Pharmacology for mobility: musculoskeletal

Question 1

NSAIDS MOA

Answer 1

Block prostaglandin via Cox1 and Cox2

Question 2

Indications for NSAIDS

Answer 2

Inflammation, pain, fever

Question 3

First generation NSAIDS

Answer 3

Ibuprofen (Advil) and Naproxen (Aleve)

Question 4

Second generation NSAIDS

Answer 4

Celecoxib (Celebrex)
Slightly more GI protection
Related to Sulfa

Question 5

ASA description

Answer 5

Aspirin
Prevention of MI/ stroke via interrupting platelet aggregation
Contraindicated in <18 yrs → Reye’s Syndrome

Question 6

Harmful effects of inhibition of COX-1

Answer 6

Gastric erosion and ulceration
Bleeding tendencies
Renal impairment

Question 7

Harmful effects of inhibition of COX-2

Answer 7

Renal impairment
Promotion of MI and stroke (secondary to suppressing vasodilation)

Question 8

Nursing considerations for NSAIDs

Answer 8

Best administered with food
Monitor kidney function
Monitor for adverse effects of HTN
Monitor for signs of bleeding
All NSAIDs contraindicated in pregnancy

Question 9

Steven Johnson Syndrome description

Answer 9

Blistering of the skin and mucous membranes

Question 10

What does cortisol do?

Answer 10

Reduces inflammation
Increases blood sugar
Increases blood pressure

Question 11

Prednisone (Deltasone) classification

Answer 11

Corticosteroid also called steroids or glucocorticoids

Question 12

MOA of prednisone (Deltasone)

Answer 12

Mimics Cortisol (a hormone produced by our adrenal glands)
Potent anti-inflammatory and immunosuppressant
Works rapidly and is often only used for a short period of time

Question 13

Indication for prednisone

Answer 13

Used to treat autoimmune disorders (like rheumatoid arthritis)

Question 14

Therapeutic effects of prednisone

Answer 14

Suppression of the inflammatory and immune responses in autoimmune disorders

Question 15

Adverse effects of prednisone (Deltasone)

Answer 15

Fluid retention
Hypokalemia
High blood pressure
Mood swings, psychological and behavioural changes
Weight gain
Hyperglycemia
Increased risk of infection
Slow wound healing, bruising
Peptic ulcers
Osteoporosis

Question 16

Contraindications and precautions of prednisone

Answer 16

Presence of active infection should not take (prednisone will mask symptoms of infection)
Peptic ulcer
Hypersensitivity
Should not be taken long term → will cause adrenal suppression so taper dose over time

Question 17

Nursing considerations and assessment of prednisone

Answer 17

Monitor intake/ output
Assess for: edema, weigh daily, auscultate lungs, skin assessment
Monitor serum electrolytes and glucose
Administer with meals to prevent GI irritation
Stopping doses abruptly can cause adrenal insufficiency → anorexia, nausea/ vomiting, weakness, fatigue, dyspnea, low blood pressure, hypoglycemia. Patients should not skip doses
Patient should increase foods with calcium and potassium
Monitor for improvement of disorder symptoms

Question 18

What does the nurse identify as possible complications of glucocorticoid therapy? Select all that apply:
a. Impaired carbohydrate and glucose tolerance
b. Increased production of glucocorticoids from the adrenals
c. Predisposition to gastrointestinal ulceration
d. Decrease in serum sodium and glucose levels
e. Increase in plaque development in coronary arteries

Answer 18

a. Impaired carbohydrate and glucose tolerance
c. Predisposition to gastrointestinal ulceration

Question 19

methotrexate (Rheumatrex) classification

Answer 19

Disease Modifying Antirheumatic Drug (DMARD)

Question 20

methotrexate (Rheumatrex) MOA

Answer 20

Interferes with folic acid metabolism → inhibits DNA synthesis and cells reproduction, also immunosuppressive → suppresses T and B lymphocyte activity
Kills rapidly dividing cells (skin, nails, hair, GI mucosa, bone marrow, reproductive cells)

Question 21

Indications for methotrexate (Rheumatrex)

Answer 21

Rheumatoid arthritis, psoriasis, different types of cancer

Question 22

methotrexate (Rheumatrex) therapeutic effects

Answer 22

Slow disease progression
Fast acting, therapeutic effects seen within 3-6 weeks

Question 23

Contraindications for methotrexate (Rheumatrex)

Answer 23

Hypersensitivity
Immunosuppression
Hepatic impairment
Pregnancy/ breast feeding

Question 24

Precautions for methotrexate (Rheumatrex)

Answer 24

Renal impairment
Active infection

Question 25

Adverse effects for methotrexate (Rheumatrex)

Answer 25

Hepatic fibrosis Bone marrow suppression (risk for bleeding, infection, anemia) GI ulceration Pneumonitis

Question 26

Nursing considerations for methotrexate (Rheumatrex)

Answer 26

Assess vital signs GI assessment (monitor for diarrhea, pain, stomatitis) Signs of bone marrow suppression → bleeding gums, bruising, petechiae, melon, hematuria, hematemesis, fatigue shortness of breath Intake/ output, weights Assess for signs of pulmonary toxicity (dry cough is an early sign) Administer antiemetic prophylactically Liver enzymes, CBC

Question 27

Tumour necrosis factor

Answer 27

In rheumatoid arthritis, tumour necrosis factor (TNF) plays a large role in promoting infiltration of neutrophils and macrophages which results in inflammation and joint destruction

Question 28

Infliximab (Remicade) classification

Answer 28

Disease Modifying Antirheumatic Drug (DMARD) Tumor Necrosis Factor Antagonist

Question 29

Infliximab (Remicade) MOA

Answer 29

Neutralizes TNF, an immune mediator in RA, thereby suppressing inflammation

Question 30

Infliximab (Remicade) indications

Answer 30

Active rheumatoid arthritis, active Crohn's disease, psoriasis, ankylosing spondylitis

Question 31

Therapeutic effect of infliximab (Remicade)

Answer 31

Decreased pain and swelling, decreased rate of joint destruction and improved physical function

Question 32

Additional info of infliximab (Remicade)

Answer 32

Often used in combination with Methotrexate IV administered

Question 33

Adverse effects of infliximab (Remicade)

Answer 33

Immunosuppression → increased risk of serious infections (especially infections caused by M. Tuberculosis), fungal infections, and opportunistic infections -Because TNF normally plays a role in response to infection, drugs that neutralize this factor, risk of infection increases -Diabetes, HIV, and concurrent immunosuppressant drug use will increase the developing an infection while on the drug Heart failure

Question 34

Contraindications of infliximab (Remicade)

Answer 34

Hypersensitivity to Infliximab Active infection Use cautiously in patients with a history of tuberculosis, patients with recurrent infections

Question 35

Nursing considerations for infliximab (Remicade)

Answer 35

Infusion reaction - Continuous monitoring of IV site - Minor vs Severe Infection - Signs of new onset - Fever/ chills Neutropenia - CBC monitored frequently Heart failure - Edema, weight gain, SOB, crackles

Question 36

A nurse teaches a patient who is to start taking infliximab (Remicade) for rheumatoid arthritis. Which of these cardiac findings should the nurse instruct the patient to report as a complication of this treatment? a. Calf pain b. Pedal edema c. Cool, pale toes d. Clubbed fingernails

Answer 36

b. Pedal edema

Question 37

A patient is taking methotrexate (Rheumatrex) for rheumatoid arthritis. Which therapeutic action should a nurse expect if the medication is having the desired effect? a. Selective inhibition of cyclooxyrgenase b. Neutralization of tumour necrosis factor c. Inhibition of T-cell activation d. Suppression of T and B lymphocytes

Answer 37

d. Suppression of T and B lymphocytes

Question 38

Allopurinol (Zyloprim) classification

Answer 38

Xanthine Oxidase Inhibitor

Question 39

Allopurinol (Zyloprim) MOA

Answer 39

Xanthine oxidase is an enzyme required for uric acid formation. By inhibiting this enzyme, thereby reducing the production of uric acid in the body

Question 40

Indication for allopurinol (Zyloprim)

Answer 40

Gout

Question 41

Therapeutic effect of allopurinol (Zyloprim)

Answer 41

Dissolve uric crystals, prevent new crystal formation, prevent disease progression, reduce frequency of attacks, improve quality of life

Question 42

Adverse effects of allopurinol (Zyloprim)

Answer 42

Generally, well tolerated Hypersensitivity → rash, fever, liver and kidney dysfunction Mild GI upset May initially worsen gout attack Kidney stones

Question 43

Contraindications of allopurinol (Zyloprim)

Answer 43

Use with caution in patients with kidney dysfunction Discontinue immediately if signs of hypersensitivity Encourage fluid intake

Question 44

Normal function of calcium

Answer 44

Nervous system MSK system Cardiovascular system

Question 45

Where is vitamin D and calcium absorbed?

Answer 45

In the small intestine

Question 46

Hypercalcemia

Answer 46

3-4g a day over long periods of time Most likely in those also receiving large amounts of vitamin D GI disturbance: N/ V/ constipation Renal dysfunction (polyuria, nephrolithiasis) CNS effects (lethargy, depression) Cardiac dysrhythmias Risk of vascular calcification, MI and stroke

Question 47

Role of vitamin D for calcium

Answer 47

Increases plasma calcium levels - Increases calcium reabsorption from bone - Decreases calcium excretion by the kidney - Increases calcium absorption from the intestine Produced naturally in humans when our skin is exposed to sunlight Vitamin D2 is a form of vitamin D that occurs in plants and is used for medications and supplements and to fortify foods

Question 48

Alendronate (Fosamax) classification

Answer 48

Bisphonate

Question 49

Alendronate (Fosamax) MOA

Answer 49

Reduces the number and activity of osteoclasts

Question 50

Contraindications for alendronate (Fosamax)

Answer 50

OP in postmenopausal women, GIOP, OP in men

Question 51

Therapeutic effects of alendronate (Fosamax)

Answer 51

Strengthens bone and reduces risks of fractures associated with osteoporosis

Question 52

Adverse effects of alendronate (Fosamax)

Answer 52

Esophagitis: occurs with prolonged contact with the esophageal mucosa if the drug fails to pass completely into the esophagus MSK pain: can occur with initial dose or month after. Not a reason to stop - notify the prescriber and manage the pain. Often resolves with time RARE: ocular inflammation, atypical femur fractures

Question 53

Administration of alendronate (Fosamax)

Answer 53

Maximize bioavailability (morning, empty stomach, before breakfast, with only water, no food or drink for 30 mins after) Minimize risk of esophageal injury: Take with a full glass of water Remain upright (sitting or standing) for at least 30 mins Avoid chewing or sucking on alendronate tablets