Musculoskeletal Drugs
Selective estrogen receptor modulators (SERMs) Bisphosphonates Calcitonin Calcium supplements A. Increases the excretion of calcium B. Raises calcium levels C. Reduces the number of osteoclasts D. Mimics the effects of estrogen on the bones
A. Increases the excretion of calcium: CALCITONIN Calcitonin acts similarly to the calcitonin the thyroid gland produces by increasing the excretion of calcium. B. Raises calcium levels: CALCIUM SUPPLEMENTS Calcium supplements raise calcium levels and also help neutralize gastric acid. C. Reduces the number of osteoclasts: BISOPHOSPHONATES Bisphosphonates treat age-related and glucocorticoid-related osteoporosis by reducing the number of osteoclasts D. Mimics the effects of estrogen on the bones: SERMs Selective estrogen receptor modulators, called SERMs, treat postmenopausal osteoporosis by mimicking the effects of estrogen on the bones
Prior to administering an oral dose of neostigmine (Prostigmin), a cholinesterase inhibitor, to a patient who has myasthenia gravis, you should check for which of the following? Abdominal distention Ability to swallow Excessive oral secretions Presence of bowel sounds
Ability to swallow Muscle weakness associated with myasthenia gravis may affect the ability to swallow. Prior to giving an oral medication, the health care provider should evaluate the patient's ability to swallow with sips of water. Neostigmine may cause increased gastric and oral secretions and increased gastric motility.
A health care professional is preparing to administer neostigmine (Prostigmin) to a patient. Which of the following information in the patient's health history should alert her to use caution when administering neostigmine? Glaucoma Thrombocytopenia Hepatitis Asthma
Asthma Neostigmine can cause bronchospasm. It requires cautious use with patients who have asthma. The health care professional should monitor breath sounds, and have atropine (AtroPen) available to reverse the effects of neostigmine.
A health care professional is preparing to administer neostigmine (Prostigmin) to a patient who has myasthenia gravis. Knowing the adverse effects of neostigmine, which of the following drugs should the health care professional have ready to administer? Atropine (AtroPen) Lidocaine (Xylocaine) Epinephrine (Adrenalin) Naloxone
Atropine (AtroPen) It is important to have atropine, an anticholinergic, available to reverse bradycardia that can result from the administration of neostigmine, a cholinesterase inhibitor.
A health care professional is caring for a patient who is about to begin methotrexate therapy for rheumatoid arthritis. The health care professional should include which of the following information? (Select all that apply.) Avoid people who are sick. Periodic laboratory tests are essential. The drug's effects are immediate. Report bruising or petechiae. Avoid drinking alcohol.
Avoid people who are sick is correct. Methotrexate causes bone marrow suppression and increases the risk for infection. Patients taking the drug should avoid contact with large crowds or people who are sick or have a communicable illness. Periodic laboratory tests are essential is correct. Periodic laboratory tests help the primary care provider monitor for kidney and liver damage. It is important to assess for jaundice and abdominal pain because they can indicate liver damage. Report bruising or petechiae is correct. Methotrexate can cause thrombocytopenia. Patients should report bruising or petechiae, because this indicates a low platelet count. Health care professionals should monitor laboratory values for a decrease in platelets and red and white blood cells. Avoid drinking alcohol is correct. Alcohol ingestion can increase the risk of liver damage. Patients taking methotrexate should avoid drinking alcohol.
A health care professional should tell a patient who is taking methotrexate to monitor for which of the following? Muscle pain Peripheral edema Black, tarry stools Redness in the calf
Black, tarry stools Methotrexate can cause gastric intestinal ulceration, which can lead to perforation and bleeding. The patient should watch for blood in stools or emesis and report either to the health care professional immediately.
A health care professional is caring for a patient who has myasthenia gravis and has been prescribed neostigmine (Prostigmin) to increase muscle strength. The health care professional should tell the patient to watch for which of the following as an indication of a serious adverse reaction to the drug? Constipation Bradycardia Edema Fever
Bradycardia Neostigmine causes bradycardia. The health care professional should show the patient how to measure his apical pulse and notify the primary care provider if the rate is below 60/min. It is essential to have atropine (AtroPen) on hand to reverse the effects of neostigmine.
A health care professional is caring for a patient who is beginning raloxifene (Evista) therapy to prevent osteoporosis. The health care professional should tell the patient to monitor for which of the following as an indication of a serious adverse reaction to the drug? Loss of hair Numbness of the fingertips Calf pain Blisters on mucous membranes
Calf pain Raloxifene can increase the risk of deep-vein thrombosis, which can lead to a pulmonary embolism or cerebrovascular accident. Patients should avoid long periods of inactivity, and report any pain, redness, or swelling in the calf.
A health care professional is administering succinylcholine (Anectine) to a patient. Which of the following information is correct regarding depolarizing neuromuscular blocking agents? Reverses with a cholinesterase inhibitor, such as neostigmine (Prostigmin) Causes muscle paralysis by binding with cholinergic receptors at the neuromuscular junction Prevents the nerve from depolarizing and the skeletal muscle from contracting Blocks acetylcholine from binding with cholinergic receptors at the motor endplate
Causes muscle paralysis by binding with cholinergic receptors at the neuromuscular junction Succinylcholine, a depolarizing muscle relaxant, mimics acetylcholine (Miochol-E) by binding with the cholinergic receptors at the neuromuscular junction.
Prior to administering calcitonin-salmon (Miacalcin) for the first time to a patient who is diagnosed with postmenopausal osteoporosis, the health care professional should perform which of the following tasks? Check urine for sedimentation. Assess liver function. Check for allergies using skin testing. Evaluate breath sounds.
Check for allergies using skin testing. Calcitonin-salmon is developed using salmon. The health care professional should perform skin testing to check for an allergy to salmon or fish protein, and have epinephrine, antihistamines, and resuscitation equipment available.
A health care professional is caring for a patient who is taking alendronate (Fosamax) to treat postmenopausal osteoporosis. The health care professional should explain to the patient that alendronate increases bone mass by which of the following actions? Decreases activity of osteoclasts Increases calcium excretion Promotes intestinal absorption of calcium and phosphorus Reduces action of osteoblasts
Decreases activity of osteoclasts Osteoclasts are cells that cause bone resorption or bone loss. Alendronate reduces the activity of osteoclasts, reducing bone loss and increasing bone mass.
A health care professional is caring for a patient who is taking prednisone and also takes 1,500 mg/day of calcium carbonate (Tums) to reduce the risk of osteoporosis. Which of the following information should the health care professional include? (Select all that apply.) Take the calcium tablets with food. Drink 8 oz of water with the calcium tablets. Chew calcium tablets before swallowing them. Take the drugs 1 hr apart. Divide the daily dose into three 500-mg doses.
Drink 8 oz of water with the calcium tablets is correct. Patients should drink 8 oz of water after taking the calcium carbonate to ensure complete passage of the drug and to maintain hydration. Chew calcium tablets before swallowing them is correct. Patients should chew the tablets before swallowing them to increase bioavailability. Patients should not swallow chewable tablets whole. Take the drugs 1 hr apart is correct. Glucocorticoids reduce the absorption of calcium carbonate. Patients should allow 1 hr in between the two to ensure optimal absorption. Divide the daily dose into three 500-mg doses is correct. Patients should not take more than 600 mg of calcium carbonate at one time. Patients should divide the daily dosage into three doses to increase absorption of the calcium carbonate/
The health care provider prescribes alendronate (Fosamax) to reduce bone resorption and instructs the patient to monitor for which of the following indications of a serious adverse effect of this drug? Calf inflammation Chest pain Dizziness Dysphagia
Dysphagia Dysphagia (difficulty swallowing) can indicate esophagitis, a rare but serious adverse effect of alendronate. The patient must understand that she has to notify the provider of any pain or difficulty swallowing and of worsening heartburn. Alendronate is unlikely to cause deep-vein thrombosis. This serious adverse effect is more likely with raloxifene (Evista). Alendronate is more likely to cause musculoskeletal pain than chest pain. Alendronate is unlikely to cause dizziness. Dizziness might accompany bradycardia, a potentially serious adverse effect of neostigmine (Prostigmin) and of parenteral calcium interacting with digoxin (Lanoxin).
A patient with rheumatoid arthritis is taking methotrexate. Toxicity from methotrexate may be reduced with which of the following? Folic acid Magnesium sulfate Ferrous sulfate Niacin
Folic acid Folic acid may reduce the toxic effects of methotrexate. Toxicity may be reduced with 5 mg or more of a folic acid supplement per week.
A health care professional is caring for a patient who is postoperative and who demonstrates weakness and needs mechanical ventilation. The patient received pancuronium during the surgery. The health care professional should suspect prolonged paralysis from a drug interaction with which of the following? Neostigmine (Prostigmin) Atropine (AtroPen) Dantrolene (Dantrium) Gentamicin
Gentamicin Gentamicin, an aminoglycoside, can interact with the nondepolarizing neuromuscular blocker and increase the effects of the neuromuscular blockade causing prolonged paralysis.
A patient is given raloxifene (Evista), a selective estrogen receptor modulator (SERM), to treat osteoporosis. Which of the following is an adverse effect of raloxifene (Evista)? Hot flashes Breast cancer Blurred vision Jaw pain
Hot flashes Raloxifene may cause hot flashes, leg cramps, and pulmonary embolism. It is used to reduce the risk of breast cancer. Bisphosphonates may cause jaw pain and blurred vision.
A health care professional should recognize that depolarizing muscle relaxants, such as succinylcholine (Anectine), require cautious use with patients who have which of the following? (Select all that apply.) Hyperkalemia Myasthenia gravis Renal calculi Bowel obstruction Respiratory depression
Hyperkalemia is correct. Succinylcholine can cause potassium release, resulting in hyperkalemia. Health care professionals should monitor for cardiac dysrhythmias, and check potassium levels prior to use. Myasthenia gravis is correct. Patients who have myasthenia gravis can have increased neuromuscular blockade when given succinylcholine; therefore, they might need a reduced dosage. Respiratory depression is correct. Pancuronium causes respiratory paralysis. Health care professionals should have mechanical ventilation available, especially for patients who have respiratory depression.
A health care professional is caring for a patient who is taking raloxifene (Evista). Which of the following information should the health care professional include? (Select all that apply.) Increase self-breast examinations to two times per month. Increase activity, such as walking. Use a contraceptive if there is any risk of pregnancy. Take the drug on an empty stomach. Increase intake of calcium and vitamin D.
Increase activity, such as walking is correct. Patients taking raloxifene should avoid long periods of inactivity to prevent deep-vein thrombosis. Also, walking or other weight-bearing exercise can help increase bone density. Use a contraceptive if there is any risk of pregnancy is correct. Raloxifene is a pregnancy category X drug and can cause severe fetal harm. Women who are pregnant, breastfeeding, or might become pregnant should not take the drug. Increase intake of calcium and vitamin D is correct. Increasing calcium and vitamin D helps improve the effectiveness of raloxifene and increases bone mass.
The primary care provider prescribes calcitonin salmon (Miacalcin) for a patient. Knowing the adverse effects of calcitonin, you should instruct the patient to do which of the following? Increase fluid intake. Rise slowly from a reclinining position. Increase calcium intake. Wear sunscreen and protective clothing.
Increase calcium intake. Calcitonin may cause hypocalcemia due to increased excretion of calcium. Instruct the patient to increase calcium intake and monitor for indications of hypocalcemia, such as muscle cramps and numbness in the fingers or toes. Calcitonin is not known to cause orthostatic hypotension or photosensitivity. Drinking water will not reduce the adverse effects of calcitonin.
A health care professional should question the use of etanercept (Enbrel) for a patient who has a history of diabetes mellitus because of which of the following risks? Kidney toxicity Infection Gout Deep-vein thrombosis
Infection Etanercept increases the risk of developing a serious infection. Primary care providers should not prescribe etanercept for patients who have an existing infection and should use it cautiously with patients who have diabetes mellitus because the disease itself increases infection risk.
A health care professional should tell a patient who is taking alendronate (Fosamax) to monitor for which of the following adverse effects? (Select all that apply.) Jaw pain Drowsiness Blurred vision Tinnitus Muscle pain
Jaw pain is correct. Alendronate can cause osteonecrosis of the jaw, and patients who develop it should report it to the health care professional. Blurred vision is correct. Alendronate can cause ocular inflammation. The patient should report any eye pain or blurred vision. Muscle pain is correct. Alendronate can cause musculoskeletal pain. If analgesics do not help, the patient might have to stop taking alendronate.
A health care professional is preparing to administer alendronate (Fosamax) to a patient who has osteoporosis. The health care professional should recognize which of the following as an adverse effect of alendronate? Venous thromboemboli Ventricular dysrhythmias Breast cancer Joint pain
Joint pain Alendronate can cause joint and muscle pain. Patients may treat joint pain with analgesics. Other adverse effects include nausea, visual disturbances, and esophagitis.
A health care professional is caring for a patient who was given succinylcholine (Anectine), a depolarizing neuromuscular blocker, during a surgical procedure. The patient develops rigid muscles, tachycardia, and a sudden spike in temperature. The health care professional should immediately suspect which of the following? Malignant hyperthermia Neuroleptic malignant syndrome Toxic epidermal necrolysis Stevens-Johnson syndrome
Malignant hyperthermia Succinylcholine and inhalation anesthetics can trigger malignant hyperthermia, a potentially fatal condition. It causes muscle rigidity and an increase in body temperature.
65yo Female pt. Today weighs 77kg (170lb) and is 160cm tall (5'2.5"). She has lost 2.5cm (1") since last year. She is past menopause. She takes: deltasone for flair ups, prednisone regularly, tums, but not taking her calcium carbonate. Which of the following information in the patient's history causes the health care provider to suspect the patient has osteoporosis? (Select all that apply.) Menopause Calcium supplements Long-term corticosteroid use Weight Loss of height
Menopause Long-term corticosteroid use Loss of height Menopause and long-term corticosteroid use are causes of osteoporosis due to increased bone resorption. Loss of height may be an indication of a compression fracture in the spine due to diminished bone density. Osteoporosis is more common in women who are thin and have a low body mass index (BMI). This patient's BMI is 31.2, which is classifed as overweight. The calcium supplements are not an indication of osteoporosis. Calcium supplements can help prevent osteoporosis.
Which of the following is a therapeutic action of raloxifene (Evista)? Blocks the effects of estrogen on endometrial tissue Mimics the effects of estrogen on bone tissue Stimulates secretion of parathyroid hormone Stimulates menstruation
Mimics the effects of estrogen on bone tissue Raloxifene mimics the effects of estrogen on bone tissue, minimizing or stopping bone loss.
A calcium supplement is prescribed to prevent osteoporosis in a patient who is postmenopausal. You should instruct the patient to monitor for which of the following indications of hypercalcemia? Eye twitching Bleeding gums Tinnitus Nausea
Nausea Manifestations of HYPERcalcemia include anorexia, nausea, vomiting, and constipation. HYPOcalcemia may cause twitching, tetany, and muscle spasms. Vitamin C deficiency may cause bleeding gums and gingivitis.
You are admitting a patient who is awake postoperatively but shows signs of muscle weakness. The patient was given pancuronium in the surgical suite. You should prepare to administer which of the following drugs to reverse the effects of pancuronium? Naloxone Neostigmine (Prostigmin) Succinylcholine (Anectine) Dantrolene (Dantrium)
Neostigmine (Prostigmin) Neostigmine, a cholinesterase inhibitor, is given to reverse the effects of pancuronium, a nondepolarizing neuromuscular blocking agent. Naloxone is an opioid antagonist given to reverse the effects of opioids. Succinylcholine is a depolarizing neuromuscular blocking agent and will cause increased muscle relaxation. Dantrolene is a skeletal muscle relaxant given to treat malignant hyperthermia and spasticity.
When treating a patient who has malignant hyperthermia, the health care professional should do which of the following? (Select all that apply.) Administer a depolarizing neuromuscular blocking agent. Provide cooling measures. Administer dantrolene (Dantrium). Discontinue anesthesia. Reduce the IV fluid infusion rate.
Provide cooling measures is correct. The patient requires immediate cooling with a cold saline infusion, ice packs, and a cooling blanket. Temperature and vital signs require continuous monitoring. Administer dantrolene (Dantrium) is correct. Dantrolene reduces the metabolic activity of skeletal muscles and helps reverse malignant hyperthermia. Discontinue anesthesia is correct. Health care professionals should stop succinylcholine and anesthesia immediately, and abort the procedure until the patient is stabilized.
A health care professional is caring for a patient who is taking a calcium supplement and reports flank pain. The health care professional should suspect the patient has which of the following? Renal calculi Pancreatitis Liver disease Hip fracture
Renal calculi Calcium supplements can cause renal calculi. Patients should increase water intake while taking calcium supplements to hydrate the kidneys and report any blood in the urine or flank pain.
A health care professional is caring for a patient who is to begin taking calcitonin-salmon (Miacalcin) intranasal spray to treat osteoporosis. Which of the following information should the health care professional include? (Select all that apply.) Report rash or itching. Deliver two sprays to each nostril. Prime the pump. Report nasal irritation. Hold the pump horizontally.
Report rash or itching is correct. The health care professional should tell the patient to stop using the drug and seek medical attention if any swelling or rash develops. Prime the pump is correct. The patient should prime the pump before use the first time to ensure proper dosage. Report nasal irritation is correct. The patient should report any nasal irritation or bleeding. The patient might need parenteral administration if there is severe nasal irritation.
65yo Female pt. Today weighs 77kg (170lb) and is 160cm tall (5'2.5"). She has lost 2.5cm (1") since last year. She is past menopause. She takes: deltasone for flair ups, prednisone regularly, tums, but not taking her calcium carbonate. The health care provider instructs the patient about the importance of taking the prescribed 1,500 mg/day dosage of calcium carbonate (Tums). Which of the following instructions should the health care provider recommend? Set up a simple reminder system. Take the three tablets at the same time. Reduce fluid intake to increase effectiveness. Take the drug with meals to reduce gastric irritation.
Set up a simple reminder system. If the patient's nonadherence is unintentional, the health care provider can work with her to devise a reminder system that will work for her, such as a calendar, a tablet counter, or a watch alarm routine. Patients should take no more than 600 mg of calcium at one time for optimal absorption. Patients should take calcium carbonate that is supplied in a chewable formulation such as Tums on an empty stomach followed by a full glass of water. Calcium carbonate is also used as an antacid to neutralize gastric acid. It is not necessary to take it with meals to reduce gastric irritation.
A health care professional is caring for a patient who is taking etanercept (Enbrel), a DMARD II that treats rheumatoid arthritis. The health care professional should monitor the patient for which of the following indications of a serious adverse reaction to the drug? Excessive salivation Increased thirst Blood in the urine Shortness of breath
Shortness of breath Etanercept can cause heart failure, manifesting as shortness of breath, cough, elevated blood pressure and heart rate, and pink-tinged sputum.
A health care professional should tell a patient who is taking etanercept (Enbrel) for rheumatoid arthritis to report which of the following? Skin rash Tinnitus Diarrhea Dysphagia
Skin rash Etanercept can cause serious skin infections, such as Stevens-Johnson syndrome and toxic epidermal necrolysis. Patients should report any skin rashes or blisters immediately.
A patient is prescribed methotrexate for rheumatoid arthritis. Knowing the adverse effects of methotrexate, you should advise the patient to monitor for which of the following? Dysphagia Sore throat Edema Paresthesia
Sore throat Methotrexate may cause bone marrow suppression. The patient should report any sign of infection, such as a sore throat or fever. Dysphagia, edema, and paresthesia (numbness or tingling sensations on the skin) are not common adverse effects of methotrexate. Adverse effects this drug does cause include headache, mucositis, gastric ulcers, gingivitis, and hepatotoxicity.
When instructing the patient about alendronate, which of the following information should the health care provider include? (Select all that apply) Take the drug on an empty stomach. Take the drug before bedtime. Take the drug with an antacid. Sit upright for 30 minutes following dosage. Take with a full glass of water.
Take the drug on an empty stomach. Sit upright for 30 minutes following dosage. Take with a full glass of water. Alendronate should be taken in the morning on an empty stomach for optimal bioavailability. Alendronate should be taken first thing in the morning before breakfast. Patients should wait 30 minutes before taking calcium or an antacid that might reduce the absorption of alendronate. Following dosage, the patient should sit or stand upright for at least 30 minutes to reduce the risk of esophagitis. Patients should wait 30 minutes before taking calcium or an antacid that may reduce absorption of alendronate. Alendronate should be taken with a full glass of water to reduce the risk of esophagitis.
65yo Female pt. Today weighs 77kg (170lb) and is 160cm tall (5'2.5"). She has lost 2.5cm (1") since last year. She is past menopause. She takes: deltasone for flair ups, prednisone regularly, tums, but not taking her calcium carbonate. The health care provider explains to the patient that there may be a drug interaction between the glucocorticoid and the calcium supplement. Which of the following may occur? The glucocorticoid may cause reduced absorption of the calcium supplement. The glucocorticoid may potentiate the effects of the calcium supplement. The calcium supplement used with the glucocorticoid may cause bradycardia. The calcium supplement may increase the risk for peptic ulcer disease.
The glucocorticoid may cause reduced absorption of the calcium supplement. Because the glucocorticoid can reduce the absorption of calcium, patients should take the calcium supplement 1 hr before or 1 to 2 hr after they take the glucocorticoid. Glucocorticoids can increase potassium loss, but they are unlikely to affect calcium levels without supplements. Parenteral calcium given to patients who are on digoxin (Lanoxin) can cause severe bradycardia. The calcium supplement should not increase the risk for peptic ulcer disease; however, it can increase the risk for renal calculi (kidney stones).
A patient is prescribed etanercept (Enbrel) to treat rheumatoid arthritis. Prior to beginning the treatment, the patient should be tested for which of the following? Pancreatitis Hepatitis Tuberculosis Gastritis
Tuberculosis Patients should be tested for tuberculosis prior to treatment with etanercept. Tuberculosis in patients taking etanercept may spread to other organs and be difficult to treat. Patients should be monitored for the development of tuberculosis during etanercept therapy as well.
When administering succinylcholine (Anectine) for relaxation during a surgical procedure, you should remember that succinylcholine provides analgesia. causes sedation. blocks respiratory muscles. reduces anxiety.
blocks respiratory muscles. Succinylcholine does not provide analgesia. A sedative should be administered to sedate the patient. Succinylcholine blocks both skeletal and respiratory muscles, making it essential to provide the patient with mechanical ventilation. Succinylcholine does not reduce anxiety.
A health care professional is talking about self-administering methotrexate to a patient who has rheumatoid arthritis. The health care professional should tell the patient to use a nonsteroidal anti-inflammatory drug (NSAID) to reduce toxicity. take it with food to reduce gastric irritation. drink 2 to 3 L of water per day to promote the drug's excretion. take it in the morning to prevent insomnia.
drink 2 to 3 L of water per day to promote the drug's excretion. Methotrexate can cause kidney damage. Adequate hydration optimizes drug excretion and helps prevent kidney damage. Patients can take sodium bicarbonate tablets to increase urine alkalinity and reduce the drug precipitation that can lead to kidney damage.
Alendronate (Fosamax) is contraindicated for patients who have heart failure. are allergic to fish protein. should remain flat on bed rest. have tuberculosis.
should remain flat on bed rest. Alendronate is inappropriate for a patient who is unable to sit or stand for 30 min. Patients should drink 8 oz of water after taking the drug and sit or stand upright for at least 30 min to prevent esophagitis.
