MUSCULOSKELETAL .docx

ETANERCEPT CHAPTER 31 CONNECTIVE TISSUE DISORDER Therapeutic Use DMARDs are drugs that treat and decrease joint inflammation, and subsequently prevent joint damage. Biologic DMARD drugs are tumor necrosis factor antagonists—drugs that bind with naturally occurring tumor necrosis factor, preventing i...

ETANERCEPT CHAPTER 31 CONNECTIVE TISSUE DISORDER Therapeutic Use DMARDs are drugs that treat and decrease joint inflammation, and subsequently prevent joint damage. Biologic DMARD drugs are tumor necrosis factor antagonists—drugs that bind with naturally occurring tumor necrosis factor, preventing it from attaching to cells on the surface of synovial tissue in the joints. Administration Administer by subcutaneous injection. Give once weekly.  Monitor site for redness, pain, and swelling after administration. Adverse Drug Reactions Increased susceptibility to infections Dizziness  Abdominal pain Pharyngitis Psoriasis Upper Respiratory Infections Rare occurrence of severe allergic reactions such as Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and erythema multiforme Local injection site reaction Heart failure Reactivation of latent tuberculosis (TB) Client Instructions Report signs and symptoms of infection immediately. Avoid immunizations, especially those that contain live vaccines. Report skin rashes immediately. Advise clients to report reactions that do not subside within a few days. Report signs and symptoms of heart failure (cough, shortness of breath, elevated blood pressure and heart rate, pink sputum) immediately. Report shortness of breath or new production of sputum. Contraindications Active infection  Hematologic disease  Malignancy Interventions Assess for infection prior to each injection. Monitor for signs and symptoms of infection during therapy. Monitor for skin reactions, redness, warmth, and itching at the injection site. Monitor clients for signs and symptoms of heart failure (cough, shortness of breath, elevated blood pressure and heart rate, pink sputum). Administer TB test prior to starting therapy. Precautions Autoimmune diseases Live vaccines Heart failure ALENDRONATE Chapter 32 Bone Disorders pg. 275 Therapeutic Use: Prevention and treatment of postmenopausal osteoporosis, glucocorticoid-related osteoporosis, and age-related osteoporosis in men. Administration: Give drug 30 minutes before breakfast with a full glass of water. Have client sit or stand for 30 minutes after administration. Avoid giving calcium-containing drugs/supplements within 30 minutes of administration. Adverse Drug Reactions: Esophagitis  Gastrointestinal disturbances (nausea and vomiting, abdominal pain) Muscle and joint pain Eye pain and vision changes Client Instructions: Instruct clients to take drug with full glass of water. Instruct clients to do the following for 30 minutes after taking drug: Avoid eating or drinking anything other than water. Avoid taking calcium supplement or antacid. Advise clients to take analgesic for muscle and joint pain and report pain that persists. Instruct clients to report changes in swallowing or vision to provider. Contraindications Esophageal strictures/disorders or difficulty swallowing  Clients unable to sit up for 30 minutes after administration.  Renal insufficiency  Hypocalcemia Interventions Esophageal strictures/disorders or difficulty swallowing  Clients unable to sit up for 30 minutes after administration. Renal insufficiency  Hypocalcemia Interactions: Calcium supplements and dairy products decrease absorption when given within 30 minutes of each other. Precautions Upper gastrointestinal disorders  Infection  Liver disease  Heart failure CALCITONIN-SALMON CHAPTER 32 BONE DISORDERS pg. 275 Therapeutic Use: Treatment of postmenopausal osteoporosis Hypercalcemia secondary to hyperparathyroidism Paget’s disease Administration Intranasal spray Hold nasal pump upright. If using pump for the first time, prime pump according to manufacturer’s instructions. Spray ONCE in nostril opposite of previous instillation. Intramuscular/Subcutaneous  Rotate injection sites. Subcutaneous is preferred route - Administer IM if dose more than 2ml Protect from light. Keep calcitonin salmon refrigerated. Adverse Drug Reactions Nasal dryness and irritation with intranasal calcitonin Hypersensitivity reactions/ anaphylaxis Hypocalcemia Decrease in therapeutic effects over time Nasal form of calcitonin may cause nasal dryness and irritation as well as headaches and epistaxis Injectable form may cause injection site reaction, nausea and vomiting and polyuria. Client Instructions Report signs and symptoms of infection immediately. Avoid immunizations, especially those that contain live vaccines. Report skin rashes immediately. Advise clients to report reactions that do not subside within a few days. Report signs and symptoms of heart failure (cough, shortness of breath, elevated blood pressure and heart rate, pink sputum) immediately. Report shortness of breath or new production of sputum. Contraindications Interactions: May decrease serum lithium levels. Previous treatment with bisphosphonates may decrease the response to calcitonin. Interventions When administering intranasal calcitonin. Alternate nostril used daily. Assess prior to administration for irritation/ulceration. Prior to beginning therapy, Perform intradermal allergy test. Development of erythema within 15 minutes indicates sensitivity. Have epinephrine 1:1000, antihistamines, and oxygen available during early therapy. Monitor for hypocalcemia (serum calcium level, muscle spasms, tingling of fingers and toes). Provide diet high in calcium and vitamin D.