Exam 4 Musculoskeletal drugs

Calcium Citrate drug class

Calcium Supplements

Calcium Citrate therepuetuic uses

• Oral: hypocalcemia or deficiencies of PTH, Vit. D, dietary calcium

• Calcium + Vit. D: reduce the risk of osteoporosis (in conjunction with calcitonin or bisphosphonate)

Calcium Citrate complications

• Hypercalcemia

  • Tachycardia, hypertension 🡪 bradycardia, hypotension

  • Muscle weakness, hypotonia, constipation, NV, abdominal pain, lethargy

Calcium Citrate contraindications/precautions

• Precautions: renal disease

• Contraindications: hypercalcemia, renal calculi, hypophosphatemia, digoxin toxicity, VF

Calcium Citrate interactions

• Glucocorticoids

  • Reduces absorption of calcium

• Tetracyclines and thyroid hormone

  • Decreases absorption of tetracyclines and thyroid hormone

• Thiazide diuretics

  • Increases risk of hypercalcemia

• Foods: spinach, rhubarb, beets, bran, whole grains

  • Decrease calcium absorption

• Digoxin

  • Severe bradycardia (IV calcium)

why is hypercalcemia so dangeorus?

can damage and slow cardiovasc system

Raloxifene drug class

Selective Estrogen Receptor Modulator:

Raloxifene therepeutic uses

• Prevents and treats postmenopausal osteoporosis

  • Prevent spinal fractures in females

• Prevents breast cancer

Raloxifene complications

• VTE risk

  • DVT and PE

• Hot flashes

Raloxifene contraindications/precautions

• Precautions: surgery and prolonged immobility periods

• Contraindications: history/risk VTE

Raloxifene interactions

• Estrogen therapy

Raloxifene monitoring

- Bone density scans every 12-18 months

– monitor calcium levels

- Monitor LFTs

Raloxifene MOA

- Decreases bone resorption, which slows bone loss and preserves bone mineral density

– works as an antagonist to estrogen on breast and endometrial tissue

• can Decrease plasma levels of cholesterol

Raloxifene important things to note

• high risk for harm and benefit

• can treat breast and cervical cancer 

• mainly just for females

• high VTE risk

Alendronate drug class

Bisphosphonates

Alendronate therepeutic uses

• Prevents and treats postmenopausal osteoporosis

• Males with osteoporosis

• Prevents osteoporosis

  • Long-term GC

• Paget disease

• Hypercalcemia (malignancy)

Alendronate complications

• Esophagitis, ulceration

  • Sit upright for 30 min after administration

• GI

  • Abdominal pain, N, D, constipation

• MSK pain

• Visual disturbances

• Atypical fractures

• Renal toxicity

  • IV

Alendronate contraindications/precautions

• Precautions: upper GI disorders, liver impairment

• Contraindications: dysphagia, esophageal stricture, serious renal impairments, hypocalcemia

Alendronate interactions

• Calcium, iron, magnesium, antacids, orange juice, caffeine

  • Decreases the absorption of alendronate

Alendronate MOA

decrease the action of osteoclasts and inhibit bone resorption

Alendronate important things to note

• high risk of causing esophagitis 

• sit upright for at least 30 minutes after taking. do NOT take laying down

• risk of atypical fractures 

  • flat and irregular bones

Calcitonin-Salmon drug class

Calcitonin

Calcitonin-Salmon therepeutic uses

• Treats (does not prevent):

  • Postmenopausal osteoporosis

  • Moderate-to-severe Paget disease

  • Hypercalcemia (hyperparathyroidism)

  • Cancer

Calcitonin-Salmon complications

• Nausea

• Nasal irritation

  • IN route

Calcitonin-Salmon contraindications/precautions

• Precautions: kidney disease

• Contraindications: hypersensitivity to fish protein

Calcitonin-Salmon interactions

• Lithium

  • Decrease blood lithium levels

Calcitonin-Salmon MOA

decreases bone resorption by inhibiting the activity of osteoclasts in osteoporosis; increases renal calcium excretion by inhibiting tubular resorption

Calcitonin-Salmon important thing to note

• treat but does NOT prevent 

• intranasal. can cause nose irritation

• has fish product in it. asses for fish allergies!!!

• not good for bipolar clients taking lithium 

Methotrexate drug class

Disease-Modifying Antirheumatic Drugs (DMARDs) I – Immunomodulator

Methotrexate therepeutic uses

• Analgesia for pain, inflammation

• Delay disease progression (RA)

• Management of IBD

• Psoriatic Arthritis

• abortion

Methotrexate complications

• Immunosuppression

  • Monitor for infection

  • Bone marrow suppression

• Hepatic toxicity

• GI ulcerations

• Fetal demise

Methotrexate contraindications/precautions

• Precautions: liver/kidney impairments, bone marrow suppression, PUD

• Contraindications: pregnancy/breastfeeding, liver failure, alcohol use disorder, blood dyscrasias

Methotrexate interactions

• Salicylates, NSAIDs, sulfonamides, penicillin, tetracyclines

  • Methotrexate toxicity

DMARD class 1 vs class 2

class 1 is non biologic

class 2 is biologic (active agent going into body)

are DMARDs first line agents?

No. try NSAIDS and corticosteroids first

when taking methotrexate, monitor for

Infection and liver labs

Sulfasalazine drug class

DMARDs I – Anti-Inflammatory

Sulfasalazine thereputic uses

• Analgesia for pain, inflammation

• Delay disease progression (RA)

• Psoriatic Arthritis

• Management of IBD

Sulfasalazine complications

• GI discomfort

  • NVD, pain

• Hepatic dysfunction

• Bone marrow suppression

• Rash

• Male infertility

Sulfasalazine contraindications/precautions

• Precautions: pregnancy (NTD); may cause male infertility; liver/kidney impairments, cancer/bone marrow suppression, PUD

Sulfasalazine interactions

• Nephrotoxic and hepatotoxic agents

  • Worsen impairments

Etanercept drug class

DMARDs II – Tumor Necrosis Factor (TNF) Antagonists

Etanercept therepeutic uses

• Analgesia for pain, inflammation

• Delay disease progression (RA)

• Management of IBD

• Psoriatic Arthritis

Etanercept complications

• Injection-site irritation

  • SC 

• Immunosuppression

  • Increased risk for infection

    • Test for Hep B and TB

• Severe skin infections

  • Stevens-Johnson syndrome (SJS)

• Heart failure

• Blood dyscrasias

Etanercept contraindications/precautions

• Precautions: heart failure, CNS disorders (MS), blood dyscrasias, liver impairment

• Contraindications: cancer, infections, lactation

Etanercept interactions

• Live vaccines

  • Increased risk for infection

• Concurrent use of immunosuppressants

If a client taking entercept develops a rash, what is your first priority

get to emergency room ASAP because SJS can be deadly 

entercept important things to note

• dont give with live vaccines

  • Flu

  • Varicella

  • MMR

Hydroxychloroquine drug class

DMARDs I – Antimalarial

Hydroxychloroquine therepeutic uses

• Analgesia for pain, inflammation

• Delay disease progression (RA)

• SLE (lupus)

• Management of IBD

Hydroxychloroquine complications

• Retinal damage

  • Stop agent if occurs

Hydroxychloroquine contraindications/precautions

• Precautions: liver/kidney impairment

Hydroxychloroquine interactions

• Digoxin

  • Digoxin toxicity

• QT-prolonging agents

  • May further prolong QT

Colchicine drug class

Antigout – Anti-Inflammatory Agents

Colchicine therepuetic uses

Acute gout attack

Colchicine complications

• GI distress

  • Abdominal pain, NVD

• Thrombocytopenia

  • Monitor for bleeding

• Rhabdomyolysis (breakdown of muscle tissue and it can cause renal failure and myalgia)

Colchicine contraindications/precautions

• Precautions: older adults, blood disorders

• Contraindications: severe renal/hepatic/cardiac/GI dysfunction

Colchicine interactions

• Grapefruit juice

  • Increase side effects

Allopurinol drug class

Antigout – Hyperuricemia Agents

Allopurinol therepeutic uses

• Chronic gout

• Frequent gout attacks

Allopurinol complications

• Rash, fever

• Kidney injury

• Hepatitis

• GI distress

  • NV

• Increase in gout attacks

  • 1^st month of therapy

  • in first month may have gout attacks but its typically self limited

Allopurinol contraindications/precautions

• Contraindications: hypersensitivity

Allopurinol interactions

• Warfarin

  • Slows metabolism of warfarin

    • Risk for bleeding

clients taking Allopurinol should monitor

• look at baseline kidney and liver labs