Chapter 12 Musculoskeletal Medications

Cyclobenzaprine

Has interactions with anti-histamines because it can cause drowsiness.

Methotrexate side effects

Hepatotoxicity, bone marrow suppression, blood dyscrasias

Raloxifene

Increases bone mineral density, is an estrogen. -Increased risk for embolism and DVT

§The nurse is reviewing the laboratory studies on a client receiving dantrolene sodium. Which laboratory test would identify an adverse effect associated with the administration of this mediation?

Liver Function Test

Cox-2 Inhibitors

interacts with Ace and Arbs, cannot take if allergic to sulfa drugs

One a muscle is paralyzed, what can the patient do?

perform strengthening exercises to promote strength in other muscles, example is abnormal head position.

Biphosphonate

prevents bone loss in osteoporosis

DMARD's

slow joint degeneration and progression of RA, cyclosporine, adalimuab, Etanercept

Pregabalin (Lyrica)

-Indications: Used for the treatment of fibromyalgia, shingles pain, and diabetic neuropathy pain -Adverse Reactions/Side Effects: May cause suicidal thoughts in a few patients. Risk for hypersensitivity reaction in patients taking angiotensin-converting enzyme (ACE) inhibitors. May cause edema of hands, feet, and legs; dizziness or sleepiness

Neostigmine

A drug that inhibits the activity of acetylcholinesterase, can treat myasthenia gravis, is cholinergic. Take at same time everyday.

Phantom Limb pain*

Amitriptyline and carbamazepine can be used to help this.

The nurse is reinforcing discharge instructions to a client receiving baclofen. Which should the nurse include in the instructions?

Avoid use of alcohol

Dantrolene

Can cause decreased blood pressure, dry mouth, decreased respirations and dry mouth.

Benzodiazepines

Can cause depression, increase hallucinations, confusion, agitation, amnesia affects, drowsiness, ataxia, tremors. -Chlordiazepoxide

Skeletal Muscle Relaxants

Caution in those with liver problems, hepatotoxicity, cardiac disorders, older adults, alcohol. -Dantrolene caution because of blood dyscrasias -Tricyclic: hypotension, respiratory depression

Allopurinol

Caution with impaired renal function,

Naproxen Side Effects*

Constipation, dizziness, tinnitus and GERD

§The nurse is monitoring a client receiving baclofen for side effects related to the medication. Which should indicate that the client is experiencing a side effect?

Drowsiness

Metaxalone

Drowsiness, GI upset, affects the liver, be careful because of sedative affects

SNRI's

Duloxetine can be used for lower back pain.

Calcium

Patients with hypocalcemia may be given calcitonin (Miacalcin), which is available as a nasal spray or in an injectable form. Calcitonin is naturally produced by the thyroid gland to deposit calcium into bones. Calcitonin can come from humans or fish such as salmon.

Gout Medications

Probenecid (Benemid), Colchicine, Allopurinol (Zyloprim) -side effects if Colchine is N/V/D -Nsaid's decrease pain, no alcohol, increase fluids -Probenacids, acts on kidneys and can cause stones

Osteoporosis

Results from a lack of calcium in the body; this disease creates holes in the bones and gives bone a sponge-like appearance. In all cases, the bones are not firm, and they break easily, even under little stress or pressure. Sometimes calcium and vitamin D are used to prevent bone break

SAMA

Sedation, anti-convulsant, muscle relaxant, anti-anxiety

§The nurse is reviewing the record of a client who has been prescribed baclofen. Which disorder should alert the nurse to contact the primary health care provider.

Seizure Disorder

When to take calcium

Should be taken 2 hrs apart from other medications.

Osteoporosis Therapy*

Some medications, such as estrogen (or hormone) replacement therapy (ERT), inhibit bone resorption of calcium and can reduce the extent of osteoporosis. However, this type of treatment has side effects, such as breast and uterine cancer and blood clots. For this reason, these drugs are used with caution. If a patient prefers not to take ERT, she may choose to take a bisphosphonate, which is a similar medication without the side effects. These drugs are similar to bisphosphate salts, which are found naturally in the body. An example of a bisphosphonate is alendronate sodium (Fosamax).

Alendronate is prescribed for a client with osteoporosis and the nurse is providing instructions for the administration of the medication. Which instruction should the nurse reinforce?

Take medication with full glass of water

What are antispasmodics and an example?

These drugs relax muscles and relief muscle spasms, such as metaxalone. They can be classified as benzodiazepines. -Botulinum type A in lower doses can be an effective muscle relaxer by blocking acetylcholine release thus paralyzing the muscle. Used to treat migraines, headaches, spasticity, head position and neck pain.

The client has been taking medication for rheumatoid arthritis for 3 weeks. During the administration of etanercept, it is most important for the nurse to collect which data?

WBC/Platelet count

§A client with acute muscle spasms has been taking baclofen. The client calls the clinic nurse because of continuous feelings of weakness and fatigue and asks the nurse about discontinuing the medication. The nurse should make which appropriate response to the client?

Weakness and fatigue commonly occur and will diminish when stopped

Monoclonal antibodies

a collection of identical antibodies that interact with a single antigen site, for osteoporosis. Denosumob

During the monitoring of a client's response to disease-modifying antirheumatic drugs (DMARDS), which findings should the nurse interpret as acceptable responses? Multiple Select

a.Symptom control during periods of emotional stress b.Normal white blood cell, platelet, and neutrophil counts c.Radiological findings that show nonprogression o joint degeneration d.An increased range of motion in the affected joints 3 months into therapy

Osteomalacia

abnormal softening of bones in adults, rickets in children

Dantrolene sodium is prescribed for a client experiencing flexor spasms, and the client asks the nurse about the action of the medication. The nurse responds knowing that which is the therapeutic action of this medication?

Acts directly on the skeletal muscle to relieve spasticity

Gout*

Gout is caused by a buildup of uric acid in the joints. -When the acute attack has ended, patients start taking antigout medication such as allopurinol (Zyloprim) or febuxostat (Uloric) to lower the uric acid level in the body.

Fibromyalgia

disorder of chronic pain in muscles and the soft tissue surrounding joints. This rheumatological illness is difficult to manage. Treatment includes decreasing the contributory factors (e.g., lack of exercise, poor coping response to stress), physical therapy, antidepressants, antiinflammatory medications, trigger point injections, and narcotic analgesics.

Alenodrate*

is taken weekly, you need to take this medicine with a full glass of water at least 30 mins before first med, food or beverage of the day. Do not lay down for at least 30 mins after.