DSM: Drugs for Bone and Joint Disorders

A patient is prescribed a bisphosphonate medication. Which finding should the nurse identify that supports the use of this medication?

Paget's disease. Bisphosphonates are used to treat both Paget's disease and osteoporosis. Nonsteroidal anti-inflammatory drugs are used to treat osteoarthritis and rheumatoid arthritis. Calcitonin is used to treat hyperparathyroidism. Bisphosphonate uses include: Osteoporosis: In postmenopausal women.In men.Glucocorticoid induced. Paget's disease.

A patient with Paget's disease asks why a bisphosphonate is prescribed as a treatment. Which response should the nurse make?

"Bisphosphonates are prescribed to lower alkaline phosphatase levels." Bisphosphonates are the primary tx for Paget's disease because they lower alkaline phosphatase (ALP) levels. They are administered until the pt's ALP levels are within normal limits. Vit D preparations provide an activated form of vitamin D to facilitate calcium absorption. Disease-modifying antirheumatic drugs modify immune and inflammatory responses in patients with rheumatoid arthritis. Nonsteroidal anti-inflammatory drugs decrease the inflammatory response and alleviate pain in patients with osteoarthritis.

The nurse is teaching about the effects of calcitriol (Rocaltrol) in patients with chronic kidney disease (CKD). Which statement should the nurse include?

"Calcium and vitamin D levels should be monitored when administering this medication." When administering calcitriol, there is a risk for hypercalcemia, which should be monitored by assessing calcium and vitamin D levels. Bone pain, anemia, and osteonecrosis of the jaw are potential adverse effects of bisphosphonate therapy. The diet should include foods high in calcium and vitamin D, because this is preferred over using medication.

A patient receiving chemotherapy asks why allopurinol (Zyloprim) was prescribed when there is no history of gout. Which response should the nurse make?

"Chemotherapy may cause elevated uric acid levels." Chemotherapy drugs are designed to kill cancer cells. When these cells die, they release their contents, including uric acid, which can accumulate in the kidneys. Allopurinol can be used prophylactically to reduce the severity of the hyperuricemia associated with antineoplastic and radiation therapies, both of which increase plasma uric acid levels by promoting nucleic acid degradation.

The nurse is teaching a patient with osteoporosis about a calcium supplement and a bisphosphonate. Which patient statement indicates teaching was effective?

"I should take the calcium at least 2 hours after taking the bisphosphonate." Bisphosphonates should be administered alone with plain water 30 minutes before eating any food for the day. Calcium supplements should be taken 2 hours apart from bisphosphonates. The patient should not take both at the same time. The bisphosphonate should only be taken in the morning. Calcium should be taken with meals or within 1 hour of meals to facilitate absorption.

A patient receiving calcium gluconate is having continuous cardiac monitoring. Which should the nurse explain as the rationale for this intervention?

"Intravenous calcium gluconate can cause dysrhythmias due to hypercalcemia." Calcium and phosphorus are inversely proportional and affect one another.

A patient taking alendronate (Fosamax) for osteoporosis asks why another bone density exam is needed when one was done the previous year. Which information should the nurse provide in response?

"It monitors the effectiveness of the medication"

A patient is instructed to take a nonsteroidal anti-inflammatory drug (NSAID) with food or milk. Which should the nurse explain as the rationale for this instruction?

"Prevent gastrointestinal upset"

A patient with rheumatoid arthritis is prescribed a disease-modifying antirheumatic drug (DMARD). Which should the nurse instruct the patient about this medication?

"Report any changes in vision." DMARDs may cause significant retinal changes with blurred vision, difficulty reading, photophobia, or blacked-out areas of the vision field and should be reported to the healthcare provider. Symptoms of the flu, skin rashes, and mouth sores should also be reported to the healthcare provider.

A patient taking a nonsteroidal anti-inflammatory drug (NSAID) for osteoarthritis reports stomach upset when taking the medication. Which information should the nurse provide?

"Take the medication with food or milk." NSAIDs can cause gastrointestinal upset when taken on an empty stomach. The patient should be instructed to take the medication with food or milk. Bisphosphonates are taken first thing in the morning. Pt teaching about NSAIDs includes: Take as directed. Take with food or milk to decrease GI irritation. Avoid alcohol. Notify the hcp of black, tarry stools; blood in the stool; hematemesis; change in hearing; or coffee-ground emesis. Notify the healthcare provider of tinnitus, difficulty hearing, lightheadedness, or difficulty with balance.

The nurse is teaching a patient about the pathophysiology of osteoporosis. Which patient statement should indicate an understanding of this disorder?

"The bones lose mass faster than the bone can replace it."Osteoporosis occurs when bone loss occurs faster than bone gain, leading to decreased bone density. Paget's disease is unrelated to osteoporosis and is caused by bone resorption and bone growth occurring at a rapid rate, leading to softer bones and deformities. Lack of vitamin D from sunscreen use can lead to osteomalacia, not osteoporosis.

A patient taking a bisphosphonate for Paget's disease asks how long therapy will last. Which information should the nurse provide?

"You will take this medication until your alkaline phosphatase returns to normal." use of bisphosphonates for Paget's disease is cyclic. The pt will remain on the med until alkaline phosphatase (ALP) returns to normal range, at which time it will be discontinued. If serum ALP levels rise again, tx will be restarted. Tx of osteoporosis may last several years because it is based on bone density. There is no set time frame for patients with Paget's disease to take this medication, but it will not be for life.

A patient with hypocalcemia caused by chronic kidney disease (CKD) asks why vitamin D was prescribed. Which response should the nurse make?

"Your kidneys are unable to activate vitamin D to allow you to absorb calcium."

A patient is diagnosed with rheumatoid arthritis. Which factor should the nurse explain that causes the initial inflammation in the synovial membranes?

Autoantibodies attack the tissues, where complement is activated.

A patient is diagnosed with malignant hypercalcemia. Which class of medication should the nurse anticipate being prescribed?

Bisphosphonate. Bisphosphonates are used in the tx of malignant hypercalcemia, because they suppress osteoclast activity and slow the rate of bone resorption and calcium release. Vit D preparations are used to treat hypocalcemia secondary to an inability to activate vitamin D. DMARDs are used to treat rheumatoid arthritis. NSAIDs are used to treat any type of arthritic pain.

A patient being treated with alendronate (Fosamax) asks how the drug's effectiveness will be determined. Which information should the nurse provide?

Bone density exam. The goal of bisphosphonate therapy with alendronate is to increase bone density. The healthcare provider will monitor therapy and determine success by obtaining bone density exams.

A patient is diagnosed with an exacerbation of gout. Which medication should the nurse expect to be prescribed?

Colchicine (Colcrys). Colchicine is an anti-inflammatory drug used to treat gout. Alendronate is used to treat osteoporosis. Sulfasalazine is a sulfonamide used to treat rheumatoid arthritis. Calcitriol provides active vitamin D to facilitate calcium absorption.

A patient with a history of rheumatoid arthritis reports increased early-morning joint pain. Which type of medication should the nurse anticipate being prescribegid?

Corticosteroid. Corticosteroids are drug of choice for flare-ups of rheumatoid arthritis. Bisphosphonates treat osteoporosis and Paget's disease. Glucosamine and chondroitin supplements have been used for managing osteoarthritis. Opioids are used for managing severe pain in osteoarthritis. Pharmacologic tx of rheumatoid arthritis includes: NSAIDs, Corticosteroids. Non-biologic disease-modifying antirheumatic drugs (DMARDs). Biologic DMARDS (anti-tumor necrosis factor [TNF] and non-anti-TNF drugs). Biologic DMARDS (non-TNF antagonists).

The nurse is reviewing calcium regulation. Which physiological response should the nurse expect when the thyroid gland releases calcitonin?

Decreased serum calcium level

A patient is concerned about developing rheumatoid arthritis. Which information should the nurse identify that increases this patient's risk of developing this disease?

History of autoimmune diseases. Rheumatoid arthritis (RA) is a lowlchronic, progressive disease that is characterized by disfigurement and inflammation of multiple joints. RA occurs at an earlier age than OA and has an autoimmune etiology.

The nurse is teaching a patient beginning bisphosphonate therapy about adverse effects of the drug. Which manifestation should the nurse instruct the patient to report to the healthcare provider?

Jaw pain and swelling. unusual adverse effect from bisphosphonate therapy is osteonecrosis of the jaw. Clinical manifestations include jaw pain and swelling, loosening teeth, and infection at lesion site. Any of these symptoms need to be immediately reported. Dyspepsia is a common adverse effect and need not be reported. Advise patient of common adverse effects of bisphosphonates, including: Nausea. Dyspepsia. Diarrhea. Bone pain. Back pain.

A patient with rheumatoid arthritis is prescribed adalimumab (Humira). Which finding should cause the nurse to withhold the medication and contact the healthcare provider?

Low WBC count. Adalimumab is a disease-modifying antirheumatic drug that has adverse effects of neutropenia & serious infections. drug should be withheld & hcp contacted If pt has a decreased WBC count. Adalimumab is used to treat joint pain associated with rheumatoid arthritis. Adalimumab (Humira) pharmacokinetics include: Therapeutic class: DMARD, drug for psoriasis, drug for inflammatory bowel disease. Pharmacologic class: TNF antagonist. First fully human monoclonal antibody approved by the Food and Drug Administration. Administration: subcutaneous. Peaks in about 5 days. Onset of action: 4-5 weeks. Duration of action: 10-20 days.

A patient is having an annual physical examination. Which information should the nurse realize increases this patient's risk for developing osteoporosis?

Menopause. Because of associated decrease in estrogen production, most common risk factor for osteoporosis is menopause. decreased estrogen causes bones to become weak & fragile. Other risk factors include low body weight, low physical activity, & Caucasian American or Asian American ethnicity. Major risk factors for osteoporosis include: Menopause. Increasing age. Personal history of fracture or family history of osteoporotic fracture. Excessive alcohol consumption (more than 4 drinks/day for men or 2/day for women). Caucasian or Asian race. Smoking history. Immobilization or low level of physical inactivity. Gonadal hormone deficiency (estrogen or androgen). Low vitamin D or calcium in the diet. Drugs: corticosteroids, some anticonvulsants, immunosuppressants that lower serum calcium levels.

A patient with osteoarthritis is experiencing knee pain. Which type of medication should the nurse anticipate being prescribed?

Nonsteroidal anti-inflammatory drug (NSAID). NSAIDs are used to treat pain. Alendronate (Fosamax) is a bisphosphonate used to treat osteoporosis and Paget's disease. Vitamin D preparations are used in patients who are unable to absorb vitamin D. SERMs are used to manage osteoporosis.

A patient has an elevated serum calcium level. Which physiological response should the nurse expect to lower the patient's serum calcium?

Release of calcitonin from the thyroid gland. When serum calcium levels increase, the thyroid gland releases calcitonin. This decreases calcium levels by preventing calcium resorption from the bone and increasing renal calcium excretion. Vitamin D and parathyroid hormone increase calcium levels. Increasing bone resorption causes calcium release from the bones and increases calcium levels.

A patient is prescribed calcium citrate (Citracal). Which health history information should cause the nurse to contact the healthcare provider?

Renal calculi. Calcium citrate is used in the treatment of hypocalcemia and the prevention of osteoporosis. It is contraindicated in patients with a history of renal calculi. Patient teaching for calcium salt administration includes: Take with meals or within 1 hour of meals. Increase fluid intake.

A patient is prescribed denosumab (Prolia). Which should the nurse assess before administering the first dose of the medication?

Serum calcium level. Denosumab can cause severe hypocalcemia. The serum calcium level should be assessed before administering the medication. Joint pain is not associated with osteoporosis and would not be considered. Cardiac rhythm should be monitored in patients with hypercalcemia. Uric acid levels are monitored in patients with gout.

A patient with chronic kidney disease (CKD) has a positive Chvostek's sign and a decreased serum calcium level. Which medication should the nurse expect to be prescribed?

Vitamin D. Patients with CKD are unable to activate vitamin D due to diseased kidneys. Vitamin D should be prescribed to help with calcium absorption. Bisphosphonates, corticosteroids, and anticonvulsants cause hypocalcemia and would not be prescribed

The nurse is developing a presentation about osteoarthritis (OA). Which should the nurse include in the presentation?

Weight-bearing joints are most frequently affected. OA most frequently affects weight-bearing joints. OA is not caused by increased estrogen, decreased calcium intake, or decreased vitamin D.