Musculoskeletal Medications Osteoporosis Rheumatoid Arthritis Gout Muscle Spasms.

Musculoskeletal Medications

Osteoporosis

Rheumatoid Arthritis

Gout

Muscle Spasms

Osteoporosis Medications

• Calcium Supplements– Calcium, Vitamin D, combination of both

• Symptoms Hypocalcemia– Nerve and muscle excitability– Muscle twitching, tremors, cramping– Numbness, tingling, convulsions

• Symptoms Hypercalcemia– Nausea/vomiting, anorexia– Increased thirst, increased urination– Muscle pain/weakness

Osteoporosis Medications

Osteoporosis Medications

• Bisphosphonates (Bone Resorption Inhibitors)– Action draws calcium from blood

to bone increasing bone mineralization– Example alendronate (Fosamax)– Uses osteoporosis, Paget’s disease,

hypercalcemia 2o malignancy– Adverse Reactions GI discomfort and

esophageal irritation

Osteoporosis Medications

• Bisphosphonates– Nursing Considerations• Given once weekly

• Give on an empty stomach

(poorly absorbed)

• Remain upright for 30 minutes after

(esophageal irritation)

• NSAID’s– Analgesic effect– Anti-inflammatory effect– GI Distress

• Corticosteroids– Anti-inflammatory effect– GI Distress– Long term effects

Rheumatoid Arthritis Medications

• Disease-Modifying

Antirheumatic Drugs

(DMARD’s)– Cytotoxic Drugs– Gold Salts– Antimalarial Agents– Sulfasalazine

Rheumatoid Arthritis Medications

• Disease-Modifying

Antirheumatic Drugs

(DMARD’s)– Common Side Effects• GI discomfort/ulceration

• Hepatic dysfunction

• Myelosuppression

Rheumatoid Arthritis Medications

• Disease-Modifying

Antirheumatic Drugs

(DMARD’s)– Cytotoxic Drugs• methotrexate (Rheumatrex)

• Nausea, stomatitis, alopecia, myelosuppression

Rheumatoid Arthritis Medications

• Disease-Modifying

Antirheumatic Drugs

(DMARD’s)– Antimalarial Agents• hydrochloroquine (Plaquenil)

• Relatively few side effects except for

retinal damage causing blindness

Rheumatoid Arthritis Medications

• Disease-Modifying

Antirheumatic Drugs

(DMARD’s)– Sulfasalazine• sulfasalazine (Azulfidine)

• GI discomfort (n/v, diarrhea, cramping)

• Hepatotoxicity

• Myelosuppression

Rheumatoid Arthritis Medications

• Disease-Modifying

Antirheumatic Drugs

(DMARD’s)– Evaluation

Therapeutic Effect• Relief of pain

• Decreased inflammation, swelling

• Increased joint function

Rheumatoid Arthritis Medications

• Disease-Modifying

Antirheumatic Drugs

(DMARD’s)– Evaluation

Adverse Reactions• GI discomfort, ulceration, bleeding

• Liver function tests

• CBC, platelet count

Rheumatoid Arthritis Medications

• Acute Gout– NSAID’s• Decrease pain / inflammation

– colchicine• Decrease inflammation

• GI Distress, diarrhea

• 0.5 mg q 1-2 h until pain

relieved or adverse reactions (max = 4 mg)

Anti-Gout Medications

Anti-Gout Medications

• Chronic Gout– allopurinol (Zyloprim)• Decrease uric acid

production

– probenecid (Benemid)• Increases uric acid

excretion in kidneys

• Avoid ASA products

• May be used to potentiate action of penicillin and cephalosporins

Anti-Gout Medications

• Nursing Considerations– Decrease foods high in

purine (animal fats)– Increase fluid intake

(2-3 L / day)

• Evaluation– Decreased pain / inflammation– Decreased number acute attacks– Decreased uric acid levels

Muscle Relaxants

• Common Uses– Muscle spasm– Back pain

• Example– baclofen (Lioresal)

• Side Effects / Nursing Considerations– Drowsiness, lethargy, confusion– Avoid concurrent use with other CNS

depressants

• Review– Osteoporosis• Calcium supplements

replenish calcium levels

• Bone resorption inhibitors

move calcium from blood to

bone

Musculoskeltal Medications

• Review– Rheumatoid Arthritis• NSAID’s provide short

term immediate pain relief

• Corticosteroids provide

intermediate use for

decreasing inflammation

• DMARD’s provide long term use for slowing progression of disease

Musculoskeletal Medications

• Review– Gout• colchicine used to treat

acute gout

• allopurinol (Zyloprim) used

daily to prevent chronic

gout episodes

• probenecid (Benemid) chronic gout and antiobiotic (penicillin and cephalosporins) potentiator

Musculoskeletal Medications

• Review– Muscle relaxants• Used to treat back pain

and/or muscle spasms

• CNS depressants

Musculoskeletal Medications