1. Musculoskeletal Medications Osteoporosis Rheumatoid Arthritis Gout Muscle Spasms

2. Osteoporosis Medications Calcium Supplements –Calcium, Vitamin D, combination of both

3. 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

4. Bisphosphonates (Bone Resorption Inhibitors) –Action draws calcium from blood to bone increasing bone mineralization –Example alendronate (Fosamax) –Uses osteoporosis, Paget’s disease, hypercalcemia 2 o malignancy –Adverse Reactions GI discomfort and esophageal irritation

5. Osteoporosis Medications Bisphosphonates –Nursing Considerations Given once weekly Give on an empty stomach (poorly absorbed) Remain upright for 30 minutes after (esophageal irritation)

6. NSAID’s –Analgesic effect –Anti-inflammatory effect –GI Distress Corticosteroids –Anti-inflammatory effect –GI Distress –Long term effects Rheumatoid Arthritis Medications

7. Disease-Modifying Antirheumatic Drugs (DMARD’s) –Cytotoxic Drugs –Gold Salts –Antimalarial Agents –Sulfasalazine Rheumatoid Arthritis Medications

8. Disease-Modifying Antirheumatic Drugs (DMARD’s) –Common Side Effects GI discomfort/ulceration Hepatic dysfunction Myelosuppression Rheumatoid Arthritis Medications

9. Disease-Modifying Antirheumatic Drugs (DMARD’s) –Cytotoxic Drugs methotrexate (Rheumatrex) Nausea, stomatitis, alopecia, myelosuppression Rheumatoid Arthritis Medications

10. Disease-Modifying Antirheumatic Drugs (DMARD’s) –Antimalarial Agents hydrochloroquine (Plaquenil) Relatively few side effects except for retinal damage causing blindness Rheumatoid Arthritis Medications

11. Disease-Modifying Antirheumatic Drugs (DMARD’s) –Sulfasalazine sulfasalazine (Azulfidine) GI discomfort (n/v, diarrhea, cramping) Hepatotoxicity Myelosuppression Rheumatoid Arthritis Medications

12. Disease-Modifying Antirheumatic Drugs (DMARD’s) –Evaluation Therapeutic Effect Relief of pain Decreased inflammation, swelling Increased joint function Rheumatoid Arthritis Medications

13. Disease-Modifying Antirheumatic Drugs (DMARD’s) –Evaluation Adverse Reactions GI discomfort, ulceration, bleeding Liver function tests CBC, platelet count Rheumatoid Arthritis Medications

14. 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

15. 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

16. 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

17. 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

18. Review –Osteoporosis Calcium supplements replenish calcium levels Bone resorption inhibitors move calcium from blood to bone Musculoskeltal Medications

19. 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

20. 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

21. Review –Muscle relaxants Used to treat back pain and/or muscle spasms CNS depressants Musculoskeletal Medications