Pharmacology: Musculoskeletal System PDF

Pharmacology: Musculoskeletal System 1. methotrexate/ Rheumatrex Class: DMARD I (Disease Modifying Anti-Rheumatic Drugs) (Major Non-biologic) ★ hydroxychloroquine ★ plaquenil Use: Rheumatoid Arthritis Adverse Reactio...

Pharmacology: Musculoskeletal System 1. methotrexate/ Rheumatrex Class: DMARD I (Disease Modifying Anti-Rheumatic Drugs) (Major Non-biologic) ★ hydroxychloroquine ★ plaquenil Use: Rheumatoid Arthritis Adverse Reaction: ○ Gastric Bleeding, ○ Kidney/Liver Damage ○ BMS (Bone Marrow Supression) *Risk of Infection ○ Pulmonary Fibrosis Nursing Considerations: ○ Taken Once a Week ○ Monitor for S/S of Bleeding and Jaundice ○ Drink 2-3L of Fluids ○ Avoid alcohol ○ Give Folic Acid Supplement -* to reduce risk of toxicity ○ Avoid Pregnancy During and 6 Months After ○ Monitor for decreased RBCs, WBCs, and Platelets ○ Watch O2 for Respiratory Distress ○ Takes 4-6 weeks for Full Therapeutic Effect ____________________________________________________________________________ 2. etanercept/ Enbrel Class: DMARD II (Major Biologic) ★ Humira Use: Rheumatoid Arthritis Given with methotrexate for Enhanced Effect Adverse Reaction: ○ SJS ○ Increased Risk of Infection ○ Heart Failure ○ BMS ○ Reactivation of TB Nursing Considerations ○ Give SQ (1-2x Week) ○ Report Fever/Sore Throat, Rash/Blisters (Reactions) ○ Caution in Diabetics and Active Infections ○ Test for TB Prior to Taking Medication ○ Avoid Unnecessary live Vaccines  3. raloxifene/ Evista Class: SERM (Selective Estrogen Receptor Modulators) Use: ○ Osteoporosis ○ (Mimics Effects of Estrogen on Bone Tissue) ○ Prevention/Treatment of Post Menopausal Osteoporosis ○ Reduce Risk of Estrogen Fed Breast Cancer Adverse Reaction: ○ DVT ○ PE Nursing Considerations: ○ Monitor for Calf Pain, SOB, Swollen Reddened Areas in Lower Extremeties. ○ Increase Daily Weight-Bearing Activity ○ Take Cacium and Vitamin D ○ Use Contraception ○ Teach May Cause Hot Flashes ____________________________________________________________________________ 4. alendronate/ Fosamax Class: Bisphosphonate Use: ○ Osteoporosis ○ Decreases Activity of Osteoclasts Adverse Reactions: ○ Joint, Muscle, and Jaw Pain ○ Osteonecrosis ○ Blurred Vision ○ Esophagitis Nursing Considerations: ○ Don’t Use in Patients on Flat Bed Rest ○ Take with Full Glass of Water to Ensure it Passes to Stomach/Dissolve ○ Sit or Stand 30 Minutes After ○ Wait 30 minutes Before Taking Calcium/Antacid ○ Take in the Morning ○ Bone Density Scan Every ___ Months to Monitor Therapeutic Effect  5. calcitonin salmon/ Miacalcin Class: Calcitonin (Nasal Spray) Use: ○ Osteoporosis ○ Decreases Action of Osteoclasts, Increases Exretion of Calcium ○ Hypercalcemia Secondary to Hyperparathyroidism ○ Pagets Disease Adverse Reactions: ○ Rash ○ Itching ○ Nasal Irritation ○ Hypocalcemia ○ (Tetany, Muscle Spasms, Numbness/Tingling, Seizures) Nursing Considerations ○ Hold Upright ○ Prime Pump ○ One Spray in One Nostril, Rotate sites ○ Check for Allergy with Skin Test ○ Don’t Give with Fish Protien Allergy ○ Eat Diet High in Calcium/Vitamin D ____________________________________________________________________________ 6. calcium carbonate/ TUMS Class: Calcium Supplement/ Antacid Use: ○ Osteoporosis ○ Indigestion Adverse Reactions: ○ Rena Calculi (Flank Pain) ○ Hypercalcemia (n/v, Polyuria, Constipation, Depression) Nursing Considerations ○ Divide into 500mg Doses ○ Take with Water ○ Antacids: Take 1 Hours After Meals and at Bedtime, Wait 1 Hour Before Taking Steroids, Chew Tablets, Don’t Need to Take with Food ○ Need High Fiber Diet. ○ Report Blood in Urine and Flank Pain  7. neostigmine/ Prostigmin Class: Cholinesterase Inhibitor Use: ○ Myasthenia Gravis ○ Improve Muscle Strength/Contractions ○ Endurance Adverse Reactions: ○ Bronchospasms ○ Bradycardia *Know S/S of High and Low Serum Levels Nursing Considerations: ○ Caution in Patients with Asthma ○ Use atropine to Reverse Efeects ○ Check Apical Pulse (＞60) ○ May Cause Increased Salivation ○ Test Swallowing Before Giving ○ Give 45 to 60 Minutes Before Meal ○ Take Same Time Every Day ○ Monitor for Signs of Cholinergic Crisis (High Serum Levels) S/S- Excessive Diarrhea, and/or Salivation, Respiratory Depression, Muscle Paralysis Within 1 Hour of Administration Peak of the Drug Is Less than 1 Hour Which is Why Levels Would Be High ★ S/S of Low Levels are Muscle Weakness and Respiratory Paralysis That Happens 3 or More Hours After Administering the Drug ____________________________________________________________________________ 8. succinylocholine/ Anectine Class: Neuromuscular Blocking Agent (Depolarizing) Use: ○ Decrease Muscle Contractions ○ Causes Muscle Paralysis (for ECT, Mechanical Ventilation) Adverse Reactions: ○ Hyperkalemia ○ Respiratory Depression ○ Malignant Hyperthermia Nursing Considerations: ○ Caution in Patients with MS (May Cause Hyperkalemia) *Know S/S of Malignant Hyperthemia and Nursing Interventions (Give Dantrolene) ○ Expect Post-Op Muscle Pain 9. pancuronium/ Pavulon Class: Neuromuscular Blocking Agent (Nondepolarizing) Use: Anasthesia Adverse Reactions: Respiratory Depression Nursing Considerations: ○ Don’t Give with Aminoglycosides (gentamicin,tobramycin) and tetracyclines (Increase Effects) ○ Reverse with Cholinesterasen Inhibitor (neostigmine, pyridostigmine)