Muscoskeletal Meds

ACTION/USE:

*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

• serum Ca & Vit D 
• evidence of esophageal irritation
• difficulty swallowing
• heartburn
• visual disturbances

***contraindicated in renal insufficiency

• 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))

• take 1st thing in the am, 30 mins before other meds, food or beverages
• take with H2O
• remain upright for at least 30 mins

• no evidence of esophageal irritation
• decrease incidence of fractures
• evidence of improvement in BMD   

• alendronate (Fosamax)
• risedronate (Actonel)
• ibandronate (Boniva)
• zoledronic acid (Reclast)   

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

• 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)

• slowed progression of postmenopausal osteoporosis
• decreased boen pain 

• available in subQ, IM, & intranasal spray forms
• alternate nostrils daily to prevent dryness
• store in refrigerator
• discard 30 days after 1st use   

• evidence of BMD increase
• no evidence of nasal irritaion or any injection site irritation 

• Fortical
• Miacalcin
• Calcimar

salmon

thyroid gland


***calcitonin decrease calcium serum concentration  if its high above its normal levels 

stimulates osteoblastic and inhibit PTH; it decreases at menopause=Ca level to decrease which leads to osteoporosis

hormone used to replace estrogen for relief of vasomotor symptoms and for tx & prevention of postmenopausal osteoporosis

monitor s/s thromboembolism, MI, edema, HTN, wt gain, nausea, h/a

may cause increase in HDL, glucose triglycerides, & Na

• prevention of vetebral and hip fx's
• increase in BMD
• relief of postmenopausal symptoms

• 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 

• decrease incidence of fx
• normalization of estrogen levels 

• estrogen therapy (Climara)
• estradoil (Estrace)
• Hormone therapy (Prempro)  

raloxifene (Evista)

• 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 

• BMD before and periodically during use
• monitor SE of leg cramps & hot flashes
• ***contraindicated if thromboembolic hx  

• prevention of osteoporosis
• increases BMD by reducing bone resorption 

• teach pt importance of Ca & vitD intake
• no smoking or alcohol
• wt bearing ecercises
• administed po without regards to meals   

decrease incidence of osteoporotic spine fx

teriparatide (Forteo)

• 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   

• check BMD
• increases Ca & decreases P
• monitor for *orthostatic hypoTN during 1st several doses, leg cramping

increase bone mineral density with reduce risk of fx in spine, hip, & wrist

• 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   

• increase BMD
• decrease incidence of fx 

• Calcium carbonate (Caltrate, Os-Cal)
• Calcium citrate (Citracal) 

• increase Ca intake
• osteoporosis prevention to build bone health 

• monitor serum Ca level to prevent hypercalcemia
• hx of urinary stones 

serum calcium levels WNL

• Caltrate=take with food & H2O
• Citracal=empty stomach is fine 

• decrease incidence of osteoporosis
• increased or normal serum calcium levels 

disease-modifying antirheumatic drugs

• methotrexate (Rheumatrex)
• hydroxychloroquine (Plaqeunil)
• sulfasalazine (Azulfidine)  

immunosuppressive activity used for tx of RA unresponsive to other tx

• 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) 

• reduced inflammation & pain w/t adverse drug effects or infections
• slows progression of mild RA 

• 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       

improved mobility & decreased joint pain/swelling

biologic response modifiers

• etanercept (Enbrel)
• infliximab (Remicade)
• Adalimumab (Humira)  

used to treat moderate to severe RA by disrupting the inflammatory process & delaying dx progression (also used to tx Crohn's dx)

• 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    

decreased pain & swelling with decreased rate of joint destruction & improved physical fx

• administered IV
• advise of AE of myalgia, rash, fever may occur 3-12 days after infusion
• watch for dizziness  

• report decrease in pain & swelling of joints
• no evidence of AE or infusion related reactions