Musculoskeletal Meds

Question 1

Biphosphonates

Answer 1

• Alendronate
• Risedronate
• Ibandronate
• Zoledronate

Facts:
- decrease the number and action of osteoclasts which decreases bone breakdown or resorption
- treats osteoporosis, hypercalcemia due to malignancy, paget’s disease (weak bones)
- if patient has difficulty swallowing, only use zoledronate
- do not take with orange juice, caffeine, antacids, or calcium supplements
- can cause musculoskeletal pain, esophagitis, jaw pain, afib
- take in the morning on empty stomach with 8oz of water and remain upright for 30 mins
- increse intake of vitamin D

Question 2

Antirheumatics

Answer 2

DMARDS:
- Methotrexate
- Hydroxychloroquine
- Etanercept
- Infliximab
- Adalimumab

Facts:
- slow joint degeneration and progression of rheumatoid arthritis
- drink 2-3L of fluid daily due to renal toxicity
- do not take during pregnancy, patients with psoriasis, alcohol abuse, liver failure, renal failure
- can cause increased risk of infection, bone marrow suppression, and GI ulcers
- can take 3-6 weeks to work, and full effects may take several months
-retinal exam every 6 months with hydroxychloroquine
- take with food

Glucocorticoids:
- Prednisone
- Prednisolone
- Meyhylprednisone

Facts:
- decrease inflammation and pain
- do not give live vaccines during therapy, patients with systemic fungal infections
- only use short term
- can cause hyperglycemia and hypokalemia
- take calcium and vitamin D supplements
- take with food, do not take with grapefruit juice

NSAIDs:
- Ibuprofen
-Indomethacin
- Naproxen
- Celexib

Facts:
- decreases inflammation
- can cause increase in risk of MI and stroke, sun sensitivity, GI discomfort, ulcers, renal impairment
- take with food and water
- avoid lying down for 30 minutes
- use only as needed to reduce risk of ulcers

Question 3

Antigout

Answer 3

• Allopurinol
• Colchicine

Facts:
- Allopurinol is given ALL of the time
- Colchicine is given in a Crisis and causes explosive diarrhea
- do not give with theophylline (bronchodilator)
- drink 2-3L of fluid per day due to renal, cardiac, and GI dysfunction
- if rash occurs, stop immediately
- decreases the metabolism of warfarin
- take with meals
- avoid aspirin