Musculoskeletal Disorders NURS 3010 PDF

Musculoskeletal Disorders NURS 3010- Simple and Stable Disorders Osteoporosis Pathophysiology ° When osteoclastic activity is greater than osteoblastic activity ° With age: ̴ Decrease in calcitonin levels ( no calcium in bones) ̴ Decrease in estrogen...

Musculoskeletal Disorders NURS 3010- Simple and Stable Disorders Osteoporosis Pathophysiology ° When osteoclastic activity is greater than osteoblastic activity ° With age: ̴ Decrease in calcitonin levels ( no calcium in bones) ̴ Decrease in estrogen levels (weak bones) ̴ Increase in parathyroid hormone (increases bone break down) Pharmacology ° Calcitonin ° Estrogen/Hormone Therapy (Estrace) ̴ Assist with bone remodeling ° Estrogen agonist/antagonist (Raloxifene) ̴ Assist with bone remodeling − Increased risk for DVT ° Bisphosphonates ⎯ Osteoarthritis Pathophysiology ° Progressive deterioration of the articular cartilage ° Overproduction of synovial fluid from damage, causing pain and movement restriction ° Muscle atrophy from decreased use of the joint Pharmacology ° Acetaminophen ° NSAIDs ° Corticosteroids ⎯ Paget’s Disease Pathophysiology  Musculoskeletal Disorders NURS 3010- Simple and Stable Disorders ° Bone metabolism disorder with accelerated bone remodeling, resulting in abnormally structured bone Pharmacology ° Pain management ° Calcitonin ° Bisphosphonates ⎯ Carpal Tunnel Pathophysiology ° Inflammation compresses the median nerve causing sharp pain, numbness, and tingling of the hand ° Long term atrophy of the muscles Pharmacology ° NSAIDs ° Acetaminophen ° Steroid injections ⎯ Gout Pathophysiology ° Urate crystals are deposited in joints, bone, and soft tissue, accompanied by inflammation ° To have gout, there must be hyperuricemia ° Normally resolves on its own, but can result in chronic inflammatory destructive arthritis Pharmacology ° NSAIDs  Musculoskeletal Disorders NURS 3010- Simple and Stable Disorders ° Glucocorticoids ° Uric-Acid Lowering Agents  Musculoskeletal Disorders NURS 3010- Simple and Stable Disorders  Musculoskeletal Disorders NURS 3010- Simple and Stable Disorders CALCITONIN Decreases osteoclastic activity in bone, and assists with renal excretion of MOA/Purpose calcium(calcium from blood and putting it into bones) Therapeutic Use Treats postmenopausal osteoporosis, Paget’s disease, hypercalcemia Complications/S Hypocalcemia (consume calcium rich foods and Vitamin D to help absorption) E BISPHOSPHONATES Oral: (Fosamax) MOA/Purpose Impedes bone resorption by inhibiting osteoclastic activity ( stop bone breakdown,) Therapeutic Use Treats postmenopausal osteoporosis, Paget’s disease, hypercalcemia Esophagitis( spasm of smooth muscle)( if you have a contraindication with taking Complications/S bisphosphonates you need to stand for 30 minutes after taking it) E Hypocalcemia URIC ACID LOWERING AGENTS Oral/IV: (Zyloprim) MOA/Purpose Inhibit uric acid production Complications/S Hypersensitivity ( high risk may see fever, rash) E  Musculoskeletal Disorders NURS 3010- Simple and Stable Disorders Interactions Warfarin (monitor PT, INR)  Musculoskeletal Disorders NURS 3010- Simple and Stable Disorders NSAIDs Oral: 1st Generation (COX-1 & 2) 2nd Generation (Cox-2 Only) Aspirin (Celebrex) (Motrin, Advil) (Aleve) Ketorolac (IV) COX-1 Decreased platelet aggregation and kidney damage it also decreases inflammation, pain, MOA/Purpos fever e COX-2 Decreased inflammation, pain, fever Inflammation suppression Mild to moderate pain Therapeutic Fever reduction Use Protection against stroke or MI ( very low doses of aspirin given everyday can help reduce risk of stroke or MI) Osteoarthritis, rheumatoid arthritis (Celecoxib) GI discomfort (dyspepsia, pain, heartburn, nausea) GI bleeding (peptic ulcer dz, GERD)( if no history of GI problem can take PPI) Complicatio Impaired kidney function( monitor IO, characteristics of urine, peripheral edema)( older adults) ns/ SE Increased risk or heart attack and stroke ( all of the meds except for aspirin) Salicylism ( tinnitus, headache, dizziness) Anticoagulants (Warfarin and Heparin) (monitor INR, APPT) Interactions Glucocorticoids (interact with these bc they increase the chances for a GI bleed) Alcohol ( increase risk of bleeding and ulcers)  Musculoskeletal Disorders NURS 3010- Simple and Stable Disorders ACEs and ARBs( when taking with NSAIDs you run a risk of kidney failure bc it affects our RAAS system) ACETAMINOPHEN MOA/Purpos Slows productions of prostaglandins in the CNS e Therapeutic Analgesia (pain) Use Antipyretic( fever) no platelet or inflammation like NSAIDs Complicatio Acute toxicity ( liver damage) ns/SE Interactions Alcohol Warfarin ( monitor PT and INR)