Musculoskeletal Handouts PDF

pi. Medications for the Musculoskeletal System Antirheumatics BIsphosphonates Action: Provide symptomatic relief and delay in disease pro gression...

pi. Medications for the Musculoskeletal System Antirheumatics BIsphosphonates Action: Provide symptomatic relief and delay in disease pro gression by inhibiting or modulating inflammatory processes Action: Decrease the number and action of osteoclasts, resulting in bone resorption Antirheumatics Medications: ibandronate sodium (Boniva): daily Disease- methotrexate Interrupt complex risedronate (Actonel): weekly modifying (Theumatrex) immune responses, zoledronate (Reclast,Zometa):IV monthly antirheumatic hydroxychloro preventing disease drugs quine (Plaquenil) progression A. Therapeutic Use (DMARDs) etanercept{Enbr.el) 1. Prevention and treatment of osteoporosis infliximab 2. Paget's disease (Remicade) adalimumab 3. Hypercalcemia related to malignancy (Humira) B. Precautions/Interactions Glucocorticoids predntsone Decrease inflam 1. Contraindicated during lactation (Deltasone) mation by suppress prednisdlone ing leukocytes and 2. CHenUJEidi esophageal stricture or difficulty swal fibroblasts,and (Prelone) lowing may only use zoledronate reversing capillary 3. Abso^tion is decreased when taken with calcium penneability supplements, antacids, orange juice, and caffeine NSAIDs ibuprofen (Adril, Inhibit prostaglandin Motrin) synthesis.resulting C. Side Effects/Adverse Effects » diclofenac in decreasedinflam- 1. Musculoskeletal pain (Voltaren) matory responses ' i' 2. Esophagitis and GI discomfort indomethacin 3. Pain in thejaw with zoledronate (Indpcin) naproxen D. NURSING INTERVENTIONS and Client Education (Naprosyn) 1. Administer medication in the morning on an empty « celecoxib.. stomach. (Celebre}^ 2. Instruct client to consume at least 8 oz. ofwater (not carbonated). DMARDs 3. Client must remain sitting or standing for 30 min A. Therapeutic Use after taking medication. 1. Slow joint degeneration and progression ofrheuma ^^^^~4r^onsume adequate amounts ofvitamin D. toid arthritis B. Precautions/Interactions. 1. Methotrexa,te: Contraindicated in pregnancy, renal or liver failure, psoriasis, alcoholism, or hematologic dysci^ias C. Side Effects/Adverse Effects 1. Methotrexate: Increased risk ofinfection, bone marrow suppression, GI ulceration 2. Hydroxychloroquine: retinal damage (blindness) ^D. NURSING INTERVENTIONS and Client Education 1. Instruct client about measures to prevent infection. 2. Monitor liver function tests. 3. Instruct client to use reliable contraception. 4. Instruct client that initial effects may take 3-6 weeks and full therapeiuic effects make take several months. 5. Administer with food. (fi. Instruct clients taking hydroxychloroquine about the critical importance ofretinal examination every 6 months. "2^8" r- UNIT.7 PHARMffG?5LOGY^ Signs and symptoms ofStevens-Johnson syndrome include: Facial swelling Tongue swelling Hives Skin pain A red or purple skin rash that spreads within hours to days Blisters on your skin and mucous membranes, especially in your mouth, nose and eyes Shedding(sloughing)ofyour skin If you have Stevens-Johnson syndrome, several days before the rash develops you may experience: Fever « Sore throat Cough Burning eyes Malignant Hyperthermia Symptoms: A dramatic rise in body temperature, sometimes as high as 113 degrees Fahrenheit Rigid or painful muscles, especially in thejaw. Flushed skinc? Sweatings' An abnormally rapid or irregular heartbeat Rapid breathing or uncomfortable breathing Brown or cola-colored urine Very low blood pressure(shock) Coitiusion Muscle weakness or swelling after the event Malignant Hyperthermia Nursmg Interventions: stop giving the triggering medication and to stop the surgery. Doctors then give the drug dantrolene(Dantrhun)by IV to relax muscles and stop muscle metabolism o Lowering body temperature with: o Cool mist and fkns o Cooling blankets o Cooled intravenous fluids Administering oxygen « Using medications to: o Control the heartbeat o Stabilize blood pressure Monitoring in an intensive care unit