IV Therapy Musculoskeletal drugs

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Questions and Answers

What is the primary action of Disease Modifying Anti-Rheumatic Drugs (DMARDs) in the treatment of rheumatoid arthritis?

Provide immediate pain relief

Relieve muscle spasms

Promote bone density

Slow joint degeneration (correct)

Which of the following is a common adverse reaction to DMARDs?

Alopecia (correct)

Constipation

Headaches

Increased appetite

Which adverse reaction is specifically associated with the use of Plaquenil?

Visual acuity improvement

Hearing loss

Retinal damage (correct)

Increased risk of infection

Methotrexate is contraindicated for which of the following patients?

Patients with renal insufficiency Signup and view all the answers

What should women taking DMARDs be cautious about?

Not becoming pregnant Signup and view all the answers

What is the interaction risk when combining sulfa drugs with methotrexate?

Increased risk of methotrexate toxicity Signup and view all the answers

What is the role of Bone Resorption Inhibitors (Bisphosphonates)?

Inhibit bone resorption Signup and view all the answers

Which deformity is specifically associated with late-stage rheumatoid arthritis?

Swan-neck deformity Signup and view all the answers

What is a contraindication for the use of bisphosphonates?

Serious kidney impairment Signup and view all the answers

Which of the following is a common side effect associated with all uric acid inhibitors?

Nausea, vomiting, and diarrhea Signup and view all the answers

What should be monitored regularly in patients taking bisphosphonates?

Blood calcium levels Signup and view all the answers

What interaction reduces the effectiveness of bisphosphonates?

Antacids Signup and view all the answers

Which skeletal muscle relaxant is known to increase the risk of hepatic toxicity?

Tizanidine Signup and view all the answers

In patients taking colchicine for an acute gout attack, what is a significant adverse effect to monitor for?

Thrombocytopenia Signup and view all the answers

What is the recommended action if a rash develops in a patient taking allopurinol?

Stop the drug and notify the provider Signup and view all the answers

Which of the following should be taken with caution to avoid increasing side effects when using colchicine?

Grapefruit juice Signup and view all the answers

What is the appropriate nursing intervention following administration of a bisphosphonate?

Ensure the patient remains upright for 30 minutes Signup and view all the answers

What is the maximum recommended duration for the use of skeletal muscle relaxants?

2-3 weeks Signup and view all the answers

Which drug interaction increases the risk of gastrointestinal bleeding when using allopurinol?

NSAIDs Signup and view all the answers

What is an advisable nursing intervention when administering uric acid inhibitors?

Instruct to drink plenty of water Signup and view all the answers

Which effect is associated with long-term use of skeletal muscle relaxants?

Physical dependence Signup and view all the answers

What is a potential adverse reaction for patients taking Diclofenac?

Esophageal ulceration Signup and view all the answers

What is the goal of pharmacological treatment of osteoporosis?

To increase bone mineral density Signup and view all the answers

How do bone inhibitors work?

By preventing bone resorption Signup and view all the answers

How can reflux associated with bone resorption inhibitors be minimized?

Sitting upright for at least 30 minutes after taking Signup and view all the answers

How does vitamin D enhance bone health?

By increasing calcium absorption in the intestines Signup and view all the answers

Which bone inhibitor is contraindicated during pregnancy?

Denosumab Signup and view all the answers

If a patient develops stomatitis related to DMARDs, what instructions should be given to the patient to minimize the effects of stomatitis?

Increase fluid intake and use a humidifier. Signup and view all the answers

Why should women taking DMARDs be instructed to use an effective form of birth control?

DMARDs can cause severe birth defects. Signup and view all the answers

Which DMARD is also a drug used to treat various types of cancer?

Methotrexate Signup and view all the answers

What nursing interventions are appropriate for a patient who has developed signs and symptoms of bone marrow depression related to DMARD therapy? (Select all that apply)

Monitor blood cell counts regularly Signup and view all the answers

How is the action of DMARDs appropriate in treating patients with rheumatoid arthritis?

They reduce inflammation and slow disease progression. Signup and view all the answers

What is defined as pancytopenia?

A condition characterized by a decrease in all blood cell types Signup and view all the answers

What is the definition of alopecia?

A condition involving hair loss Signup and view all the answers

Which of the following best defines exfoliative dermatitis?

A skin condition characterized by widespread redness and peeling. Signup and view all the answers

What is the drug of choice for maintenance of gouty arthritis?

Allopurinol Signup and view all the answers

What should be included in a teaching plan for a patient with gout?

All of the above Signup and view all the answers

What is the most common adverse effect of muscle relaxants?

Drowsiness Signup and view all the answers

Before giving a PRN muscle relaxant, what must the nurse first assess?

Patient's level of pain Signup and view all the answers

Why are muscle relaxants useful in treating the pain associated with acute muscle injuries?

They decrease muscle tension and spasms. Signup and view all the answers

How would the nurse evaluate the effectiveness of DMARDs and muscle relaxants?

By assessing the patient's pain level and range of motion Signup and view all the answers

Study Notes

Disease-Modifying Anti-Rheumatic Drugs (DMARDs)

Slow joint degeneration and progression of rheumatoid arthritis (RA).
Used when pain relief and anti-inflammatory drugs are ineffective.
Act by producing immunosuppression; also treat fibromyalgia and inflammatory bowel diseases (Crohn's disease).
Common adverse reactions: Nausea, stomatitis, alopecia.
Other potential adverse reactions: Skin rash, fever, easy bruising, visual changes, tinnitus, hearing loss.
Sulfasalazine-containing DMARDs: Ocular changes, gastrointestinal upset, mild pancytopenia.
Plaquenil: Can cause retinal damage.
Contraindications (Methotrexate): Renal insufficiency, liver disease, alcohol abuse, folate deficiency, pancytopenia.
Contraindications (Enbrel, Humira, Remicade): Heart failure (HF) or neurological demyelinating diseases.
Late-stage RA deformities: Boutonniere deformity of the thumb, ulnar deviation of metacarpophalangeal joints, swan-neck deformity of fingers.
Precautions: Pregnancy and drug transmission to semen (barrier methods).
Methotrexate precautions: Monitor thrombocytopenia, leukopenia, liver, and kidney functions every 3 months.
Reporting issues: Report mouth sores, diarrhea, fever, sore throat, easy bruising, rash, itching, or nausea/vomiting.
Drug interactions (DMARDs):
- Sulfa drugs increase methotrexate toxicity.
- Aspirin and NSAIDs increase methotrexate toxicity.
Nursing Interventions: Monitor labs (thrombocytopenia, leukopenia, liver enzymes, kidney function). Monitor for drug toxicity. Teach patient compliance, birth control, reporting of infections/bleeding/allergies.

Bone Resorption Inhibitors (Bisphosphonates)

Inhibit bone resorption, increasing bone density and reversing osteoporosis.
Used for osteoporosis in postmenopausal women and in hypercalcemia of malignancy.
No completely safe drug: No drug is risk-free.
Adverse reactions:
- Increased/recurrent bone pain.
- Esophagitis, esophageal ulceration, dyspepsia, acid regurgitation, dysphagia.
- Abdominal pain, nausea, diarrhea, constipation.
- Musculoskeletal pain.
- Visual disturbances.
- Increased risk of bleeding (especially with other clotting inhibitors).
- Nephrotoxicity (IV infusions).
Contraindications: Pregnancy, lactation, hypocalcemia, dysphagia, esophageal stricture, serious kidney impairment. Fosamax and Actonel in patients with hypocalcemia.
Drug interactions:
- Antacids decrease bisphosphonate effectiveness.
- Aspirin increases risk of GI bleeds.
- Theophylline increases Theophylline toxicity.
- Caffeine, orange juice, magnesium supplements, iron, and calcium decrease alendronate absorption (wait 2 hours).
Nursing Interventions: Administer with 8 oz water, upright position, stay upright 30 minutes after. Take first thing in the morning on an empty stomach. Supplement calcium and vitamin D if needed. Regular bone scans (12-18 months). Monitor blood calcium. Exercise (30-40 minutes daily).

Uric Acid Inhibitors

Used for acute gout attacks (colchicine); preventing attacks (allopurinol, probenecid, febuxostat).
Adverse reactions: Nausea, vomiting, diarrhea (all drugs).
Allopurinol: Skin rash, hepatitis, kidney damage.
Colchicine: Severe nausea, vomiting, bone marrow depression, thrombocytopenia, rhabdomyolysis.
Probenecid: Kidney stones, kidney problems.
Contraindications: Pregnancy, lactation.
Anturane (sulfinpyrazone): Peptic ulcer disease.
Colchicine: Serious GI, renal, hepatic, or cardiac disorders.
Probenecid: Blood dyscrasias, uric acid kidney stones, children under 2 years.
Drug interactions:
- Grapefruit juice increases colchicine side effects.
- Ampicillin may cause rash with allopurinol.
- Theophylline increases allopurinol toxicity.
- Coumadin increases allopurinol bleeding risk.
- Penicillin increases antibiotic levels with probenecid.
- NSAIDs increase NSAID levels with probenecid.
- Barbiturates increase sedation with probenecid.
- Salicylates decrease probenecid effectiveness.

Oral anticoagulants increase bleeding risk with Anturane. Tobutamide increases hypoglycemia risk with Anturane.

Nursing Interventions: Take with meals/plenty of water (3000 cc/day). Maintain adequate urine. Monitor stool and urine for blood. Keep colchicine on hand. Monitor uric acid levels, CBC, UA, liver, and kidney function. Stop drug and notify provider if rash develops. Avoid alcohol and high-purine foods. Regular exercise.

Skeletal Muscle Relaxants

Uses: For acute musculoskeletal pain.
Adverse Reactions (all): Drowsiness, dizziness, UTI (Zanaflex). Some drugs include hepatic toxicity; chronic use may lead to physical dependence.
Baclofen: Nausea, constipation, urinary retention, seizures.
Dantrolene: Hepatic toxicity, muscle weakness.
Contraindications: Pregnancy, lactation.
Flexeril & MAOIs: Avoid within 14 days of MAOI use.
Flexeril: Recent MI, cardiac conduction problems, or hyperthyroidism.
Diazepam: Controlled substance (IV use).
Drug Interactions: CNS depressants increase CNS depressant effects. Flexeril and MAOIs increase risk of seizures/fever. Norflex and Haldol increase psychosis risk. Zanaflex and antihypertensives increase hypotension risk.
Nursing Interventions: Take with or after meals to minimize GI problems. Short-term use only (2-3 weeks). Avoid alcohol/CNS depressants.

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Description

This quiz covers essential information on disease-modifying anti-rheumatic drugs (DMARDs), focusing on their uses, mechanisms, contraindications, and possible adverse reactions. It highlights the significance of DMARDs in managing rheumatoid arthritis and related conditions. Test your knowledge on the key aspects of DMARDs and their impact on joint health.