Muscoskeletal Meds

  1. What is the action/use of BIOPHOSPHANATES ?

    *inhibits osteoclastic bone resorption to increase BMD & total bone mass

    *used for prevention & tx of postmenopausal osteoporosis, steroid induced osteoporosis, paget's dx, osteoporosis in men
  2. What assessments should be done before administering BIOPHOSPHANATES?
    • serum Ca & Vit D 
    • evidence of esophageal irritation
    • difficulty swallowing
    • heartburn
    • visual disturbances

    ***contraindicated in renal insufficiency
  3. What are the expected outcomes for BIOPHOSPHANATES?
    • prevention of or decrease in progression of osteoporosis
    • decrease in progression of Paget's dx
    • improvement in BMD from corticostreoid-induced osteoporosis (zoledronic acid (Reclast))
  4. What interventions for administration of BIOPHOSPHANATES?
    • take 1st thing in the am, 30 mins before other meds, food or beverages
    • take with H2O
    • remain upright for at least 30 mins
  5. What evaluation for administration of BIOPHOPHANATES?
    • no evidence of esophageal irritation
    • decrease incidence of fractures
    • evidence of improvement in BMD   
  6. Name 4 types of biophopahantes medications.
    • alendronate (Fosamax)
    • risedronate (Actonel)
    • ibandronate (Boniva)
    • zoledronic acid (Reclast)   
  7. What is the action/use of CALCITONIN?
    thyroid hormonse used to treat osteoporosis in women at least 5 yrs postmenopausal and Paget's disease by inhibiting osteoclastic bone resorption & decreasing bone turnover
  8. What assessments should be done before administering CALCITONIN?
    • nasal mucosa: rhinitis, *epistaxis
    • SE of N/V
    • monitor serum Ca (watch for s/s of hypocalcemia=nervousness, muscle twitching, paresthesia)
    • assess for hypersensitivity=rash, flushing, fever, hives)
  9. What are the expected outcomes for CALCITONIN?
    • slowed progression of postmenopausal osteoporosis
    • decreased boen pain 
  10. What interventions should be done for CALCITONIN?
    • available in subQ, IM, & intranasal spray forms
    • alternate nostrils daily to prevent dryness
    • store in refrigerator
    • discard 30 days after 1st use   
  11. What evaluation for CALCITONIN?
    • evidence of BMD increase
    • no evidence of nasal irritaion or any injection site irritation 
  12. Name 3 types of CALCITONIN? 
    • Fortical
    • Miacalcin
    • Calcimar
  13. Calcitonin is derived from?
  14. What secretes CALCITONIN?
    thyroid gland

    ***calcitonin decrease calcium serum concentration  if its high above its normal levels 
  15. What is the role of estrogen ?
    stimulates osteoblastic and inhibit PTH; it decreases at menopause=Ca level to decrease which leads to osteoporosis
  16. What is the action/use of ESTROGEN/HORMONE THERAPY?
    hormone used to replace estrogen for relief of vasomotor symptoms and for tx & prevention of postmenopausal osteoporosis
  17. What assessments for ESTROGEN/HORMONE THERAPY?
    monitor s/s thromboembolism, MI, edema, HTN, wt gain, nausea, h/a

    may cause increase in HDL, glucose triglycerides, & Na
  18. What are the expected outcomes for ESTROGEN/HORMONE THERAPY?
    • prevention of vetebral and hip fx's
    • increase in BMD
    • relief of postmenopausal symptoms
  19. What are the interventions for ESTROGEN/HORMONE THERAPY?
    • should be usd in lowest effective dose of shortest duration to meet goals
    • HRT use not recommended solely or osteoporosis prevention, other meds should be considered first 
  20. What evaluation for ESTROGEN/HORMONE THERAPY?
    • decrease incidence of fx
    • normalization of estrogen levels 
  21. Name 3 types of ESTROGEN/HORMONE THERAPY.
    • estrogen therapy (Climara)
    • estradoil (Estrace)
    • Hormone therapy (Prempro)  
  22. Name 1 type of Estrogen Antagonist.
    raloxifene (Evista)
  23. What action/use for ESTROGEN ANTAGONIST?
    • synthetic estrogen that inhibits bone resoprtion used in tx and prevention of postmenopausal osteoporosis
    • produces estrogen-like effects on bone without breast ot uterus involvement 
  24. What assessments for ESTROGEN ANTAGONIST?
    • BMD before and periodically during use
    • monitor SE of leg cramps & hot flashes
    • ***contraindicated if thromboembolic hx  
  25. What are the expected otcomes for ESTROGEN ANTAGONIST?
    • prevention of osteoporosis
    • increases BMD by reducing bone resorption 
  26. What are the interventions for ESTROGEN ANTAGONIST?
    • teach pt importance of Ca & vitD intake
    • no smoking or alcohol
    • wt bearing ecercises
    • administed po without regards to meals   
  27. What evaluation for ESTROGEN ANTAGONIST?
    decrease incidence of osteoporotic spine fx
  28. Name 1 type of PARATHYROID HORMONE.
    teriparatide (Forteo)
  29. What action/use for  PARATHYROID HORMONE?
    • PTH regulates Ca & P metabolism
    • it stimulates osteoblastic activity & increases BMD used for tx of osteoporosis in postmenopausal women at high risk for fx
    • most useful for those who failed osteoporosis therapies

    *** when Ca levels decreases, PTH increases & stimulate bone to promote osteoclastic activity & release Ca in the blood   
  30. What assessments for PARATHYROID HORMONE?
    • check BMD
    • increases Ca & decreases P
    • monitor for *orthostatic hypoTN during 1st several doses, leg cramping
  31. What expected outcomes for PARATHYROID HORMONE?
    increase bone mineral density with reduce risk of fx in spine, hip, & wrist
  32. What interventions for PARATHYROID HORMONE?
    • should not be used for more than 2 yr
    • daildy subQ injection into thigh or abd wall
    • store pen in refrigerator, use STAT then return
    • Forteo pen can be used for 28 days then discarded   
  33. What evaluation for PARATHYROID HORMONE?
    • increase BMD
    • decrease incidence of fx 
  34. Name 2 types of CALCIUM SUPPLEMENTS.
    • Calcium carbonate (Caltrate, Os-Cal)
    • Calcium citrate (Citracal) 
  35. What action/use for CALCIUM SUPPLEMENTS?
    • increase Ca intake
    • osteoporosis prevention to build bone health 
  36. What assessments for CALCIUM SUPPLEMENTS?
    • monitor serum Ca level to prevent hypercalcemia
    • hx of urinary stones 
  37. What expected outcomes for CALCIUM SUPPLEMENTS?
    serum calcium levels WNL
  38. What intervention for CALCIUM SUPPLEMENTS?
    • Caltrate=take with food & H2O
    • Citracal=empty stomach is fine 
  39. What evaluation for CALCIUM SUPPLEMENTS?
    • decrease incidence of osteoporosis
    • increased or normal serum calcium levels 
  40. What does DMARD's stands for ?
    disease-modifying antirheumatic drugs
  41. Name 3 types of DMARD's.
    • methotrexate (Rheumatrex)
    • hydroxychloroquine (Plaqeunil)
    • sulfasalazine (Azulfidine)  
  42. What action/sue for DMARD's?
    immunosuppressive activity used for tx of RA unresponsive to other tx
  43. What assessment for DMARD's?
    • abd pain
    • CBC for decreased WBC's/platelets
    • increased liver enzymes(avoid alcohol)
    • CXR for s/s of pneumonitis
    • joint pain, ROM, hair loss, mouth sores
    • Plaquenil can cause retinal damage (need eye exam q6-12mo) 
  44. What expected outcomes for DMARD's?
    • reduced inflammation & pain w/t adverse drug effects or infections
    • slows progression of mild RA 
  45. What interventions for DMARD's?
    • adminitered weekly
    • slow acting taking 4-6wks to work
    • instruct to avoid crowds
    • bleeding precautions
    • avoid OTC and herbals
    • push fluids
    • use SPF30
    • pregnancy not recommended d/t birth defects       
  46. What evaluation for DMARD's?
    improved mobility & decreased joint pain/swelling
  47. What does BRD's stands for?
    biologic response modifiers
  48. Name 3 types of BRD's.
    • etanercept (Enbrel)
    • infliximab (Remicade)
    • Adalimumab (Humira)  
  49. What action/use for BRD's?
    used to treat moderate to severe RA by disrupting the inflammatory process & delaying dx progression (also used to tx Crohn's dx)
  50. What assessment for BRD's?
    • assess for infusion related reactions such as fever, urticaria, pruritis during & after infusion
    • assess for latent TB
    • monitir liver fx
    • CBC for leucopenia & thrombocytopenia
    • joint pain & ROM    
  51. What expected outcome for BRD's?
    decreased pain & swelling with decreased rate of joint destruction & improved physical fx
  52. What interventions for BRD's?
    • administered IV
    • advise of AE of myalgia, rash, fever may occur 3-12 days after infusion
    • watch for dizziness  
  53. What evaluation for BRD's?
    • report decrease in pain & swelling of joints
    • no evidence of AE or infusion related reactions 
Card Set
Muscoskeletal Meds