musculoskeletal medications osteoporosis rheumatoid arthritis gout muscle spasms
TRANSCRIPT
• Symptoms Hypocalcemia– Nerve and muscle excitability– Muscle twitching, tremors, cramping– Numbness, tingling, convulsions
• Symptoms Hypercalcemia– Nausea/vomiting, anorexia– Increased thirst, increased urination– Muscle pain/weakness
Osteoporosis Medications
Osteoporosis Medications
• Bisphosphonates (Bone Resorption Inhibitors)– Action draws calcium from blood
to bone increasing bone mineralization– Example alendronate (Fosamax)– Uses osteoporosis, Paget’s disease,
hypercalcemia 2o malignancy– Adverse Reactions GI discomfort and
esophageal irritation
Osteoporosis Medications
• Bisphosphonates– Nursing Considerations• Given once weekly
• Give on an empty stomach
(poorly absorbed)
• Remain upright for 30 minutes after
(esophageal irritation)
• NSAID’s– Analgesic effect– Anti-inflammatory effect– GI Distress
• Corticosteroids– Anti-inflammatory effect– GI Distress– Long term effects
Rheumatoid Arthritis Medications
• Disease-Modifying
Antirheumatic Drugs
(DMARD’s)– Cytotoxic Drugs– Gold Salts– Antimalarial Agents– Sulfasalazine
Rheumatoid Arthritis Medications
• Disease-Modifying
Antirheumatic Drugs
(DMARD’s)– Common Side Effects• GI discomfort/ulceration
• Hepatic dysfunction
• Myelosuppression
Rheumatoid Arthritis Medications
• Disease-Modifying
Antirheumatic Drugs
(DMARD’s)– Cytotoxic Drugs• methotrexate (Rheumatrex)
• Nausea, stomatitis, alopecia, myelosuppression
Rheumatoid Arthritis Medications
• Disease-Modifying
Antirheumatic Drugs
(DMARD’s)– Antimalarial Agents• hydrochloroquine (Plaquenil)
• Relatively few side effects except for
retinal damage causing blindness
Rheumatoid Arthritis Medications
• Disease-Modifying
Antirheumatic Drugs
(DMARD’s)– Sulfasalazine• sulfasalazine (Azulfidine)
• GI discomfort (n/v, diarrhea, cramping)
• Hepatotoxicity
• Myelosuppression
Rheumatoid Arthritis Medications
• Disease-Modifying
Antirheumatic Drugs
(DMARD’s)– Evaluation
Therapeutic Effect• Relief of pain
• Decreased inflammation, swelling
• Increased joint function
Rheumatoid Arthritis Medications
• Disease-Modifying
Antirheumatic Drugs
(DMARD’s)– Evaluation
Adverse Reactions• GI discomfort, ulceration, bleeding
• Liver function tests
• CBC, platelet count
Rheumatoid Arthritis Medications
• Acute Gout– NSAID’s• Decrease pain / inflammation
– colchicine• Decrease inflammation
• GI Distress, diarrhea
• 0.5 mg q 1-2 h until pain
relieved or adverse reactions (max = 4 mg)
Anti-Gout Medications
Anti-Gout Medications
• Chronic Gout– allopurinol (Zyloprim)• Decrease uric acid
production
– probenecid (Benemid)• Increases uric acid
excretion in kidneys
• Avoid ASA products
• May be used to potentiate action of penicillin and cephalosporins
Anti-Gout Medications
• Nursing Considerations– Decrease foods high in
purine (animal fats)– Increase fluid intake
(2-3 L / day)
• Evaluation– Decreased pain / inflammation– Decreased number acute attacks– Decreased uric acid levels
Muscle Relaxants
• Common Uses– Muscle spasm– Back pain
• Example– baclofen (Lioresal)
• Side Effects / Nursing Considerations– Drowsiness, lethargy, confusion– Avoid concurrent use with other CNS
depressants
• Review– Osteoporosis• Calcium supplements
replenish calcium levels
• Bone resorption inhibitors
move calcium from blood to
bone
Musculoskeltal Medications
• Review– Rheumatoid Arthritis• NSAID’s provide short
term immediate pain relief
• Corticosteroids provide
intermediate use for
decreasing inflammation
• DMARD’s provide long term use for slowing progression of disease
Musculoskeletal Medications
• Review– Gout• colchicine used to treat
acute gout
• allopurinol (Zyloprim) used
daily to prevent chronic
gout episodes
• probenecid (Benemid) chronic gout and antiobiotic (penicillin and cephalosporins) potentiator
Musculoskeletal Medications