3 Ps- wk 12-13 drug cards

Drugs affecting calcium levels and bone mineralization:

Calcium Supplements- Prototype: calcium carbonate

Vitamin D- Prototype: calcitriol

Bisphosphonates- Prototype: Alendronate

Calcium Supplements –

Prototype: calcium carbonate

Class:

Calcium preparation, antacid, and phosphate binder

Calcium Supplements –

Prototype: calcium carbonate

Absorption:

Requires stomach acid to absorb

Calcium Supplements –

Prototype: calcium carbonate

Indications:

Hypocalcemia
Hypothyroidism
Hypoparathyroidism
Osteoporosis

As a calcium supplement in postmenopausal clients and during pregnancy

Calcium Supplements –

Prototype: calcium carbonate

Therapeutic effects:

Improves calcium levels within the body
Reduces heartburn and gastroesophageal reflux disease
Increases gut motility

Calcium Supplements –

Prototype: calcium carbonate

side/adverse effects:

Constipation

Hypercalcemia (symptoms include nausea and vomiting, abdominal pain, and weight loss).

Kidney stones

Nausea

Calcium Supplements –

Prototype: calcium carbonate

Nursing Considerations:

Take with food to help with absorption. (increases stomach acid)

Do not give with other medications (may interfere with absorption)

Encourage fluid intake to reduce risk of kidney stones.

Vitamin D is mandatory for calcium absorption.

Vitamin D 

Prototype: calcitriol

Indications:

Hypocalcemia
Hypoparathyroidism
Hemodialysis clients with hyperphosphatemia

Vitamin D 

Prototype: calcitriol

Therapeutic Effects:

Increases serum calcium levels

Vitamin D 

Prototype: calcitriol

Side/Adverse Effects:

Constipation

Dry mouth

Bone pain

Metallic taste

Polyuria

Pruritis

Increased liver enzymes (AST)

Elevated blood urea nitrogen (BUN) levels.

vitamin D toxicity (symptoms include recurrent vomiting, confusion, apathy, and dehydration)

Vitamin D 

Prototype: calcitriol

Nursing Considerations:

Use cautiously in clients with renal and hepatic impairment

Watch for signs of Vit. D toxicity and Hypercalcemia

Do not take other Vit D containing products

Bisphosphonates-

Prototype: Alendronate

Indications:

Osteoporosis in postmenopausal clients
Paget’s disease
Glucocorticoid-induced osteoporosis

Bisphosphonates-

Prototype: Alendronate

Therapeutic Effects:

Increases bone mass

Bisphosphonates-

Prototype: Alendronate

Side/Adverse Effects:

Abdominal pain
Acid regurgitation
Constipation/diarrhea
Dyspepsia
Nausea
Musculoskeletal pain

Bisphosphonates-

Prototype: Alendronate

Nursing Considerations:

VERY IMPORTANT!!!!

Take with full glass of water

Take 30 min before food or meds

Remain upright for 30 min

Do not take if Pregnant

Do not give with other medications (may interfere with absorption)

Adverse effects of bisphosphonates drug class include

gastrointestinal symptoms (such as abdominal pain, dyspepsia, nausea, vomiting, and diarrhea)

esophageal irritation (leading to heartburn and difficulty swallowing)

musculoskeletal pain

osteonecrosis of the jaw (death of bone tissue in the jaw leading to pain, swelling, infection, and exposed bone in severe cases)

atypical fractures

Drugs Affecting Spasticity and Pain:

Pain- Review Non-Opiod and Opiod medications from week 7

Skeletal Muscle Relaxant and Antispasticity Agent- Prototype: Baclofen

Adjunct pain medication-Skeletal Muscle Relaxant- Prototype: Cyclobenzaprine

Adjunct pain medication-Anticonvulsants- Prototype: Gabapentin

Skeletal Muscle Relaxant and Antispasticity Agent

Prototype: Baclofen

Class:

Centrally acting muscle relaxant  Antispasticity Agent

Skeletal Muscle Relaxant and Antispasticity Agent

Prototype: Baclofen

Mechanism of Action:

Inhibits GABA receptors on spinal cord

Reduces nerve impulse transmission to skeletal muscle —> decreased muscle spasticity

Skeletal Muscle Relaxant and Antispasticity Agent

Prototype: Baclofen

Therapeutic Effects:

Suppresses hyperactive reflexes

Alleviates spasticity

Reduces discomfort and rigidity

Skeletal Muscle Relaxant and Antispasticity Agent

Prototype: Baclofen

Side/Adverse Effects:

CNS depression

Drowsiness

Confusion

Nausea/Vomiting

Constipation

Urinary Retention

Hypotension

Arrhythmias

Skeletal Muscle Relaxant and Antispasticity Agent

Prototype: Baclofen

Contraindications:

Other CNS depressants

Caution:

Pregnancy/BF

Older Adults

Heart Failure

BPH

Hx: schizophrenia

Skeletal Muscle Relaxant and Antispasticity Agent

Prototype: Baclofen

Nursing Considerations:

•Assess alertness, orientation, and affect.

•Evaluate muscle strength before and after administration of medication.

•Auscultate bowel sounds and monitor bowel movements due to constipation and to avoid a fecal impaction.

•Obtain baseline liver function tests and serum BUN/creatinine levels and assess these levels periodically during therapy to assess for changes.

•Ensure safety precautions are in place to prevent falls because of fatigue, weakness, and confusion.

•Provide additional measures to relieve discomfort such as heat, rest, NSAIDs, and positioning to augment effects of the drug.

•Emphasize to the client/caregiver that the drug must be gradually discontinued over a 1- to 2-week period.

Skeletal Muscle Relaxant and Antispasticity Agent

Prototype: Baclofen

The client taking a muscle relaxant should:

•Eat plenty of fruits, vegetables, and whole grains to prevent or reduce constipation.

•Drink at least 6–8 8-oz of water daily to promote regular bowel movements.

•Have a clear understanding of the baclofen pump if applicable, such as frequent monitoring, adjusting the dose, and programming the unit, to avoid complications.

•Report painful or frequent urination, constipation, headache, insomnia, or excessive fatigue.

•Understand various nonpharmacological comfort measures to use, such as heat, rest, or position change, to help relieve discomfort.

•Notify provider if signs or symptoms of liver dysfunction appear, such as right upper quadrant pain, jaundice, dark urine, and clay-colored stools.

Skeletal Muscle Relaxant and Antispasticity Agent

Prototype: Baclofen

The client taking a muscle relaxant should NOT:

•Chew, break, or crush extended-release capsules.

•Rise or change positions quickly due to possible orthostatic hypotension.

•Drive or engage in potentially hazardous tasks that require alertness and focus until the effects of the drug are known.

•Stop the drug abruptly, to prevent negative effects.

Adjunct pain medication-Skeletal Muscle Relaxant

Prototype: Cyclobenzaprine

Mechanism of Action:

Reduces tonic somatic muscle activity at brain stem

Adjunct pain medication-Skeletal Muscle Relaxant

Prototype: Cyclobenzaprine

Therapeutic Effects:

Reduction of muscle spasms

Adjunct pain medication-Skeletal Muscle Relaxant

Prototype: Cyclobenzaprine

Side/Adverse Effects:

CNS Depression

Dizziness

Drowsiness

Dry mouth

Urinary retention

Serotonin Syndrome

GI Upset

Adjunct pain medication-Skeletal Muscle Relaxant

Prototype: Cyclobenzaprine

Contraindications:

Hypersensitivity

MAOI use within 14 days

CHF

Hyperthyroidism

Adjunct pain medication-Skeletal Muscle Relaxant

Prototype: Cyclobenzaprine

Nursing Considerations:

Monitor neurological status

Use cautiously with older clients

Caution with hepatic impairment

Caution with other CNS depressants

Administer with meals to minimize GI upset

Assess for pain and muscle stiffness

Use cautiously with antidepressants and other CNS depressants

Adjunct pain medication-Skeletal Muscle Relaxant

Prototype: Cyclobenzaprine

_______ _______ symptoms may develop when used with antidepressants. These symptoms may include:

Serotonin syndrome

mental status changes (confusion, agitation, hallucinations)

autonomic instability (diaphoresis, tachycardia, labile blood pressure, hyperthermia)

neuromuscular abnormalities (tremor, ataxia, hyperreflexia, clonus, muscle rigidity)

gastrointestinal symptoms (nausea, vomiting, diarrhea)

Adjunct pain medication-Anticonvulsants

Prototype: Gabapentin

Class:

Anticonvulsants / GABA analogue

Adjunct pain medication-Anticonvulsants

Prototype: Gabapentin

Mechanism of Action:

ppt states “unknown” ???

Adjunct pain medication-Anticonvulsants

Prototype: Gabapentin

Therapeutic Effects:

Decreased neuropathic pain

Decreased seizures

Adjunct pain medication-Anticonvulsants

Prototype: Gabapentin

Side/Adverse Effects:

CNS Depression

Dizziness

Somnolence

Ataxia

Peripheral edema

Suicidal ideations

Adjunct pain medication-Anticonvulsants

Prototype: Gabapentin

Contraindications:

Allergic reaction to any ingredients

Avoid other CNS depressants

Adjunct pain medication-Anticonvulsants

Prototype: Gabapentin

Nursing Considerations:

Monitor for CNS depression

Administer at bedtime for sedation

Do not stop abruptly

Monitor renal function

Assess for suicidal thoughts or ideations

Adjunct pain medication-Anticonvulsants

Prototype: Gabapentin

Teach clients:

Do not drive or operate machinery when starting medication

Do not take within two hours of antacid medications

Sedative side effects

Do not increase dosage recommendations