IV therapy Musculoskeletal drugs

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Questions and Answers

What do Disease Modifying Anti-Rheumatic Drugs (DMARDs) primarily aim to achieve in patients with Rheumatoid arthritis?

Provide immediate pain relief

Enhance joint flexibility

Increase bone density

Slow joint degeneration and disease progression (correct)

Which of the following is NOT a contraindication for the use of Methotrexate?

Renal insufficiency

Folate deficiency

Liver disease

Diabetes mellitus (correct)

What is a key nursing intervention when a patient is on DMARD therapy?

Monitor hematology, liver, and renal functions every 3 months (correct)

Ensure the patient avoids all physical activity

Administer the medication daily

Educate the patient to self-adjust dosages as needed

What common adverse reaction should a nurse anticipate in patients taking Hydroxychloroquine?

Skin rash Signup and view all the answers

What potential risk is associated with combining Methotrexate and sulfa drugs?

Increased risk of Methotrexate toxicity Signup and view all the answers

Which condition can Bisphosphonates be used to treat?

Osteoporosis Signup and view all the answers

What is a common gastrointestinal side effect of Bisphosphonates?

Nausea and diarrhea Signup and view all the answers

What precautions should men take while on Methotrexate?

Use barrier methods for birth control Signup and view all the answers

Which of the following is a contraindication for the use of bisphosphonates like Alendronate sodium?

Hypocalcemia Signup and view all the answers

What is a recommended nursing intervention for patients taking Alendronate sodium?

Remain upright for at least 30 minutes after administration. Signup and view all the answers

Which interaction is known to decrease the absorption of Alendronate sodium?

Calcium supplements Signup and view all the answers

What is a common adverse effect associated with Allopurinol?

Skin rash or Stevens-Johnson syndrome Signup and view all the answers

Which medication should be avoided in patients with peptic ulcer disease?

Anturane Signup and view all the answers

What is a potential adverse effect of Colchicine?

Severe nausea and vomiting Signup and view all the answers

What should patients taking uric acid inhibitors do to help prevent kidney stones?

Consume at least 3000 cc of water daily. Signup and view all the answers

Which of the following is a serious side effect of probenecid?

Kidney injury Signup and view all the answers

Which of the following should be done to monitor a patient's condition while they are on allopurinol or probenecid?

Check for the development of a rash Signup and view all the answers

What is the recommended daily fluid intake for a patient experiencing an acute attack of gout?

At least 10 glasses of water Signup and view all the answers

What should be avoided while taking skeletal muscle relaxants to prevent increased CNS depressant effects?

Alcohol and other CNS depressants Signup and view all the answers

What common adverse reaction occurs with all skeletal muscle relaxants?

Drowsiness Signup and view all the answers

Which condition indicates a contraindication for using Flexeril?

Recent myocardial infarction Signup and view all the answers

What should patients taking colchicine for acute attacks of gout expect in terms of symptom relief?

Relief within a few hours Signup and view all the answers

Which of the following skeletal muscle relaxants is associated with a risk of hepatic toxicity?

Tizanidine Signup and view all the answers

When taking medications like Zanaflex, what adverse effect should a patient particularly monitor for?

Symptoms of urinary tract infection Signup and view all the answers

Study Notes

Musculoskeletal Drugs

Disease Modifying Anti-Rheumatic Drugs (DMARDs) slow joint degeneration and progression of rheumatoid arthritis (RA).
DMARDs are used when pain relief agents and anti-inflammatory drugs are no longer effective.
DMARDs act by producing immunosuppression and also treat fibromyalgia and inflammatory bowel diseases, such as Crohn's disease.

Adverse Reactions

Common adverse reactions include nausea, stomatitis, and alopecia.
Be aware of skin rash, fever, easy bruising, visual changes, tinnitus, or hearing loss.
Sulfasalazine containing DMARDs can cause ocular changes, gastrointestinal upset, and mild pancytopenia.
Plaquenil can cause retinal damage.

Contraindications

Methotrexate is contraindicated in patients with renal insufficiency, liver disease, alcohol abuse, folate deficiency, and pancytopenia.
Enbrel, Humira, and Remicade are contraindicated in patients with heart failure (HF) or neurological demyelinating diseases.

Rheumatoid Arthritis (Late Stage) Deformities

Boutonniere deformity of the thumb
Ulnar deviation of metacarpophalangeal joints
Swan-neck deformity of fingers

Precautions

Women should not become pregnant while taking these drugs.
Men should use barrier methods to prevent transmission of drug through semen.
Methotrexate can cause thrombocytopenia and leukopenia. Liver and renal functions should be monitored every 3 months.
Notify the physician if symptoms like mouth sores, diarrhea, fever, sore throat, easy bruising, rash, itching, or nausea/vomiting arise.

Interactions

Sulfa drugs increase the risk of methotrexate toxicity.
Aspirin and NSAIDs increase the risk of methotrexate toxicity.

Nursing Interventions

Monitor labs (thrombocytopenia, leukopenia, liver enzymes, and kidney function).
Monitor for toxicity.
Hydroxychloroquine can cause skin rash, fever, cough, and easy bruising.
Teach patients to take the drugs at the same time (methotrexate), to use effective birth control methods, and to report any signs of infection, bleeding, or allergic reactions.

Drugs (DMARDs)

Adalimumab - Humira
Etanercept - Enbrel
Hydroxychloroquine sulfate - Plaquenil
Infliximab - Remicade
Methotrexate - Rheumatrex

Bone Resorption Inhibitors (Bisphosphonates)

Actions: Inhibit normal and abnormal bone resorption, increasing bone density and reversing osteoporosis.
Uses: Osteoporosis in postmenopausal women and in hypercalcemia of malignancy.

Adverse Reactions (Bisphosphonates)

No drug is fully risk-free, including bone resorption inhibitors
N/D
Increased or recurrent bone pain
Esophagitis, esophageal ulceration, dyspepsia, acid regurgitation, dysphagia
Abdominal pain, nausea, diarrhea, constipation
Musculoskeletal pain
Visual disturbances
Increased risk of bleeding, especially when taken with other drugs inhibiting clotting.
Nephrotoxicity with IV infusions.

Contraindications (Bisphosphonates)

Pregnancy and lactation
Fosamax and Actonel - patients with hypocalcemia
Dysphagia, esophageal stricture, or disorders, serious kidney impairment, or hypocalcemia.

Interactions (Bisphosphonates)

Antacids decrease the effectiveness of bisphosphonates.
Aspirin increases the risk of GI bleeds.
Theophylline increases the risk of theophylline toxicity.
Caffeine, orange juice, magnesium supplements, iron, and calcium decrease absorption of alendronate. Wait 2 hours between the bisphosphonate and these supplements.

Nursing Interventions (Bisphosphonates)

Administer with 8 oz of water while the patient is in an upright position to prevent esophageal irritation. Stay upright for 30 minutes after taking the medication.
Take first thing in the morning on an empty stomach.
Supplement calcium and vitamin D if dietary intake is inadequate. - Clients need a bone scan every 12-18 months.
Monitor blood calcium.
Exercise 30-40 minutes daily (walking).

Drugs (Bisphosphonates)

Alendronate sodium - Fosamax
Ibandronate - Boniva
Risedronate sodium - Actonel

Uric Acid Inhibitors

Uses: Acute attacks of gout (colchicine); or for preventing acute gout attacks (allopurinol, probenecid, febuxostat).
Adverse Effects:
- Nausea, vomiting, diarrhea (N/V/D) in all drugs
- Allopurinol can cause skin rash, hepatitis, and kidney damage.
- Colchicine can cause severe nausea, vomiting, and bone marrow depression, thrombocytopenia, and rhabdomyolysis.
- Probenecid can cause kidney stones and kidney problems.

Contraindications (Uric Acid Inhibitors)

Pregnancy and lactation
Anturane - peptic ulcer disease
Colchicine - serious GI, renal, hepatic, or cardiac disorders
Probenecid - Blood dyscrasias, uric acid kidney stones, and children under 2 years

Interactions (Uric Acid Inhibitors)

Grapefruit juice - may increase side effects in colchicine
Ampicillin leads to a possible risk of rash in allopurinol
Theophylline increases risk of theophylline toxicity in allopurinol
Coumadin increases risk of bleeding in allopurinol
Penicillin increase serum levels of antibiotics in probenecid
NSAIDs increase serum levels of NSAIDs in probenecid
Barbiturates increase sedation levels in probenecid
Salicylates decrease probenecid effectiveness
Oral anticoagulants increase risk of bleeding in anturane
Tobutamide increases risk of hypoglycemia in anturane

Nursing Interventions (Uric Acid Inhibitors)

Patient teaching: Take as prescribed with meals and plenty of water (3000 cc/day). Maintain adequate urine.
Monitor stool and urine for blood
Colchicine kept on hand for acute attacks.
See improvement within hours.
Check joints every 2 hours for improvements.
Take with food. Drink 10 glasses of water daily until the attack subsides.
Monitor uric acid levels, CBC, UA, liver, and kidney function tests
If rash develops with allopurinol or probenecid, stop drug and notify the provider.
Avoid alcohol and foods high in purine.
Regular exercise.

Drugs (Uric Acid Inhibitors)

Zyloprime/Allopurinol
Colchicine
Probenecid
Anturane/Sulfinpyrazone
Uloric/Febuxostat

Skeletal Muscle Relaxants

Uses: Acute painful musculoskeletal conditions.
Adverse Reactions (All): Drowsiness, dizziness, UTI (Zanaflex). Diazepam, cyclobenzaprine, tizanidine - hepatic toxicity with tizanidine. Physical dependence from chronic long-term use.
Baclofen - Nausea, constipation, urinary retention, seizures.
Dantrolene - Hepatic toxicity, muscle weakness.

Contraindications (Skeletal Muscle Relaxants)

Pregnancy and lactation
Flexeril and MAOIs- not to be taken within 14 days of MAOI
Flexeril contraindicated for patients with recent MI, cardiac conduction problems, or hyperthyroidism.
Diazepam is a controlled substance with IV use

Drug Interactions (Skeletal Muscle Relaxants)

CNS depressants increase CNS depressant effects.
Flexeril and MAOIs increase the risk for seizures and fever.
Norflex and Haldol increase the risk of psychosis.
Zanaflex and antihypertensives may increase the risk of hypotension

Drugs (Skeletal Muscle Relaxants)

Diazepam - Valium
Orphenadrine citrate - Norflex
Tizanidine - Zanaflex
Cyclobenzaprine - Flexeril
Baclofen
Dantrolene - Dantrium

Nursing Interventions (Skeletal Muscle Relaxants)

DMARDs, uric acid inhibitors, and skeletal muscle relaxants- Take with or immediately after meals to minimize GI problems.
Skeletal Muscle Relaxants - Short-term use only (no longer than 2-3 weeks). Avoid alcohol or other CNS depressants.

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Description

Test your knowledge on the role of Disease Modifying Anti-Rheumatic Drugs (DMARDs) in managing Rheumatoid Arthritis. Identify which conditions are contraindications for Methotrexate use in this insightful quiz.