Comprehensive Pharmacology: DMARDs, SERMs, Gout, Osteoporosis, and Glucocorticoids

Methotrexate - Classification

Disease-modifying antirheumatic drug (DMARD)

Methotrexate - Therapeutic use

Decreases joint inflammation and, subsequently, joint damage

Methotrexate - Adverse drug reaction

Hepatic fibrosis, increased risk of infection, liver damage, gastrointestinal ulceration, pulmonary fibrosis, bone marrow suppression

Methotrexate - Nursing intervention

Monitor for decreased platelets, red and white blood cell counts, signs and symptoms of infection, liver function, gastrointestinal bleeding, respiratory distress

Methotrexate - Administration

Give once a week via route prescribed (oral, subcutaneous, or intramuscular); folic acid supplement may be prescribed to decrease risk of toxicity

Methotrexate - Contraindication

Pregnancy, liver insufficiency or hepatitis, renal insufficiency

Methotrexate - Client education

Takes 3-6 weeks to feel effects, can take several months to feel full effect; drink 2-3 L of fluids per day

Raloxifene - Classification

Selective estrogen receptor modulator (SERM)

Raloxifene - Therapeutic use

Postmenopausal osteoporosis

Raloxifene - Adverse drug reaction

Increased risk of deep vein thrombosis (DVT) and pulmonary emboli, hot flashes, stroke

Raloxifene - Nursing intervention

Observe for signs and symptoms of thromboembolism, monitor bone density

Raloxifene - Administration

Give orally daily; may be given with or without food

Raloxifene - Contraindication

Teratogenic, lactation, current and past history of deep vein thrombosis

Raloxifene - Client education

Report pain in the calf or difficulty breathing; warn clients that hot flashes may occur

Colchicine - Classification

Anti-inflammatory agent

Colchicine - Therapeutic use

Abort an acute gout attack in response to precursor findings

Colchicine - Adverse drug reaction

Mild gastrointestinal distress which can progress to gastrointestinal toxicity, bone marrow suppression

Colchicine - Nursing intervention

Monitor uric acid levels, CBC, UA, BUN

Colchicine - Administration

Give orally for gout treatment

Colchicine - Contraindication

Severe renal, cardiac, hepatic, or gastrointestinal dysfunction

Colchicine - Client education

Avoid eating or drinking grapefruit or foods high in purine; if severe gastrointestinal distress occurs, stop this medication; take with food

Alendronate - Classification

Bisphosphonate

Alendronate - Therapeutic use

Prevention and treatment of postmenopausal osteoporosis, age-related osteoporosis in men, Paget's disease

Alendronate - Adverse drug reaction

Esophagitis, gastrointestinal disturbances, muscle and joint pain, eye pain, and vision changes

Alendronate - Nursing intervention

For 30 minutes after taking the drug, have clients remain in upright position and avoid eating or drinking anything other than water

Alendronate - Administration

Give drug 30 minutes before breakfast with a full glass of water; have client sit or stand for 30 minutes after administration

Alendronate - Contraindication

Esophageal strictures/disorders or difficulty swallowing, clients unable to sit up for 30 minutes after administration, renal insufficiency, hypocalcemia

Alendronate - Client education

Take with a full glass of water, sit or stand up, avoid eating or drinking anything other than water, and avoid taking calcium supplements or antacids for 30 minutes after taking the drug.

Prednisone - Classification

Glucocorticoid

Prednisone - Therapeutic use

Symptomatic relief of pain and inflammation for a wide variety of disorders; delay progression of some disorders, such as rheumatoid arthritis

Prednisone - Adverse drug reaction

Suppression of adrenal function, risk of infection, osteoporosis, fluid retention, gastrointestinal discomfort

Prednisone - Nursing intervention

Monitor blood glucose levels (especially for clients who have diabetes mellitus), gastrointestinal bleeding, signs of infection, edema, crackles in the lungs, generalized weakness

Prednisone - Administration

Give PO or as a joint injection

Prednisone - Contraindication

Recent live virus immunization, systemic fungal infection, cataracts

Prednisone - Client education

Avoid taking NSAIDs, take with food or meals, short-term therapy can be used while waiting for peak therapeutic effect of DMARDs

Allopurinol - Classification

Agent for hyperuricemia

Allopurinol - Therapeutic use

Hyperuricemia due to chronic tophaceous gout

Allopurinol - Adverse drug reaction

Hypersensitivity syndrome, gastrointestinal disturbances, kidney or liver damage, hepatitis, may increase gout attacks, metallic taste in the mouth

Allopurinol - Nursing intervention

Monitor for symptoms of hypersensitivity syndrome, CBC, unusual taste sensations; stop drug therapy immediately for signs of hypersensitivity syndrome

Allopurinol - Administration

Give orally or IV; monitor uric acid levels (initially every 1 to 2 weeks to establish the appropriate dosage)

Allopurinol - Contraindication

Hypersensitivity to the medication, idiopathic hemochromatosis

Allopurinol - Client education

Report fever, rash, abdominal pain, swelling, or low urine output immediately and stop taking the drug; take with food

Calcium Citrate - Classification

Calcium supplement

Calcium Citrate - Therapeutic use

Hypocalcemia

Calcium Citrate - Adverse drug reaction

Hypercalcemia, nausea, vomiting, constipation, kidney stones

Calcium Citrate - Nursing intervention

Monitor serum calcium, signs of decreased gastric and intestinal motility, urine output in excess of intake, signs of decreased gastric and intestinal motility, flank pain, and blood in urine

Calcium Citrate - Administration

Give orally or IV; give clients glass of water after swallowing

Calcium Citrate - Contraindication

Hypercalcemia, kidney stones, low phosphate levels, cardiac dysrhythmias

Calcium Citrate - Client education

Instruct clients to take 1-2 hours before or after taking other medications such as glucocorticoids, thyroid supplements, and tetracycline and quinolone antibiotics