PAIN AND INFLAMMATION/MSK

me crunching on a granola bar

methotrexate (non-biological DMARD)

an immunosuppressant that interferes with B and T lymphocyte activity. used to suppress the immune response in rheumatic arthritis (an autoimmune disease). this drug can slow or even stop the progression of RA, as well as treat cancer in larger doses. ADRs include nausea/vomiting, dizziness, headache, blurred vision, hepatotoxicity(not recommended for alcoholics), bone marrow suppression (causing low platelets and RBCs), immunosuppression leading to an increased susceptibility to disease, and pulmonary fibrosis. monitor CBC and liver function tests. is usually administered once a week and paired with an NSAID initially; folic acid supplement may decrease risk of toxicity. patient may complain of abdominal pain; monitor skin for s/s of jaundice. patient should maintain hydration and drink at least 2L of fluid a day. very teratogenic.

etanercept (biologic DMARD)

inactivates TNF resulting in reduced inflammation of synovial tissue in the joints and immunosuppression. usually parenteral; important to assess skin at injection site. ADRs include immunosuppression dizziness, URIs, abdominal pain, psoriasis, SJS, pancytopenia (reduced levels of all blood cells), heart failure, and TB. given once weekly; is not given if an active infection is present. monitor client for s/s of infection and of heart failure. test for TB constantly. client should not take any live vaccines.

raloxifene

binds to estrogen receptors to activate hormone in some tissues and block it in other tissues (selective estrogen receptor modulator). this causes a decrease in bone resorption and bone loss, treating and preventing postmenopausal osteoporosis. valuable for clients who have estrogen-dependent or positive cancer. ADRs include stroke, thromboembolic events (PE, DVT), and vasomotor s/s (hot-flashes). very teratogenic. monitor bone density to determine effectiveness, along with monitoring cholesterol, hormone levels, and fibrinogen. given on a daily basis. patient needs to keep calcium levels high, engage in weight bearing activities, and be on contraception.

alendronate

decreases bone resorption by inhibiting the activity of osteoclasts. treats all types of osteoporosis (post-menopause in women, age-related in men, and glucocorticoid-related in clients on long term steroid therapy). ADRs include GI issues (nausea, vomiting, abdominal pain), esophagitis, muscle and joint pain (analgesics can help), eye pain/vision changes, and possible osteonecrosis in the jaw. give with a full glass of water and sit patient upright for 30 min after admin to help it dissolve in the stomach. not recommended for those with hypocalcemia or renal insufficiency. calcium/dairy impairs absorption.

calcitonin-salmon

treats established postmenopausal osteoporosis, hypercalcemia secondary to hyperparathyroidism, and Paget’s disease. inhibits the action of osteoclasts and increasing the excretion of calcium, thereby decreasing serum calcium in those experiencing hypercalcemia. ADRs include hypersensitivity reactions and anaphylaxis and hypocalcemia. nasal form can cause dryness, irritation, and bleeding. therapeutic effects may lessen if the client is taking this drug over a long period of time (more than 1 year). monitor Ca for hypocalcemia and perform an ID allergy test before admin. encourage a high consumption of calcium and vitamin D. antihistamines, oxygen, and epinephrine should be present incase of anaphylaxis. hold if patient has salmon allergy.

calcium citrate (supplement)/carbonate (antacid)

provide a non-dietary source of calcium. effective in neutralizing gastric acid. can be used for hypocalcemia or those experiencing or at risk for a calcium deficiency (adolescents going through puberty, those pregnant or breastfeeding, postmenopausal, and those at risk for osteoporosis). can also help with gastric hyperacidity. ADRs can include hypercalcemia (showing nausea vomiting, constipation, polyuria, and depression). can also cause renal calculi/hypercalciuria, and iron deficiency anemia (via impaired absorption). should be given 1 hour before or 1-2 hours after other meds, with antacids being given 1 hour after meals with a full glass of water. should not take more than 600mg in one dose. monitor Ca serum levels and for any ADRs. vitamin D enhances absorption. client should increase fiber intake. not recommended for hypophosphatemia.

aspirin/ibuprofen (1st gen NSAIDs)

nonselective COX inhibitors that block platelet aggregation, inflammation, pain, and fever. can also help with period cramps. ADRs arise as a result of COX-1 being blocked. they include gastric upset, heartburn, ulceration, bleeding, renal dysfunction, salicliysm, and reye’s syndrome in children. monitor patients for bleeding in any form (occult, petechiae, etc.), Is and Os/decreased renal function (elevated BUN and creatinine), s/s of salicilysm, and all other ADRs. discontinue a week before surgery, adhere to 81 mg dose, take with food, and avoid alcohol. do not give to children under 18 who have vital infections. teratogenic; not recommended for those with preexisting PUD or those peri-op.

celecoxib (2nd gen NSAIDs)

developed to minimize ADRs via COX-1 inhibition in 1st gen drugs. treats pain, suppresses inflammation, reduces fever, and helps with period cramps by inhibiting COX-2 selectively. ADRs include gastric upset, diarrhea, heartburn, nausea, and gastric ulceration; not as bad as 1st gen side effects. can still cause renal dysfunction and cardiovascular/cerebrovascular events. monitor for ADRs, test for H.pylori before admin, monitor Is and Os, monitor for renal impairment, and for MI or CVA. should be a short term use drug. client should take w/ food and report any ADRs. teratogenic.

tramadol

binds to selected opioid receptors to block reuptake of norepinephrine and serotonin, treating moderate to moderately severe pain. ADRs are rare, but can include sedation, dizziness, headache, nausea, and constipation. can also rarely cause seizures, urinary retention, and respiratory depression. monitor patients during ambulation for dizziness and give drug in low dose in a short term to minimize ADRs. watch respirations closely, monitor for seizures and watch urine output. takes about 1 hour to kick in. avoid patient should avoid activities requiring mental alertness, increase fluid and fiber intake, change positions slowly, and report any ADRs.

acetaminophen (Tylenol)

COX inhibitor that is limited to the CNS and does not have anti-inflammatory or anti-coagulant effects. does not affect gastric mucosa or platelets. works to reduce pain and fever. ADRs include liver toxicity (toxic hepatitis) and HTN in women. antidote is acetylsystine. ensure patient is not taking multiple OTC drugs alongside this one as it can be present in many different types of OTCs, causing toxicity. limit dose to no more than 4mg per day. BP should be monitored often. not recommended for those with alcohol dependence/abuse issues.

morphine

an opioid agonist that serves as an analgesic for moderate to severe pain. can also induce sedation and lessen anxiety in pre-op clients. mimics actions of opioids, endorphins, and enkephalins by binding to mu receptors at opioid receptor sites. stimulation of these receptors causes analgesia (pain relief), sedation, euphoria, and respiratory depression. has a high potential for abuse. ADRS include CNS effects, respiratory depression, constipation, nausea/vomiting, orthostatic hypotension, urinary retention, and cough suppression. antidote is naloxone. monitor vitals, respirations, and Is and Os for risk of urinary retention. can show tolerance with chronic use; client needs to be tapered off. also monitor bowel function, encourage coughing, and watch fiber intake. initial dose should be as low as possible.

mu receptors

stimulated by opioid drugs; cause pain relief, euphoria, sedation, physical dependence, and respiratory depression

kappa receptors

stimulated by opioid medications, causing analgesia, sedation and psychotomimetic effects (effects that mimic psychosis such as hallucinations and delusion).

butorphanol/pentazocine

opioid agonist-antagonists that help relieve moderate to severe pain and act as an adjunct to anesthesia. mu receptor antagonists and kappa receptor agonists, causing fewer mu-related ADRs (respiratory depression, dependence, etc.) and a more mild analgesic effect. med reconciliation is important as these can precipitate withdrawal in clients addicted to opioids. ADRs include mild CNS effects (dizziness, lightheadedness, etc.), respiratory depression, and an increase in cardiac workload. can precipitate abstinence syndrome in clients who become dependent. monitor vital signs and respiratory status.

naloxone (narcan)

opioid antagonist that reverses effect of opioids by blocking opioid receptors. can be used to reverse overdose. ADRs include ventricular arrhythmias, increased HR and RR, and abstinence syndrome. has short lasting effects that last 60-90 minutes. pain that opioids were muting eventually comes back. monitor vital signs and EKG.

allopurinol

inhibits enzyme xanthin oxidase (XO), preventing uric acid from being produced. can help treat gout/hyperuricemia. ADRs include hypersensitivity syndrome (fever and rash), CNS effects (drowsiness, vertigo), GI issues, bone marrow suppression (thrombocytopenia), cataracts in long term use, metallic taste, and renal dysfunction. monitor CBC, uric acid, and ophthalmic exams. patient should stay hydrated (3L fluid/day) to prevent kidney damage.

predisnone

a glucocorticoid that works to relieve pain and inflammation. inhibits the synthesis of prostaglandins (reduces pain), decreases permeability of capillaries (reduces swelling), inhibits lysosomal activity (reduces inflammation), and decreases production of lymphocytes (decreases immune response). ADRs include adrenal suppression, hyperglycemia, myopathy, electrolyte imbalances, osteoporosis, PUD, and immunosuppression. monitor blood glucose, Is and Os, ophthalmic exams, s/s of infections, and taper client off. client should work to avoid osteoporosis (increase calcium intake, weight bearing activity, etc.) and not be administered any live vaccines due to reduced immune response.