Musculoskeletal Medications

Question 1

What drug therapy can be used for Rheumatoid Arthritis (RA)?

Answer 1

non-steroidal anti-inflammatory drugs (NSAIDs), Glucocorticoids, disease modifying anti-rhematic drugs (DMARDs)

Question 2

methotrexate (Rheumatrexate): class

Answer 2

Nonbiological (Traditional) DMARD

Question 3

methotrexate (Rheumatrexate): Use

Answer 3

decrease inflammation/ joint pain

Question 4

methotrexate (Rheumatrexate): EPA

Answer 4

immunosuppression, takes weeks to take effect

Question 5

methotrexate (Rheumatrexate): ADR

Answer 5

dizzy, headache, blurred vision, N/V, hepatotoxic, renal damage, infection, bone arrow suppression, GI bleeding, pulmonary fibrosis

Question 6

methotrexate (Rheumatrexate): RN Interventions

Answer 6

monitor lab values, take contraceptives, hydrate 2L a day, report adverse reactions, monitor respiratory status

Question 7

methotrexate (Rheumatrexate): contraindications

Answer 7

Teratogenic. Caution in w/ peptic ulcer disease, ulcerative colitis. Infections. Liver disease, heavy ETOH use.
Med Interactions: Warfarin, Digoxin, NSAIDs
Caffeine can reduce effectiveness!

Question 8

etanercept (Enbrel): class

Answer 8

biological DMARDs

Question 9

biological DMARDs

Answer 9

etanercepts (Enbrel), infliximab (Remicade), adalimumab (Humira)

Question 10

etanercept (Enbrel): use

Answer 10

decrease joint inflammation and subsequent damage, once weekly

Question 11

etanercept (Enbrel): EPA

Answer 11

inactivates tumor necrosis factor (TNF)

Question 12

etanercept (Enbrel): ADR

Answer 12

immunosuppression, pancytopenia, heart failure, dizzy, abdominal pain, psoriasis

Question 13

etanercept (Enbrel): RN Interventions

Answer 13

monitor for infection, monitor for heart failure, TB test prior to start of therapy, monitor lab values

Question 14

etanercept (Enbrel): contraindications

Answer 14

NO live vaccines, active infection, hematological disorders, malignancy, interacts with chemotherapeutics = bone marrow suppression, do not give with Anikinra (Kineret)

Question 15

What medications treat osteoporosis?

Answer 15

SERMs, Bisphosphonates, calcitonin, calcium supplements

Question 16

raloxifene(Evista): class

Answer 16

Selective Estrogen Receptor Modulators (SERMs)

Question 17

raloxifene(Evista): Use

Answer 17

bone reabsorption inhibitor, postmenopausal osteoporosis, reducing risk of estrogen receptor-positive breast cancer

Question 18

raloxifene(Evista): EPA

Answer 18

activate estrogen receptors in some tissue and blocks receptors in others (breast)

Question 19

raloxifene(Evista): ADR

Answer 19

increased risk of stroke, PE, DVT, Hot flashes

Question 20

raloxifene(Evista): Contraindications

Answer 20

teratogenic, do not give with history of PE/DVT, caution with HLD, and concurrent estrogen use

Question 21

raloxifene(Evista): RN Interventions

Answer 21

monitor and report s/sx of thrombi-emboli, encourage calcium and vitamin D intake, do weight bearing activates, educate on hot flashes

Question 22

alendronate (Fosamax): class

Answer 22

bisphosphonates

Question 23

bisphosphonate medications

Answer 23

alendronate (fosamax), risedronate (actonel), ibandronate (Boniva)

Question 24

alendronate (fosamax): use

Answer 24

postmenopausal, age-related and glucocorticoid osteoporosis

Question 25

alendronate (fosamax): EPA

Answer 25

bone reabsorption inhibitor, inhibits osteoclast activity - decrease bone absorption

Question 26

alendronate (fosamax): ADR

Answer 26

GI distress, muscle and joint pain

Question 27

alendronate (fosamax): contraindications

Answer 27

esophageal disorders, renal insufficiency, hypocalcemia, calcium supplements & dairy reduce absorption

Question 28

alendronate (fosamax): RN Interventions

Answer 28

monitor for esophagitis, take with full glass of water, sit at a 90 degree angle for 30 minutes, 30 minutes prior to other food, report vision changes

Question 29

calcitonin-salmon (Miacalcin, Calcimar): class

Answer 29

Hypocalcemic: Calcitonin

Question 30

calcitonin-salmon (Miacalcin, Calcimar): Use

Answer 30

treats established postmenopausal osteoporosis, hypercalcemia, hyperparathyroidism, Paget's disease

Question 31

calcitonin-salmon (Miacalcin, Calcimar): EPA

Answer 31

inhibits actions of osteoclasts, increase excretion of calcium

Question 32

calcitonin-salmon (Miacalcin, Calcimar): ADR

Answer 32

allergy to salmon protein or gelatin diluent, hypocalcemia, nasal dryness and irritation, headache, epistaxis, N/V, polyuria

Question 33

calcitonin-salmon (Miacalcin, Calcimar): contraindications

Answer 33

allergy to salmon/fish proteins, interaction with lithium, may have lower effectiveness if bisphosphonate previously taken

Question 34

calcitonin-salmon (Miacalcin, Calcimar): RN Interventions

Answer 34

inspect nares, diet high in calcium and vitamin D, intradermal allergy test, keep some forms in fridge and protected from light, s/sx hypocalcemia, regular bone density testing

Question 35

What is Hypocalcemia and what does it present as?

Answer 35

calcium level lower than 9.0 CATS: convulsions, arrhythmias, tetany, stridor and spasms

Question 36

What is Hypercalcemia and what does it present as?

Answer 36

calcium level higher than 10.5 Moans, bones, stones, groans, other: N/V, constipation, pancreatitis, weakness, bone pain, fractures, polyuria, nephrocalcinosis, confusion, poor concentration, secondary hypertension, short QT

Question 37

calcium citrate (Citracal) or calcium carbonate (Tums): class

Answer 37

calcium supplements

Question 38

calcium citrate (Citracal) or calcium carbonate (Tums): use

Answer 38

calcium replacement, antacid

Question 39

calcium citrate (Citracal) or calcium carbonate (Tums): EPA

Answer 39

provide calcium, acts as a base

Question 40

calcium citrate (Citracal) or calcium carbonate (Tums): ADR

Answer 40

hypercalcemia, N/V constipation, polyuria, depression, renal stones

Question 41

calcium citrate (Citracal) or calcium carbonate (Tums): contraindications

Answer 41

Avoid in hypercalcemia OR hypophosphatemia. Caution w/ kidney stones, cardiac dysrhythmias, slow gastric motility. Interactions: above meds. Digoxin, thiazide diuretics. Some foods.

Question 42

calcium citrate (Citracal) or calcium carbonate (Tums): RN Interventions

Answer 42

monitor calcium levels, give IV Slowly, administer 1 hr before or 2 hrs after other medications, do not take more than 600mg at a time, chew and take with water