decrease solubility of bone mineral and bone reabsorption

Monitor fluoride levels every three months, six monthly bone density scans

Education- take after meals and avoid milk or dairy products ( reduce GI absorption), maintain adequate calcium intake

Question 8

Bisphosphonates (alendronate)

Answer 8

Inhibit bone reabsorption increasing mineral density of bones. Slow accelerated bone turnover, relieve bone pain

Take 30min before food, no foods high in calcium/mineral/vitamins/supplements or antacids within 2 hours as interfere with absorption, avoid lying down 30mins post as GI irritation can occur, assess renal function before commencing treatment, dilute and infuse over 4 hours, don’t add to calcium containing solutions like hartmanns, asses for electrolyte imbalance

Side effects- nausea, flu like symptoms

Educate- take with water, report symptoms like worsening heartburn or difficulty swallowing, fever may occur with IV infusion but will subside, report tingling around mouth or numbness (indicate electrolyte imbalance), take Vit and calcium supplements