IV Therapy Musculoskeletal Drugs PDF

MUSCULOSKELETAL DRUGS DISEASE MODIFYING ANTI- RHEUMATIC DRUGS (DMARDS) Slow the joint degeneration and progression of Rheumatoid arthritis (RA) Used when pain of RA can no longer be controlled by pain relief agents and anti- inflammatory drugs Actions--Produce immunosuppression Also trea...

MUSCULOSKELETAL DRUGS DISEASE MODIFYING ANTI- RHEUMATIC DRUGS (DMARDS) Slow the joint degeneration and progression of Rheumatoid arthritis (RA) Used when pain of RA can no longer be controlled by pain relief agents and anti- inflammatory drugs Actions--Produce immunosuppression Also treat fibromyalgia and inflammatory bowel disease, such as Crohns ADVERSE REACTIONS Nausea Stomatitis Alopecia Be alert for skin rash, fever, cough, or easy bruising, Visual changes, tinnitus, or hearing loss. For sulfa containing DMARDs, ocular changes, GI upset, mild pancytopenia (sulfasalazine) Retinal damage with Plaquenil. CONTRAINDICATIONS Methotrexate—renal insufficiency, liver disease, alcohol abuse, folate deficiency, pancytopenia Enbrel, Humira, and Remicade—HF or neurological demyelinating diseases PRECAUTIONS  Women should not become pregnant  Men should use barrier methods to prevent transmission of drug through semen  Methotrexate can cause thrombocytopenia and leukopenia. Hematology, liver and renal functions studied every 3 months.  Take on same day each week.  Notify md if sore mouth or sores in mouth, diarrhea, fever, sore throat, easy bruising, rash itching, n/v. INTERACTIONS Sulfa drugs—increased risk of methotrexate toxicity Aspirin and NSAIDs—increased risk of methotrexate toxicity NURSING INTERVENTIONS Monitor labs—thrombocytopenia, leukopenia, liver enzymes, kidney function Monitor for toxicity Hydroxychloroquine—skin rash, fever, cough, easy bruising Patient teaching Take at same time (methotrexate) Use effective birth control methods Report s/s infection, bleeding, allergic reaction DRUGS Adalimumab – Humira Etanercept – Enbrel Hydroxychloroquine sulfate – Plaquenil Infliximab – Remicade Methotrexate - Rheumatrex BONE RESORPTION INHIBITORS BISPHOSPHONATES Actions: inhibit normal and abnormal bone resorption. Results in increased density, reversing osteoporosis. Uses: Osteoporosis in postmenopausal women and men Hypercalcemia of malignant diseases Paget’s disease of bone ADVERSE REACTIONS N/D Increased or recurrent bone pain Headache Esophagitis, esophageal ulceration, dyspepsia, acid regurgitation, dysphagia Abdominal pain, nausea, diarrhea, constipation Musculoskeletal pain Visual disturbances Increased risk of bleeding, esp. when taking with another drug that inhibits clotting—e.g. ASA Nephrotoxicity with IV infusion CONTRAINDICATIONS Pregnancy and lactation Fosamax and Actonel—patients with hypocalcemia Dysphagia, esophageal stricture, or d/o, serious kidney impairment, hypocalcemia. INTERACTIONS Antacids—decreased effectiveness of bisphosphates Aspirin—increased risk of GI bleed Theophylline—increased risk of theophylline toxicity Caffeine, orange juice, magnesium supplements, iron, calcium (wait 2 hrs between them) decreases absorption of alendronate NURSING INTERVENTIONS Give with 8 oz water while patient is in an upright position. Must stay upright for 30 minutes. Take first thing in the morning on empty stomach Take supplemental calcium and vitamin D if dietary intake is inadequate Clients need bone scan every 12-18 months Monitor blood calcium Exercise 30-40 minutes a day like walking DRUGS Alendronate sodium – Fosamax Ibandronate – Boniva Risedronate sodium - Actonel URIC ACID INHIBITORS Uses – acute attacks of gout (colchicine) or in preventing acute attacks of gout (allopurinol, probenecid, febuxostat) Adverse effects All meds N/V/D Allopurinol - skin rash; (Stevens Johnson’s syndrome), Hepatitis, kidney damage Colchicine – severe n/v, and bone marrow depression, thrombocytopenia, Rhabdomyolosis--Used as second line of treatment. Probenecid – Renal stones, kidney injury CONTRAINDICATIONS Pregnancy and lactation Anturane—peptic ulcer disease Colchicine—serious GI, renal, hepatic, and cardiac disorders Probenecid—blood dyscrasias, uric acid kidney stones, and children under 2 years INTERACTIONS Colchicine Grapefruit juice-may increase side effects Allopurinol Ampicillin—increased risk of rash Theophylline—increased risk of theophylline toxicity Coumadin- increases risk of bleeding Probenecid Penicillins—increased serum levels of antibiotic NSAIDS—increased serum level of NSAIDs Barbiturates—increased sedation levels Salicylates-decreased effectiveness of probenecid Anturane Oral anticoagulants—increased risk of bleeding Tobutamide—increased risk of hypoglycemia ANTIGOUT MEDICATIONS Patient teaching Take as prescribed with meals with plenty of water, 3000 cc per day. Need 2l of urine a day. This prevents stone formation in GU tract. Observe stool and urine for blood Colchicine kept on hand for acute attacks Will see improvement within hours Check joints every 2 hours for improvement Take with food Drink at least 10 glasses of water a day until the acute attack has subsided Monitor uric acid levels, CBC, UA, liver and kidney function tests With allopurinol and probenecid: if rash develops, advise clients to stop medication and notify the provider Avoid alcohol and foods high in purine Regular exercise DRUGS 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 Pregnancy and lactation Flexeril and MAOIs—can’t take within 14 days of MAOI Flexeril contraindicated in patients with recent MI, cardiac conduction d/o and hyperthyroidism. Diazepam is a controlled substances schedule IV DRUG INTERACTIONS CNS depressants increase CNS depressant effects Flexeril and MAOIs—increases risk for seizures and fever Norflex and Haldol—increased psychosis Zanaflex and antihypertensives—increased risk of hypotension DRUGS Skeletal Muscle Relaxants Diazepam – Valium Orphenadrine citrate – Norflex Tizanidine – Zanaflex Cyclobenzaprine – Flexeril Baclofen – Gablofen Dantrolene - Dantrium NURSING INTERVENTIONS DMARDs, uric acid inhibitors, and skeletal muscle relaxants 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 while taking these drugs.