Pharm Bone Disorder, Local Anesthetic, Gout, Adjuvant

Which drugs are used for bone disorder?

- calcium citrate (PO) / calcium gluconate (IV)
- raloxifene
- alendronate/risedronate

Which drugs are calcium supplements?

calcium citrate (PO) / calcium gluconate (IV)

Indications for calcium citrate

hypocalcemia, parathyroid hormone deficiency, vitamin D or dietary calcium deficiencies

Indications for calcium gluconate

CRITICALLY low calcium levels or an antidote for mg sulfate toxicity

Complications of calcium supplements

hypercalcemia

S/sx of hypercalcemia

- calcium > 10.5
- initially: tachycardia, HTN leading to bradycardia & hypotension
- muscle weakness, hypotonia, constipation, N/V, abdominal pain, lethargy, confusion
- BONES, STONES, MOANS, GROANS

Contraindications for calcium supplements

hypercalcemia, renal calculi, hypophosphatemia, digoxin toxicity, and ventricular fib

Interactions for calcium supplements

glucocorticoids, tetracyclines, thyroid hormone, thiazide, food w/calcium (spinach, rhubarb, bran, beets), digoxin

labs for calcium supplements

calcium, bun, creatinine

Nursing action for calcium supplements

- take 1 hr prior from glucocorticoids and tetracyclines
- take 4 hrs apart from thyroid med

Antidote for hypercalcemia

bisphosphonates like alendronate

Indications for raloxifene

- prevent/treat POST-menopausal osteoporosis and prevent spinal fractures in females
- protect against breast cancer

Complications of raloxifene

PE
DVT
Hot flashes

Nursing action for raloxifene

- stop 72hrs prior to schedule immobilization
- monitor for DVT (red, swollen)

Contraindications for raloxifene

pregnancy and venous thrombosis

What medication should not be taken with raloxifene

estrogen hormone therapy

Pt edu for raloxifene

- monitor bone density every 12-18 months and calcium levels
- intake of dietary calcium and vitamin D
- perform weight-bearing exercise
- minimize period of restricted activity

Indications for alendronate/risedronate

prophylaxis and treatment of menopausal osteoporosis

Complications of alendronate/risedronate

- ESOPHAGITIS/ESOPHAGEAL ulceration
- HEART BURN
- musculoskeletal pain
- VISUAL DISTURBANCE
- OSTEONECROSIS of jaw
- KIDNEY toxicity
- atypical femoral fractures

Contraindications of alendronate/risedronate

- dysphagia, esophageal disorders, kidney impairment, hypocalcemia
- pt who cannot sit up right or stand for 30 min

Pt education for alendronate/risedronate

- sit up or ambulate for 30 min after po
- avoid eating for 1 hr after taking po
- avoid calcium for 2 hrs
- visit dentist before treatment and avoid dental work

When should nurse HOLD alendronate?

if pt cannot swallow/painful swallowing med, new or worsening HEART BURN

Which drugs are antigout?

allopurinol and colchicine

s/sx of gout

- hot and red
- sudden, severe pain
- swelling
- great toe

Indication for allourinol

- CHRONIC gout/maintenance med
- take this all the time

Complications of allopurinol

- hypersensitivity injury (fever, rash)
- kidney impairment
- hepatitis
- GI distress
- INCREASED GOUT ATTACKS
- DARK, concentrated URINE

When should nurse HOLD allopurinol?

RASH, if IV infusion

What can be prescribed with allopurinol to help with gout attacks?

colchicine and nsaids

Which drug should not be taken with allopurinol?

warfarin > increase risk of bleeding

Pt. edu for gout

- avoid alcohol and foods high in purine (red meat, liver, shellfish)
- increase fluids, bmi, exercise
- gout attacks first month

Labs for allopurinol and colchicine

bun, creatinine, ast, alt

Indication for colchicine

acute gout attacks

Complications of colchicine

- GI distress
- Suppressed bone marrow
- rhabdomyolysis (muscle tenderness/pain)

When should nurse hold colchicine

rhabdomyolysis > sudden muscle pain or tenderness

Contraindication of colchicine

severe renal, cardiac, hepatic, or GI dysfunction

pt edu for colchicine

avoid grapefruit juice

General concepts of adjuvant medications

- always given w/other primary pain meds to increase pain relief while reducing the dose of opioids
- not used as a substitute for opioids

NSAID complicaitons

- kidney dysfunction (BUN/creatinine, s/s of nephrotoxicity)
- GI distress > ulceration (coffee ground emesis, black tarry stools)

Indication for lidocaine

- used for pain management for minor surgical procedures: labor and delivery, and regional anesthesia
- relieve pain and numb skin

Duration of lidocaine

1 to 3 hrs, no loss of consciousness

lidocaine local application s/sx

burning, stinging, swelling

Contraindications of lidocaine

supraventricular dysrhythmias and heart block

Nursing actions for lidocaine

- assess numbness to the area before starting procedure
- monitor for pain throughout the procedure
- spinal headache: remain flat in bed 12 hrs after procedure
- monitor ekg, vitals, and allergic reaction

Complications for lidocaine (parenteral)

seizures, respiratory depression, hypotension, allergy

What drug should be avoided when using lidocaine?

nsaids