Musculoskeletal. Drug Study Notes and Quiz
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Questions and Answers

What is the primary mechanism of action of Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)?

  • Slows the production of inflammatory mediators (correct)
  • Increases production of prostaglandins
  • Inhibits platelet aggregation
  • Promotes blood vessel dilation

Which of the following is a characteristic of selective NSAIDs?

  • They primarily block COX-2 enzymes. (correct)
  • They are less effective against pain.
  • They block both COX-1 and COX-2 enzymes.
  • They have a higher incidence of GI irritation.

What is one of the common side effects associated with NSAID use?

  • Insomnia
  • GI irritation (correct)
  • Increased eye pressure
  • Muscle cramps

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

<p>History of migraine headaches (C)</p> Signup and view all the answers

What should patients be advised about the anti-inflammatory effect of NSAIDs?

<p>It may take 1-2 weeks to achieve full effect. (B)</p> Signup and view all the answers

Which of the following NSAIDs is classified as selective?

<p>Celecoxib (C)</p> Signup and view all the answers

What is a serious adverse reaction associated with NSAID use?

<p>Increased risk of cardiovascular events (A)</p> Signup and view all the answers

How can patients reduce gastrointestinal upset when taking NSAIDs?

<p>By taking the medication with food or milk (D)</p> Signup and view all the answers

Which condition is NOT typically treated with NSAIDs?

<p>Diabetes mellitus (B)</p> Signup and view all the answers

What patient education should be emphasized regarding NSAID use in children?

<p>Avoid NSAID use in acute illness. (D)</p> Signup and view all the answers

What is the primary mechanism of action of indirect thrombin inhibitors?

<p>Increase the action of antithrombin III to inhibit thrombin (C)</p> Signup and view all the answers

Which of the following is a side effect associated with indirect thrombin inhibitors?

<p>Bruising (A)</p> Signup and view all the answers

Which condition is NOT a use for indirect thrombin inhibitors?

<p>Treating hyperlipidemia (D)</p> Signup and view all the answers

Which lab test is used to determine the therapeutic range for heparin?

<p>Activated partial thromboplastin time (aPTT) (A)</p> Signup and view all the answers

What should be monitored when administering cyclobenzaprine for the first time?

<p>Skeletal muscle reactivity (C)</p> Signup and view all the answers

What is a significant adverse reaction associated with indirect thrombin inhibitors?

<p>Bleeding complications (B)</p> Signup and view all the answers

Which of the following side effects is commonly associated with colchicine?

<p>Diarrhea (B)</p> Signup and view all the answers

Which of the following is a contraindication for heparin therapy?

<p>Hypotension (D)</p> Signup and view all the answers

What is the primary mechanism of action of uricosurics like probenecid?

<p>Inhibits renal tubular resorption of uric acid (C)</p> Signup and view all the answers

Which action is recommended for patient education regarding heparin injections?

<p>Rotate injection sites (D)</p> Signup and view all the answers

When administering allopurinol, which of the following patient instructions is correct?

<p>Drink plenty of fluids each day (B)</p> Signup and view all the answers

What is the primary risk associated with heparin-induced thrombocytopenia (HIT)?

<p>Formation of small clots in the bloodstream (A)</p> Signup and view all the answers

What is a significant drug interaction to avoid when taking uricosurics?

<p>Aspirin (C)</p> Signup and view all the answers

Which medication should be avoided during heparin therapy?

<p>Aspirin (D)</p> Signup and view all the answers

What is Protamine sulfate used for in relation to heparin?

<p>To reverse the effects of heparin overdose (B)</p> Signup and view all the answers

Which instruction is critical for patients taking allopurinol to prevent potential complications?

<p>Discontinue if experiencing rash (C)</p> Signup and view all the answers

What is a possible adverse reaction to allopurinol?

<p>Renal failure (D)</p> Signup and view all the answers

What is an important consideration regarding the schedule of follow-up appointments for patients on allopurinol?

<p>Regular assessments of kidney and liver functions are needed (C)</p> Signup and view all the answers

What should patients be educated to avoid while taking medications for gout, particularly purine-rich foods?

<p>Red meats and seafood (D)</p> Signup and view all the answers

Which is a common side effect of uric acid synthesis inhibitors like allopurinol?

<p>Breast development in men (A)</p> Signup and view all the answers

What is one of the short-term side effects of corticosteroid therapy?

<p>Acne (B)</p> Signup and view all the answers

Which condition is NOT typically treated with corticosteroids?

<p>Hypertension (B)</p> Signup and view all the answers

What is a major long-term side effect of corticosteroid use that indicates Cushing syndrome?

<p>Moon face (C)</p> Signup and view all the answers

How should oral corticosteroids be administered to coincide with natural cortisol levels?

<p>In the morning (C)</p> Signup and view all the answers

What happens if corticosteroid therapy is abruptly stopped after long-term use?

<p>Acute adrenal insufficiency (D)</p> Signup and view all the answers

What precaution should be taken when using topical corticosteroids?

<p>Use on fragile skin with caution (C)</p> Signup and view all the answers

Which of the following is a contraindication for corticosteroid therapy?

<p>Active infection (A)</p> Signup and view all the answers

Which of the following drugs is classified as a Disease-Modifying Antirheumatic Drug (DMARD)?

<p>Etanercept (B)</p> Signup and view all the answers

What type of condition do DMARDs primarily target for treatment?

<p>Inflammatory diseases (D)</p> Signup and view all the answers

What is an effect of decreased white blood cell count due to corticosteroid use?

<p>Reduced signs of infection (A)</p> Signup and view all the answers

Corticosteroids can be administered in all the following ways EXCEPT:

<p>Intravenous (C)</p> Signup and view all the answers

Which symptom indicates potential adrenal insufficiency when corticosteroid treatment is stopped?

<p>Lethargy (C)</p> Signup and view all the answers

Which dietary consideration is recommended for patients receiving corticosteroids?

<p>Diet rich in potassium (B)</p> Signup and view all the answers

Which of the following conditions is NOT typically treated with DMARDs?

<p>Common cold (B)</p> Signup and view all the answers

What is a potential side effect of immunosuppressant therapy?

<p>Immunosuppression leading to increased infection risk (A)</p> Signup and view all the answers

Which of the following is a common adverse reaction to the use of methotrexate?

<p>Blurred vision (A)</p> Signup and view all the answers

What must be assessed before administering DMARD therapy to patients?

<p>Vaccination history and signs of infection (D)</p> Signup and view all the answers

Which side effect might indicate liver problems during rheumatoid arthritis treatment?

<p>Nausea and vomiting (C)</p> Signup and view all the answers

How long may it take for the anti-inflammatory effects of hydroxychloroquine to become evident?

<p>6-12 months (C)</p> Signup and view all the answers

Which of the following is a possible side effect of gold salts used in rheumatoid arthritis treatment?

<p>Renal damage (C)</p> Signup and view all the answers

In which scenario should the administration of DMARDs be closely monitored?

<p>Undergoing a surgical procedure with infection risk (B)</p> Signup and view all the answers

What is a nursing consideration when a patient is receiving their first dose of a DMARD?

<p>Vital signs must be documented prior to administration (B)</p> Signup and view all the answers

What specific testing must be conducted prior to initiating therapy with a DMARD?

<p>Tuberculosis screening (D)</p> Signup and view all the answers

Which of the following is a common side effect of azathioprine?

<p>GI irritation (D)</p> Signup and view all the answers

What is a critical aspect of patient education regarding DMARD therapy?

<p>Contact provider if symptoms worsen (A)</p> Signup and view all the answers

Which clinical manifestation should prompt immediate communication with a healthcare provider during DMARD therapy?

<p>Fever and cough (D)</p> Signup and view all the answers

What is the primary mechanism of action of bisphosphonates?

<p>Binding to calcium phosphate crystals in bone (B)</p> Signup and view all the answers

Which condition is NOT typically treated with bisphosphonates?

<p>Rheumatoid arthritis (C)</p> Signup and view all the answers

Which of the following is a side effect of estrogen receptor modulators?

<p>Hot flashes (C)</p> Signup and view all the answers

What nursing consideration is essential for a patient receiving parathyroid hormone therapy?

<p>Evaluate for risk of osteosarcoma (C)</p> Signup and view all the answers

Which side effect is associated with calcium and vitamin D supplements?

<p>Muscle weakness (D)</p> Signup and view all the answers

The use of bisphosphonates increases the risk of which serious condition?

<p>Osteonecrosis of the jawbone (B)</p> Signup and view all the answers

What instruction should be given to patients taking bisphosphonates regarding administration?

<p>Remain upright for at least 30 minutes post administration (C)</p> Signup and view all the answers

Which of the following actions is recommended for patients on estrogen receptor modulators?

<p>Avoid smoking (C)</p> Signup and view all the answers

What should patients receiving calcium and vitamin D be advised to do?

<p>Administer with meals for better absorption (A)</p> Signup and view all the answers

Which of the following is a side effect of calcitonin-salmon?

<p>Nasal irritation (D)</p> Signup and view all the answers

What is the main use of teriparatide (Forteo)?

<p>Anabolic treatment for osteoporosis (A)</p> Signup and view all the answers

What should a patient taking bisphosphonates do before any dental procedure?

<p>Notify the dentist about their medication (A)</p> Signup and view all the answers

What is a characteristic of osteonecrosis of the jawbone related to bisphosphonate therapy?

<p>It can occur after dental surgery (A)</p> Signup and view all the answers

What is the primary mechanism of action for cyclobenzaprine and tizanidine?

<p>Depresses the CNS to slow signal transmission along motor nerves (A)</p> Signup and view all the answers

Which of the following is NOT a common side effect of skeletal muscle relaxants?

<p>Hypertension (C)</p> Signup and view all the answers

Which statement regarding tizanidine's mechanism of action is true?

<p>It decreases levels of substance P (A)</p> Signup and view all the answers

What important assessment should a nurse perform prior to administering skeletal muscle relaxants?

<p>Check for cardiac history and seizure disorders (D)</p> Signup and view all the answers

Which condition is NOT typically treated with skeletal muscle relaxants?

<p>Anxiety disorders (C)</p> Signup and view all the answers

What is a potential adverse reaction to taking skeletal muscle relaxants?

<p>Cardiac dysrhythmias (D)</p> Signup and view all the answers

How long should a patient take an antidepressant like amitriptyline before expecting to feel pain relief?

<p>1-2 weeks (A)</p> Signup and view all the answers

Which medication is used primarily for neuropathic pain and fibromyalgia?

<p>Pregabalin (B)</p> Signup and view all the answers

What lab values are important to monitor if a patient exceeds the maximum daily dose of acetaminophen?

<p>Liver function tests (A)</p> Signup and view all the answers

Which of the following options is a use for antidepressants in pain management?

<p>Chronic pain such as fibromyalgia (C)</p> Signup and view all the answers

What is one nursing consideration when educating a patient about the use of skeletal muscle relaxants?

<p>Instruct the patient to avoid alcohol and other CNS depressants (C)</p> Signup and view all the answers

What common misconception might a patient have about antidepressants prescribed for pain management?

<p>They will provide immediate pain relief (B)</p> Signup and view all the answers

What is an important nursing consideration when advising a patient to use capsaicin cream?

<p>It must be used regularly over time for maximal effect. (C), The patient should wash hands after application. (D)</p> Signup and view all the answers

Which of the following is a side effect associated with tramadol?

<p>Dizziness (B)</p> Signup and view all the answers

What effect does glucosamine have that is beneficial for patients with osteoarthritis?

<p>It aids in manufacturing collagen and maintaining joint function. (A)</p> Signup and view all the answers

What should a patient using acetaminophen be advised against?

<p>Taking it with alcohol. (D)</p> Signup and view all the answers

Which of the following statements about pregabalin is true?

<p>It reduces pain perception and improves physical functioning. (B)</p> Signup and view all the answers

What is a crucial teaching point for a patient beginning a DMARD regimen?

<p>Get tested for tuberculosis before starting. (D)</p> Signup and view all the answers

Which response is appropriate for a patient wishing to discontinue prednisone abruptly?

<p>You should reduce the dose gradually instead of stopping suddenly. (C)</p> Signup and view all the answers

What is the primary mechanism of action of nonopioid centrally acting analgesics like tramadol?

<p>Inhibiting reuptake of neurotransmitters in the brain. (C)</p> Signup and view all the answers

Which statement about the use of capsaicin cream is accurate?

<p>Aloe vera can help mitigate the burning sensation. (B)</p> Signup and view all the answers

What type of patient history would contraindicate the use of tramadol?

<p>History of seizures. (D)</p> Signup and view all the answers

What should be monitored in patients taking acetaminophen to avoid adverse reactions?

<p>Significant abdominal pain. (D)</p> Signup and view all the answers

Why should a patient on DMARD therapy be cautious regarding chickenpox exposure?

<p>Higher chances of infection due to immunosuppression. (C)</p> Signup and view all the answers

How does the mechanism of action of acetaminophen differ from that of NSAIDs?

<p>Acetaminophen reduces pain perception in the brain. (D)</p> Signup and view all the answers

What should a patient taking NSAIDs be properly educated about?

<p>Taking them with food can help reduce gastrointestinal side effects. (C)</p> Signup and view all the answers

What is a common side effect associated with the use of topical analgesics?

<p>Localized burning sensation (B)</p> Signup and view all the answers

Which of the following indicates a potential allergy when taking NSAIDs?

<p>Experiencing rash or hives. (A)</p> Signup and view all the answers

What is the main action of warfarin in the body?

<p>Inhibits vitamin K activation (D)</p> Signup and view all the answers

Which of the following is a common side effect of warfarin?

<p>Headache (C)</p> Signup and view all the answers

Patients taking warfarin should specifically avoid which of the following dietary items?

<p>Excess green leafy vegetables (D)</p> Signup and view all the answers

What should a patient taking warfarin be advised regarding supplements?

<p>Consult a healthcare provider before using them (C)</p> Signup and view all the answers

What is the therapeutic INR range for a patient on warfarin?

<p>2.0-3.0 (A)</p> Signup and view all the answers

Which adverse reaction is directly associated with warfarin therapy?

<p>Skin necrosis (B)</p> Signup and view all the answers

What is the antidote for warfarin overdose?

<p>Vitamin K (D)</p> Signup and view all the answers

Which condition is a contraindication for starting warfarin therapy?

<p>Uncontrolled hypertension (B)</p> Signup and view all the answers

When transitioning from heparin to warfarin, what should be monitored?

<p>Activated partial thromboplastin time (aPTT) (A)</p> Signup and view all the answers

Which of the following should patients on warfarin be cautious of while performing daily activities?

<p>Using objects that could cause cuts (C)</p> Signup and view all the answers

How should a patient taking warfarin manage bleeding from accidental cuts?

<p>Apply pressure and notify a provider if bleeding persists (B)</p> Signup and view all the answers

In which situation should a patient be cautious before taking warfarin?

<p>During pregnancy (B)</p> Signup and view all the answers

What should a patient wear while on anticoagulant therapy like warfarin?

<p>Medical alert identification (B)</p> Signup and view all the answers

Why is it important to educate patients about green leafy vegetables while on warfarin?

<p>They are sources of vitamin K (B)</p> Signup and view all the answers

Flashcards

NSAID Mechanism

NSAIDs work by slowing the production of prostaglandins, kinins, histamine, tumor necrosis factor, and other inflammatory mediators derived from arachidonic acid.

COX Enzymes

Cyclooxygenase (COX) enzymes are involved in the production of prostaglandins, which play a role in inflammation. NSAIDs can block these enzymes.

Selective vs Nonselective NSAIDs

Selective NSAIDs target specific COX enzymes (COX-2) while nonselective NSAIDs block both COX-1 and COX-2, leading to a higher risk of side effects.

NSAID Uses

NSAIDs are used to treat pain, inflammation, and fever. They can also be used for conditions like arthritis and dysmenorrhea.

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NSAID Side Effects

Common side effects of NSAIDs include GI irritation, dizziness, headache, increased risk of bleeding, fluid retention, and edema.

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NSAID Contraindications

NSAIDs are contraindicated in patients with allergies, renal failure, active GI bleeding, blood disorders, and certain cardiovascular conditions.

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Reye Syndrome

Reye syndrome is a rare but serious condition that can occur in children with viral infections who take aspirin or other salicylates.

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NSAID Nursing Considerations

Nurses should assess for contraindications, administer NSAIDs with food to reduce GI upset, and monitor for bleeding and bruising.

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Patient Education on NSAIDs

Patients taking NSAIDs should be educated about potential side effects, interactions with other medications, and the importance of contacting their healthcare provider for any concerning symptoms.

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NSAID Interactions

NSAIDs can interact with other medications, including blood thinners, antihypertensive drugs, and oral antidiabetic drugs.

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Corticosteroids

A class of medications that reduce inflammation and immune responses by mimicking the actions of cortisol, a hormone produced by the adrenal gland.

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Prednisone

A common corticosteroid used to treat a variety of inflammatory conditions like arthritis, asthma, and autoimmune diseases.

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Methylprednisolone

A corticosteroid similar to prednisone, often used for more severe or acute inflammatory conditions.

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Dexamethasone

A potent corticosteroid known for its long duration of action, used for various conditions like allergic reactions and brain inflammation.

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Hydrocortisone

A naturally occurring corticosteroid, available in various forms like creams and injections, for localized inflammation and skin issues.

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How do corticosteroids work?

They block the production of inflammatory chemicals like cytokines and reduce the activity of immune cells, leading to decreased inflammation.

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Long-term Corticosteroid Use

Prolonged use can lead to Cushing's syndrome, characterized by weight gain, fat redistribution, muscle weakness, and other side effects.

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Acute Adrenal Insufficiency

This can occur when corticosteroids are stopped abruptly, leading to symptoms like fatigue, weakness, nausea, and low blood pressure.

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Corticosteroid Tapering

Gradually reducing the dose of corticosteroids over time to prevent adrenal insufficiency.

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Immunosuppression

Corticosteroids weaken the immune system, making the body more susceptible to infections.

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DMARDs

Disease-modifying antirheumatic drugs, such as etanercept, adalimumab, infliximab, and rituximab, are used to slow down the progression of inflammatory diseases like rheumatoid arthritis.

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TNF Blockers

DMARDs that work by blocking tumor necrosis factor (TNF), a key inflammatory molecule.

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Rheumatoid Arthritis

A chronic autoimmune disease characterized by inflammation of the joints, leading to pain, swelling, stiffness, and joint destruction.

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Corticosteroids for Asthma

Inhaled corticosteroids are commonly used to reduce inflammation in the airways of patients with asthma.

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Corticosteroid Side Effects

Common side effects include fluid retention, weight gain, increased blood sugar, mood changes, and weakened immunity.

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Colchicine

A medication used to treat acute gout attacks. It works by reducing inflammation.

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Colchicine - Side Effects

Common side effects include gastrointestinal upset, nausea, vomiting, and diarrhea.

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Colchicine - Nursing Considerations

Discontinue medication if GI symptoms occur or pain is unrelieved. Educate patients to avoid foods high in purines.

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Uricosurics

A class of medications that reduce uric acid levels in the blood by increasing its excretion in urine.

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Probenecid (Probalan)

An example of a uricosuric medication.

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Uricosuric - Nursing Considerations

Avoid aspirin during uricosuric therapy as it can interfere with their effect.

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Uric Acid Synthesis Inhibitors

Medications that block the production of uric acid in the body.

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Allopurinol (Zyloprim), Febuxostat (Uloric)

Examples of uric acid synthesis inhibitors.

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Allopurinol - Nursing Considerations

Take allopurinol with food to minimize GI side effects. Avoid aluminum-based antacids. Allopurinol interacts with warfarin.

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Febuxostat

Can be taken without regard for meals or antacids.

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Capsaicin Cream

A topical analgesic that depletes substance P from nerve endings, interrupting pain signals to the brain.

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Substance P

A neurotransmitter that may participate in the transmission of pain signals from the body to the brain.

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Uses of Capsaicin Cream

Capsaicin cream is used to manage pain associated with rheumatoid arthritis.

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Side Effects of Capsaicin Cream

Common side effects include rash, urticaria, localized burning sensation, and erythema.

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Nursing Considerations for Capsaicin Cream

Use regularly over time for maximal effect, apply with caution and avoid external heat sources, wash hands after application, and avoid contact with damaged or irritated skin.

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Tramadol (Ultram)

A nonopioid centrally acting analgesic that inhibits the action and reuptake of certain neurotransmitters, reducing pain signal transmission.

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Mechanism of Action of Tramadol

Tramadol inhibits norepinephrine and serotonin reuptake and binds to opioid receptors.

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Uses of Tramadol

Tramadol is used for moderate to severe acute pain, such as osteoarthritis and fibromyalgia.

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Side Effects of Tramadol

Common side effects include sedation, dizziness, dry mouth, and constipation.

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Contraindications for Tramadol

Tramadol should not be used in patients with epilepsy or other neurologic disorders, and should not be used with other sedative or CNS depressant medications.

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Acetaminophen (Tylenol, Ofirmev)

A commonly used analgesic that reduces pain by acting on the brain to reduce prostaglandin production.

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Acetaminophen Mechanism of Action

Acetaminophen acts centrally by reducing prostaglandin production, thus reducing pain perception.

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Uses of Acetaminophen

Acetaminophen is used for mild to moderate pain, fever, and can be combined with opioids for more severe pain.

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Side Effects of Acetaminophen

Common side effects include nausea and skin rash.

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Acetaminophen Contraindications

Acetaminophen should not be used in patients with a history of liver disease or damage, and should be taken with caution in patients taking other medications containing acetaminophen.

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Skeletal Muscle Relaxants

Medications that reduce muscle spasms and pain by decreasing signal transmission along motor nerves, often used for conditions like fibromyalgia, whiplash, and strains.

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Cyclobenzaprine (Flexeril)

A common skeletal muscle relaxant that works by depressing the central nervous system.

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Tizanidine (Zanaflex)

A skeletal muscle relaxant that reduces muscle spasms and pain by lowering substance P levels in the brain.

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Antidepressants for Pain

Certain antidepressants can be effective for chronic pain conditions by increasing natural opioid levels in the brain.

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Amitriptyline (Elavil)

A tricyclic antidepressant often used to treat chronic pain conditions like fibromyalgia.

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Duloxetine Hydrochloride (Cymbalta)

A serotonin-norepinephrine reuptake inhibitor antidepressant often prescribed for chronic pain conditions, including fibromyalgia.

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Anticonvulsants for Pain

Anticonvulsants like Pregabalin can be used to treat chronic pain conditions by reducing pain signal transmission along sensory nerves.

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Pregabalin (Lyrica)

An anticonvulsant commonly used to treat chronic pain conditions like fibromyalgia and neuropathic pain.

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Clonazepam (Klonopin)

A benzodiazepine medication used to treat restless leg syndrome and sometimes prescribed for fibromyalgia.

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Sodium Oxybate (Xyrem)

A medication used to treat narcolepsy, and sometimes for fibromyalgia, by improving sleep and reducing pain and fatigue.

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Glucosamine Supplements

Supplements that may help maintain healthy joint function by promoting the production of collagen and other components of joint cartilage.

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Osteoarthritis

A condition that affects the joints, causing pain, stiffness, and swelling, often in the knees, hips, or hands.

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Maximum Daily Dose of Acetaminophen

The highest amount of acetaminophen that is safe to take in a day, typically 4 grams (4000 mg).

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Liver Function Tests

Blood tests that measure the levels of enzymes and other substances produced by the liver to assess its health.

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TNF

Tumor Necrosis Factor, a protein involved in inflammation, can cause tissue destruction if overproduced.

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What are 3 common uses for DMARDs?

DMARDs are used to treat chronic inflammatory disorders like Rheumatoid Arthritis, Crohn's Disease, and Psoriasis.

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What is an example of a DMARD?

Adalimumab (Humira) is a type of DMARD that blocks the production of TNF, reducing inflammation.

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DMARD side effects: bone marrow suppression

DMARDs can suppress bone marrow, leading to anemia (low red blood cells) or thrombocytopenia (low platelets).

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DMARD adverse reactions: immunosuppression

DMARDs suppress the immune system, increasing the risk of infections.

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DMARD nursing consideration: infection assessment

Before starting DMARDs, assess for signs and symptoms of infection, including history of tuberculosis, hepatitis, or any opportunistic infections.

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What happens if someone has a severe allergic reaction to the first dose of a DMARD?

The first dose should be given in a setting with a readily accessible emergency cart, as severe allergic reactions are possible

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Hydroxychloroquine (Plaquenil)

An antimalarial drug used to treat rheumatoid arthritis, but with unclear mechanism of action. It has an anti-inflammatory effect and is often prescribed for its long-term potential.

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Hydroxychloroquine (Plaquenil) side effects

Side effects include GI disturbances, retinal edema, and potential blindness.

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Gold salts: Mechanism of action

Gold salts act as anti-inflammatory agents when given intramuscularly (IM) and as antirheumatic agents when given orally (PO).

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Gold salts: Side effects

Gold salts can cause renal damage, hepatic damage, corneal deposits, dermatitis, stomatitis and hematologic changes.

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Methotrexate Mechanism of action

Methotrexate inhibits the use of folic acid, a nutrient vital for cell growth. This slows down cell growth and has anti-inflammatory effects.

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Methotrexate side effects

Side effects include GI irritation like nausea, vomiting, diarrhea, and sore mouth.

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Immunosuppressants side effects

Immunosuppressants can cause GI irritation and rash.

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What are Indirect Thrombin Inhibitors?

Indirect thrombin inhibitors are medications that prevent blood clotting by enhancing the activity of antithrombin III, a protein that inhibits thrombin's conversion of fibrinogen to fibrin.

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Heparin: Unfractionated vs Low Molecular Weight (LMWH)

Unfractionated heparin is a larger molecule, while LMWHs are smaller fragments. Both enhance antithrombin, but LMWHs also have a stronger effect on factor Xa, a crucial clotting factor.

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What is Antithrombin III's role?

Antithrombin III naturally inhibits thrombin, an enzyme that converts fibrinogen to fibrin, the protein that forms blood clots.

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Uses of Indirect Thrombin Inhibitors

These medications are used to prevent formation of blood clots in high-risk patients, stop existing clots from growing, and treat pulmonary embolism.

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Common Side Effects

Common side effects include bleeding, bruising, injection site irritation, itching, and skin discoloration.

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Heparin-Induced Thrombocytopenia (HIT)

HIT is a serious side effect where antibodies attack heparin, causing platelet clumping and small blood clots.

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Heparin-Induced Thrombocytopenia & Thrombosis (HITT)

HITT is a progression of HIT with larger clots forming and blocking vessels, a life-threatening complication.

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Nursing Considerations & Patient Education

Nurses must assess for contraindications, administer correctly, monitor for side effects, and educate patients on signs of bleeding and potential interactions.

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Activated Partial Thromboplastin Time (aPTT)

aPTT is a blood test measuring the time it takes for plasma to clot. It helps determine the therapeutic range of heparin.

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Protamine Sulfate: The Antidote

Protamine sulfate is the antidote for heparin overdose or acute bleeding, acting as a direct antagonist.

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Warfarin (Coumadin)

A medication that prevents blood clots by interfering with vitamin K's role in blood clotting factor activation.

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Warfarin Mechanism

Warfarin blocks the enzyme needed for vitamin K to activate clotting factors II, VII, IX, and X in the liver.

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Warfarin Uses

Used long-term to prevent clots in conditions like coronary artery disease, atrial fibrillation, after surgery, and for immobile patients.

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Warfarin Side Effects

Common side effects include bleeding, bruising, GI upset, headache, and rash.

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Warfarin Contraindications

Not suitable for people with existing bleeding disorders, alcoholism, uncontrolled hypertension, pregnancy, breastfeeding, or taking certain medications.

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Warfarin and Alcohol

Avoid alcohol while taking warfarin as it can increase bleeding risk.

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Warfarin and Green Leafy Vegetables

Maintain a consistent intake of green leafy vegetables because they contain vitamin K, which can counteract warfarin's effects.

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Warfarin INR Monitoring

International Normalized Ratio (INR) blood tests determine the therapeutic range for warfarin.

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Warfarin Overdose Antidote

Phytonadione (AquaMephyton), a synthetic form of vitamin K, can reverse warfarin overdose.

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Warfarin and Heparin

Patients often receive heparin (immediate effect) and warfarin (delayed effect) concurrently to ensure blood thinning until warfarin reaches its full effect.

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Medical Alert for Warfarin

Patients taking warfarin should wear a medical alert bracelet or necklace to inform healthcare providers about their anticoagulant therapy.

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Warfarin and Injury

Use caution to avoid injuries while taking warfarin. Apply pressure to any bleeding for at least 10 minutes and contact medical professionals if bleeding persists.

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Warfarin and Dental/Surgical Procedures

Always inform healthcare providers about warfarin therapy before any surgical or dental procedures.

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Warfarin Storage

Store warfarin in a dry, cool place, away from moisture and light.

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Bisphosphonates

A class of medications that strengthen bones by inhibiting the breakdown of bone tissue and increasing bone density.

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Bisphosphonate Mechanism

Bisphosphonates work by inhibiting osteoclasts, cells that break down bone tissue, and promoting calcium deposition in the bone.

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Bisphosphonate Uses

Bisphosphonates are used to treat osteoporosis, Paget's disease, bone metastases, and cancer-induced hypercalcemia.

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Bisphosphonate Side Effects

Common side effects include headache, esophageal reflux, chest pain, and nausea.

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Bisphosphonate Adverse Reactions

Severe adverse reaction includes osteonecrosis of the jawbone, which can occur especially with high doses or intravenous administration.

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Bisphosphonate Administration

Bisphosphonates should be taken early in the morning, with a full glass of water, 30 minutes before food or other beverages, and the patient should remain upright for 30 minutes after taking the drug.

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Raloxifene (Evista)

An estrogen receptor modulator used to treat osteoporosis by mimicking the effects of estrogen on bones while blocking its effects in other tissues.

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Raloxifene Mechanism

Raloxifene activates estrogen receptors in bones, promoting calcium retention, while blocking estrogen receptors in the breast and uterus.

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Raloxifene Uses

Raloxifene is primarily used for the treatment of osteoporosis in postmenopausal women.

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Raloxifene Side Effects

Common side effects include hot flashes, increased blood pressure, joint pain, muscle pain, nausea, indigestion, lower extremity edema, sleep disturbances, and weight gain.

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Raloxifene Adverse Reactions

Raloxifene can increase the risk of thrombotic events such as deep vein thrombosis, stroke, myocardial infarction, and pulmonary embolism.

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Teriparatide (Forteo)

A parathyroid hormone analog that stimulates new bone formation by promoting osteoblast activity and inhibiting their death.

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Teriparatide Mechanism

Teriparatide acts as an anabolic agent, stimulating osteoblast activity and preventing their apoptosis, leading to new bone formation.

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Teriparatide Uses

Teriparatide is used to treat postmenopausal osteoporosis in women and osteoporosis as a result of hypogonadism in men.

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Teriparatide Side Effects

Common side effects include bone pain, nausea, dizziness, leg cramps, hypercalcemia, increased heart rate, injection site reactions, and orthostatic hypotension.

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Study Notes

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

  • Mechanism of Action: Slows prostaglandin, kinin, histamine, TNF, and other inflammatory mediator production from arachidonic acid. Provides analgesic, anti-inflammatory, and antipyretic effects. Prevents tissue and blood vessel response to injury. Categorized as selective or nonselective.

  • Nonselective NSAIDs: Block both COX-1 and COX-2 enzymes, often causing more side effects. COX-1 produces protective prostaglandins, COX-2 produces inflammatory prostaglandins. Examples: aspirin, ibuprofen, naproxen, nabumetone, indomethacin.

  • Selective NSAIDs: Primarily block COX-2 enzymes. Examples: celecoxib, meloxicam, diclofenac.

  • Inhibits Platelet Aggregation: Stops blood platelets from clumping together.

  • Uses: Myalgia, neuralgia, arthralgia, headache, dysmenorrhea, arthritis (rheumatoid, osteoarthritis, ankylosing spondylitis, gout), pain from procedures/injuries (dislocations, herniated disks), clot prevention.

  • Side Effects: GI irritation (heartburn, nausea, vomiting), dizziness, headache, increased bleeding risk, fluid retention, edema, increased blood pressure, reduced effectiveness of antihypertensives, increased hypoglycemia risk in diabetic patients.

  • Adverse Reactions & Contraindications: Allergic reactions, renal failure, GI bleeding/ulceration/perforation, blood disorders, increased cardiovascular risk (stroke, MI), Reye syndrome (children), toxicity (tinnitus, hyperventilation, diaphoresis, thirst, headache, drowsiness, skin eruptions, electrolyte imbalance, CNS depression, stupor, convulsions, coma, tachycardia, respiratory insufficiency).

  • Nursing Considerations & Patient Education: Assess for contraindications (allergies, asthma, blood disorders, GI/liver/kidney/heart problems, pregnancy). Administer with food, milk, antacids, or water. Anti-inflammatory effect may take 1-2 weeks. Assess for bleeding/bruising (mucous membranes, petechiae, black/tarry stool, blood in stool/urine/vomit). Advise patient to report abnormal bleeding, tinnitus, heart attack signs, weight gain/edema, and upcoming procedures. Avoid aspirin, aspirin products, other NSAIDs, blood thinners, tobacco, and alcohol. Caution use in children with illness, older adults and during pregnancy.

Corticosteroids

  • Examples: Prednisone, methylprednisolone, dexamethasone, hydrocortisone.

  • Mechanism of Action: Decrease inflammatory cytokine production (including COX-1 and COX-2) and white blood cells. Mimic natural cortisol hormones.

  • Uses: Reduce inflammatory, allergic, or immunologic response (acute adrenal emergencies, allergic states, acute brain injury, severe asthma). Herniated intervertebral disk, carpal tunnel syndrome, arthritis (rheumatoid, osteoarthritis, ankylosing spondylitis, gout), inflammatory bowel diseases, systemic lupus erythematosus, fat embolism. Local injection for joint, soft tissue, bursae, or skin issues. Topical use for integumentary, rectal, ophthalmic, or otic problems. Inhaled for asthma.

  • Short-Term Side Effects: Sodium/fluid retention, potassium depletion, increased blood pressure, acne, insomnia, nervousness, mood changes, hyperglycemia.

  • Long-Term Side Effects (Cushing Syndrome): Weight gain, fat redistribution (moon face, buffalo hump), muscle loss/weakness, hair thinning, hirsutism , stretch marks, immunosuppression, increased bleeding risk, ulcers/bleeding.

  • Adverse Reactions & Contraindications: Adrenal gland suppression (sudden stop of use can cause adrenal insufficiency, potential for death). Immunosuppression (decreased WBCs, less noticeable infection signs). Osteoporosis, cataracts, corneal fungal infections. Hypertension, ocular hemorrhage, delirium/behavior changes.

  • Nursing Considerations & Patient Education: Assess for contraindications (infection). Administer with food. Administer oral corticosteroids in the morning. Do not apply topicals to infected areas. Caution with thin skin. Effect may take several days/weeks (injected) vs 24 hours (oral). Monitor for adrenal insufficiency up to a year after stopping. Never stop abruptly (taper). Avoid tobacco, alcohol, NSAIDs. Monitor blood glucose in diabetics. Report infection signs, adrenal insufficiency, hypokalemia, unusual bleeding/bruising, rapid weight gain, and upcoming procedures.

Disease-Modifying Antirheumatic Drugs (DMARDs)

  • Examples: Etanercept, adalimumab, infliximab, rituximab.

  • Mechanism of Action: Reduce inflammatory disease progression by inhibiting TNF produced by white blood cells. DMARDs bind to TNF, blocking its interaction with inflammatory cells preventing tissue destruction. Alleviates pain, improves physical function, reduces tissue damage.

  • Uses: Chronic inflammatory disorders with severe tissue destruction. Rheumatoid arthritis, ankylosing spondylitis, psoriasis, psoriatic arthritis, Crohn's disease, ulcerative colitis.

  • Side Effects: Injection site reaction (pain, swelling, itching, redness), headache, nausea, bone marrow suppression (anemia, increased bleeding risk).

  • Adverse Reactions & Contraindications: Immunosuppression (increased infection risk), heart failure, anaphylaxis.

Antimalarials

  • Example: Hydroxychloroquine.

  • Mechanism of Action: Anti-inflammatory, unknown mechanism.

  • Uses: Rheumatoid arthritis.

  • Side Effects: GI disturbances, retinal edema, blindness.

Gold Salts

  • Examples: Gold sodium thiomalate (IM), auranofin (PO).

  • Mechanism of Action: Anti-inflammatory (IM), antirheumatic (PO).

  • Uses: Rheumatoid arthritis.

  • Side Effects: Renal damage, hepatic damage, corneal deposits, dermatitis, stomatitis, hematologic changes (thrombocytopenia, leukopenia).

  • Nursing Considerations & Patient Education: IM anti-inflammatory effect may not be evident for 3-6 months. Monitor urinalysis and CBC before each injection. Report dermatitis, metallic taste, or mouth lesions. Minimize sun exposure, meticulous oral care.

Antineoplastics

  • Example: Methotrexate.

  • Mechanism of Action: Alters folic acid use, necessary for cell growth. Anti-inflammatory.

  • Uses: Rheumatoid arthritis.

  • Side Effects: GI irritation (nausea, vomiting, anorexia, diarrhea, sore mouth), headache, blurred vision, dizziness.

  • Nursing Considerations & Patient Education: Assess for pregnancy contraindication. Monitor vital signs, WBCs, platelets, intake/output, appetite. Adequate hydration. Avoid vaccinations.

Immunosuppressants

  • Examples: Azathioprine, cyclophosphamide.

  • Mechanism of Action: Inhibits DNA, RNA, and protein synthesis.

  • Uses: Rheumatoid arthritis.

  • Side Effects: GI irritation (nausea, vomiting, anorexia), rash.

  • Nursing Considerations & Patient Education: Assess for pregnancy contraindication. Report unusual bleeding/bruising. Effect may not be evident for 12 weeks.

Topical Analgesics (e.g., Capsaicin)

  • Mechanism of Action: Depletes substance P from nerve endings, interrupting pain signals.

  • Uses: Rheumatoid arthritis.

  • Side Effects: Rash, urticaria, localized burning, erythema.

  • Nursing Considerations & Patient Education: Regular use for maximal effect. Aloe vera might help with burning. Avoid external heat sources. Wash hands, wear gloves. Avoid touching damaged skin, eyes, nose, mouth.

Nonopioid Centrally Acting Analgesics (e.g., Tramadol)

  • Mechanism of Action: Inhibits neurotransmitter (norepinephrine, serotonin) action/reuptake in spinal cord/brain, reducing pain signal transmission. Binds opioid receptors. Often used with acetaminophen.

  • Uses: Moderate to severe acute pain (osteoarthritis, fibromyalgia).

  • Side Effects: Sedation, dizziness, dry mouth, constipation.

  • Adverse Reactions & Contraindications: Seizures (avoid in patients with epilepsy/neurologic disorders).

  • Nursing Considerations & Patient Education: Assess for contraindications (other sedatives/CNS depressants, seizure history).

Acetaminophen

  • Mechanism of Action: Reduces prostaglandin production in the brain, reducing pain perception. Does not directly act at injury site, no anti-inflammatory properties.

  • Uses: Mild to moderate pain (osteoarthritis, dislocations), fever, combines with opioids for severe pain.

  • Side Effects: Nausea, skin rash.

  • Adverse Reactions & Contraindications: Allergic reactions, hepatotoxicity at high/prolonged doses.

  • Nursing Considerations & Patient Education: Assess for contraindications (other acetaminophen containing medications, liver disease). Avoid alcohol. Maximum daily dose of 4g. Variable dosage for children.

Skeletal Muscle Relaxants (e.g., Cyclobenzaprine, Tizanidine)

  • Mechanism of Action: Depresses CNS, reduces signal transmission along motor nerves, fewer muscle spasms/pain, decreasing tender areas. Tizanidine lowers substance P, reducing pain.

  • Uses: Pain, insomnia related to musculoskeletal spasms, fibromyalgia, fractures, whiplash, herniated disks, strains.

  • Side Effects: Dizziness, headache, dry mouth, blurred vision, urinary retention.

  • Adverse Reactions & Contraindications: Cardiac dysrhythmias, prolonged cardiac conduction, increased seizure risk, MAOI interactions.

  • Nursing Considerations & Patient Education: Assess for contraindications (arrhythmias, recent heart attack, seizure disorders, other CNS depressants, MAOIs). Assess consciousness, cognition, skeletal muscle, blood pressure, and pulses. Initiate fall precautions. Assess for urinary retention. Avoid operating equipment/driving/critical decisions. Avoid alcohol. Check pulse daily.

Antidepressants (e.g., Amitriptyline, Duloxetine)

  • Mechanism of Action: Increase natural opioids (endorphins, enkephalins) in the brain. Reduce depression related to chronic pain. Diminishes local pain/stiffness. Improves sleep.

  • Uses: Chronic pain (fibromyalgia), cancer pain, neuropathic pain.

  • Nursing Considerations & Patient Education: Assess for contraindications. May take 1-2 weeks for pain relief.

Anticonvulsants (e.g., Pregabalin)

  • Mechanism of Action: Reduces pain signal transmission along sensory nerves. Reduces pain perception, improves fatigue/sleep/function.

  • Uses: Fibromyalgia, neuropathic pain, migraines.

Other Medications/Supplements

  • Clonazepam (Klonopin): Decreases leg movements, especially at night. Used for fibromyalgia.

  • Sodium Oxybate (Xyrem): Improves deep sleep, growth hormone levels, reduces pain/fatigue. Used for fibromyalgia.

  • Glucosamine Supplements: Enables collagen/proteoglycan production. Resupplies joint lubricant in synovial fluid. Used for osteoarthritis.

Antigout Medications

  • Colchicine: Used for acute gout attacks. Side effects include GI upset (diarrhea, nausea, vomiting). Discontinue if symptoms persist or pain unrelieved. Avoid purine-rich foods. Drink plenty of water (at least 2000mL).

  • Uricosurics (e.g., Probenecid): Inhibit renal uric acid reabsorption, increasing uric acid secretion. Used for gout. Aspirin interferes, avoid during therapy.

  • Uric Acid Synthesis Inhibitors (e.g., Allopurinol, Febuxostat): Reduce purine conversion into uric acid. Used to prevent/shorten gout attacks. May be used with chemotherapy. Side effects include headache, rash, nausea; rare effects like breast development and erectile dysfunction in males. Potential complications: kidney stone formation, liver failure, heart failure, stroke, depression, cardiac dysrhythmias. Allopurinol guidelines: take after meals, avoid aluminum-based antacids, be aware of warfarin interactions (monitor INR closely), when IV, utilize a separate port/tubing. Febuxostat can be taken without regard for meals or antacids. Avoid purine-rich foods. Drink plenty of water.

Osteoporosis Medications

  • Bisphosphonates (e.g., Alendronate, Zoledronic acid): Move blood calcium into bone, prevent osteoclast destruction of bone cells. Increases bone density, slows bone loss. Reduce fracture risk. Indications include osteoporosis, bone metastases, multiple myeloma, Paget's disease, cancer-induced hypercalcemia. Side effects/problems include severe esophageal reflux, chest pain, nausea, osteonecrosis (jawbone).

  • Estrogen Receptor Modulators (e.g., Raloxifene): Activates estrogen receptors, blocks in breast/uterus. Increases bone density, prevents excessive reproductive tissue growth. Side effects include hot flashes, increased blood pressure, joint/muscle pain, nausea, indigestion, lower extremity edema, sleep problems, weight gain. Adverse reactions/problems are increased thrombotic risk (deep vein thrombosis, stroke, MI, pulmonary embolism.)

  • Parathyroid Hormone (e.g., Teriparatide): Anabolic drug that increases osteoblast formation, slows osteoblast apoptosis. Results in new bone formation. Indications include postmenopausal osteoporosis in women, osteoporosis due to hypogonadism in men. Side effects include bone pain, nausea, dizziness, leg cramps, hypercalcemia, increased heart rate, injection site reactions, orthostatic hypotension. Adverse reactions/problems include osteosarcoma, angioedema, serious allergic reactions

  • Calcitonin-Salmon: Increases bone mass, especially in the spine. Side effects include injection site reactions and nasal irritation.

  • Calcium and Vitamin D Supplements: Calcium builds and maintains bone, vitamin D helps absorb calcium. Slows bone loss, reduces fracture risk. Side effects include nausea, vomiting, constipation, bone pain, muscle weakness, increased thirst. Recommended dosages vary. Administer with food. Encourage calcium-rich diet. Vitamin D.

Anticoagulants

  • Indirect Thrombin Inhibitors (e.g., Heparin): Increase antithrombin III activity, inhibits thrombin. LMWHs bind antithrombin and inhibit factor Xa. Prevent venous thromboembolism in high-risk patients (surgery, heart valve disease, dysrhythmias, hemodialysis, bedrest, clotting history, pulmonary embolism). Stops clot growth. Side effects/problems include bleeding, bruising, injection site irritation, pruritus, skin changes, hemorrhage, thrombocytopenia (HIT/HITT). Assess for contraindications (allergies, liver/kidney disease, hypertension, pregnancy/postpartum) and drug interactions. Heparin administration involves a two-nurse check, avoids shaking, must be in separate tubing/syringes. Monitor aPTT (1.5-2.5 times control). Monitor platelets. Protamine sulfate is the antidote.

  • Vitamin K Antagonists (e.g., Warfarin): Inhibit vitamin K-dependent enzymes, reduce clot formation. Used for long-term therapy in chronic clot conditions (coronary artery disease, atrial fibrillation, knee/hip replacement, immobility). Side effects/problems include bleeding, bruising, GI upset, headache, rash, hemorrhage, skin necrosis. Assess for contraindications (drug interactions, alcohol, blood/bleeding disorders, uncontrolled hypertension, pregnancy/breastfeeding, elderly). Monitor INR (2.0-3.0). Limit green leafy vegetables and maintain consistent consumption. Vitamin K is the antidote. Warfarin and Heparin are often administered together until warfarin's effects are noticeable.

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