VNSG 1231 Exam 1 Blueprint - Part 1 Musculoskeletal and Nervous System Medications (50 Flashcards)

50-question practice flashcards based on the provided lecture notes for Musculoskeletal and Nervous System medications.

What is the indication of Methotrexate/Etanercept (DMARDs)?

Slow or delay the worsening of rheumatoid arthritis (RA) or inflammatory bowel disease.

What is the mechanism of action of Methotrexate/Etanercept?

interferes with lymphocyte production to suppress the immune response; inactivates tumor necrosis factor (TNF).

What are adverse reactions of Methotrexate/Etanercept?

Hepatic toxicity, ulcers in stomach and GI, teratogenic (fetal death) effects.

What are common side effects of Methotrexate/Etanercept?

Increased risk for infection; especially in diabetics.

What monitoring is recommended for patients on Methotrexate/Etanercept?

CBC every 6 months to monitor WBC; TB test if starting etanercept.

What education should be provided to patients taking Methotrexate/Etanercept?

Folic acid is sometimes given; may take 3–6 weeks to work; stay away from crowds; hand hygiene; no live vaccines; immune suppression; avoid alcohol.

What are contraindications/precautions for Methotrexate/Etanercept?

Impaired nutritional status; demyelinating disorders (MS); liver/hematologic disorders (PUD); kidney dysfunction; suppressed bone marrow function; infections; thrombocytopenia.

What are interactions with Methotrexate/Etanercept?

Alcohol; NSAIDs/Salicylates; Sulfonamides/Penicillin; Tetracycline.

What are indications for Allopurinol/Colchicine?

Used to treat gout or kidney stones.

What is the MOA of Allopurinol/Colchicine?

Decreases uric acid levels.

What are side effects of Allopurinol/Colchicine?

GI upset; N/V.

What are adverse side effects of Allopurinol/Colchicine?

Hypersensitivity reactions; potential kidney and liver toxicity.

What are contraindications for Allopurinol/Colchicine?

Hypersensitivity; blood dyscrasias; caution if pregnant/breastfeeding; renal impairment; CNS effects; liver/kidney damage more common with certain inhibitors.

What are interactions for Allopurinol/Colchicine?

Antibiotics; antineoplastics; warfarin (slower metabolism, increased bleeding risk); salicylates; oral antidiabetics; HIV meds; didanosine; grapefruit juice.

What is patient education for Allopurinol/Colchicine?

Avoid foods high in purine; increase fluid intake to 2–3 L/day.

What precautions should be considered with Allopurinol/Colchicine?

Pregnant/breastfeeding caution; renal impairment; CNS effects; liver and kidney damage more likely when paired with CYP3A4 inhibitors and P-glycoproteins.

What are indications for Calcium citrate (Citracal)?

Hypocalcemia or parathyroid deficiencies.

What is the MOA of Calcium citrate?

Increases calcium levels.

What are adverse effects of Calcium citrate?

Hypercalcemia symptoms: tachycardia, hypotension, muscle weakness, constipation, N/V/ab pain, lethargy, confusion; flank pain due to renal calculi.

What are contraindications for Calcium citrate?

Hypocalcemia; renal calculi; low phosphate; digoxin toxicity; ventricular fibrillation (v-fib).

What are interactions for Calcium citrate?

Steroids reduce absorption; reduces absorption of tetracyclines and thyroid hormones; foods like spinach, rhubarb, beets, bran, and whole grains decrease absorption.

What are interventions for Calcium citrate?

Administer 500–600 mg three times a day.

What is patient education for Calcium citrate?

Take with 8 oz of water; chew tablets; the body can absorb 500–600 mg at a time.

What is the therapeutic use of Raloxifene (Evista)?

Postmenopausal osteoporosis—prevention and treatment; reduces risk of estrogen receptor-positive breast cancer.

What are adverse drug reactions of Raloxifene?

Increased risk of DVT and PE (watch for sudden dyspnea), hot flashes, stroke.

What interventions are recommended with Raloxifene?

Observe for thromboembolisms, use lightweight covers, monitor bone density.

How is Raloxifene administered?

Oral, with or without food.

What client instructions should be given for Raloxifene?

Report leg pain and dyspnea; ensure calcium and vitamin D intake; perform daily weight-bearing exercises; avoid pregnancy; do not take estrogen replacement therapy.

What are contraindications for Raloxifene?

Teratogenic; lactation; history of DVT.

What precautions apply to Raloxifene?

Estrogen therapy and hyperlipidemia.

What are interactions with Raloxifene?

Avoid estrogen supplements; not recommended.

What is the therapeutic use of Calcitonin-salmon (Fortical)?

Treats postmenopausal osteoporosis, hypercalcemia secondary to hyperparathyroidism, and cancer.

What is the MOA of Calcitonin-salmon?

Increases renal calcium excretion.

What are side effects of Calcitonin-salmon?

Nausea and nasal dryness/irritation when given nasally.

What are contraindications for Calcitonin-salmon?

Allergy to fish protein; caution with children, lactating mothers, and kidney disease.

What are interactions with Calcitonin-salmon?

Can decrease lithium levels.

What is the assessment for Calcitonin-salmon?

Intranasal is most common; monitor Chvostek’s and Trousseau’s signs for hypocalcemia; monitor bone density.

What is the patient education for Calcitonin-salmon?

Keep container upright; alternate nostrils daily; consume a diet high in calcium and vitamin D.

What is the evaluation for Calcitonin-salmon therapy?

Increased bone density and decreased vertebral fractures.

What are the indications for Alendronate (Fosamax)?

Osteoporosis.

What is the MOA of Alendronate?

Inhibits bone resorption by decreasing the number and action of osteoclasts.

What are the side effects of Alendronate?

GI effects: N/V/D; abdominal pain; constipation; dyspepsia; musculoskeletal pain; visual disturbances.

What are adverse side effects of Alendronate?

Esophagitis, esophageal ulcers, osteonecrosis of the jaw, kidney toxicity, thromboembolic events.

What are contraindications for Alendronate?

Dysphagia; esophageal strictures/DO; inability to sit up for 30 min; liver impairment; infection; upper GI disease.

What are interactions with Alendronate?

Becomes less effective with calcium, iron, magnesium; antacids; orange juice; caffeine.

What is the assessment for Alendronate?

Monitor bone density; calcium levels; jaw/muscle pain; blurred vision.

What is the patient education for Alendronate?

Take first thing in the morning on an empty stomach; sit up for 30 minutes after taking.

What are interventions for Alendronate?

Monitor GI symptoms; ensure proper administration; monitor bone density.

What are the indications for NSAIDs (general use for first- and second-generation NSAIDs)?

Indications include swelling, fever, and pain; NSAIDs are used to prevent heart attack, stroke, and chest pain in some contexts.

What is the mechanism of action of NSAIDs?

Inhibit cyclooxygenase (COX) enzymes, reducing prostaglandin synthesis.

What are side effects of NSAIDs?

GI upset, oliguria, fluid retention, increased risk with MI and CVA, tinnitus, dizziness.

What are adverse side effects of NSAIDs?

Increased risk for myocardial infarction and cerebrovascular accidents; possible aspirin toxicity.

What are contraindications for NSAIDs?

Smoking, ACE inhibitors, pregnancy/lactation, peptic ulcer disease, bleeding disorders, sensitivity to ASA/NSAIDs.

What is an important caution about aspirin-containing regimens in NSAIDs?

Ibuprofen can decrease the effect of low-dose aspirin used to prevent MI.

What is a major safety note for ketorolac (an NSAID) in kidney disease?

Advanced kidney disease; ketorolac generally limited to 5 days or less.

What is a risk with celecoxib (second-generation NSAID)?

Increased risk of myocardial infarction and cerebrovascular accident; possible sulfonamide allergy.

What should clinicians monitor regarding NSAIDs in elderly patients with kidney disease?

Monitor for GI bleed, abdominal pain, N/V; monitor BUN and creatinine.

What is the nursing instruction for NSAIDs regarding administration and GI protection?

Take with food to reduce GI upset; avoid alcohol; discontinue 1 week before surgery/childbirth.

What is acetaminophen (Tylenol) used for?

Indication often preferred for viral infections in children; analgesic/antipyretic.

What is the mechanism of action of Acetaminophen?

Slows production of prostaglandins in the CNS.

What are side effects of Acetaminophen?

Generally well tolerated; rare hepatotoxicity at high doses.

What are adverse side effects of Acetaminophen?

Acute liver toxicity at high doses; liver failure with overdose.

What are contraindications for Acetaminophen?

Pregnancy/lactation considerations; chronic alcohol use; liver/kidney disease.

What are interactions with Acetaminophen?

Alcohol increases risk of liver damage; potential interaction with warfarin increasing bleeding risk.

What is the antidote for Acetaminophen overdose?

Acetylcysteine (given to prevent liver injury) and follow coagulation monitoring.

What is the instruction for Acetaminophen dosing?

Do not exceed the recommended dose; take only one medicine containing acetaminophen at a time.

What is the purpose of prednisone (glucocorticoid) in these notes?

Indications: pain and inflammation; slows/delays disease progression.

What is the mechanism of action of prednisone?

Provides relief of inflammation and pain; systemic effects reduce immune activity.

What are side effects of prednisone?

Risk of infection; N/V; hypotension; GI ulcers; hyperglycemia; hypokalemia; potential behavioral changes if stopped abruptly.

What are adverse effects of prednisone?

Gastrointestinal ulcers; hypertension; glucose intolerance; osteoporosis with long-term use; mood changes.

What are contraindications for prednisone?

Systemic fungal infections; live virus vaccines.

What are interactions with prednisone?

Increased risk of hypokalemia with potassium-wasting diuretics; GI upset with NSAIDs; insulin/oral hypoglycemics efficacy can be reduced.

What are patient education points for prednisone?

Notify clinician if GI bleed occurs; monitor blood sugar and potassium; eat potassium-rich foods; do not stop abruptly; gradual taper is often needed.

What are interventions for prednisone therapy?

Monitor stool, blood sugar, and potassium; gradual tapering when stopping therapy; assess infection risk.

What are indications for gabapentin (anticonvulsant) in these notes?

Relieve neuropathic pain and neuralgia.

What is the mechanism of action of gabapentin?

GABA analog; modulates neuronal excitability to reduce pain signaling.

What are side effects of gabapentin?

Drowsiness, dizziness, ataxia, peripheral edema.

What are adverse effects of gabapentin?

Mood changes, sedation, possible CNS depression.

What are contraindications for gabapentin?

Bone marrow suppression; avoid within 14 days of MAOI use.

What are interactions with gabapentin?

CNS depressants (e.g., alcohol, sedatives) can enhance sedation.

What is the nursing intervention for gabapentin therapy?

Pain assessment and monitoring response to therapy; ensure adherence.

What is an important patient education point for gabapentin?

Do not use other CNS depressants; take on a fixed schedule.

What is the indication for diazepam (benzodiazepine)?

Anxiety disorders, symptoms of alcohol withdrawal, active seizures, anesthesia.

What is the mechanism of action of diazepam?

Enhances GABA, leading to inhibition of CNS electrical activity.

What are side effects of diazepam?

Drowsiness, dizziness, hypotension, impaired recall; CNS depressant effects.

What are adverse effects of diazepam?

Respiratory depression, potential for addiction; paradoxical reaction in some patients.

What are contraindications for diazepam?

Acute narrow-angle glaucoma; pregnancy; concurrent use with other benzos, opioids; severe liver or kidney impairment.

What are interactions with diazepam?

Other CNS depressants (alcohol, opioids, sedatives); certain drugs like cimetidine, St. John’s wort may alter levels.

What are interventions for diazepam therapy?

Monitor blood pressure, respirations, heart rate; assess liver/kidney function for long-term use.

What is the patient education for diazepam?

Take with food; avoid tasks requiring alertness; change positions slowly; do not stop abruptly.

What are the indications for bupropion (antidepressant)?

Smoking withdrawal, depression, seasonal affective disorder.

What is the mechanism of action of bupropion?

Norepinephrine-dopamine reuptake inhibitor (reduces nicotine cravings).

What are side effects of bupropion?

Dry mouth, N/V, weight loss, insomnia.

What are adverse effects of bupropion?

Suicidal ideation risk; abstinence syndrome (irritability, nervousness, restlessness, difficulty concentrating).

What are contraindications for bupropion?

Known hypersensitivity; seizure disorders; eating disorders; concurrent MAOI use.

What are interventions for bupropion?

Take with food; follow prescription; monitor mental health; avoid CNS stimulants.

What is the patient education for bupropion?

Monitor for mood changes; chew gum or eat candy for dry mouth; avoid caffeine; do not exceed prescribed dose.

What is the indication for a peripheral muscle relaxant, dantrolene?

Malignant hyperthermia and muscle spasticity.

What is the mechanism of action of dantrolene?

Prevents release of calcium, reducing skeletal muscle contractions.