Bad to the Bone
The parathyroid gland releases PTH in response to hypocalcemia, increasing Ca reabsorption from renal tubules, increasing Ca absorption from food (with help of Vit D), and causing osteoclasts to release more Ca into the blood by breaking down THIS
bone, through a process called "bone resorption"
Sue suggested that students use the mneumonic "Calci-Bone-In" to remember this hormone, released from the thyroid gland. Why exactly?
calcitonin. Because the hormone calcitonin helps to deposit more Ca from the blood "INTO the bone" (thus lowering serum Ca levels).
Calcitonin's effect on blood Ca is the opposite of that of PTH (which is to free Ca OUT OF the bone and putting it into the blood, raising serum Ca levels). Mentioned near start of the video lecture
Though its primary use may be for osteoporosis and Paget's disease, this category of drug may also be used to treat bone metastases in patients with cancer
alendronate (Fosamax)
Explain why a nurse administering raloxifene (Evista) should wear gloves when handling the medication
Because of the risk that in simply touching the drug with unprotected hands the nurse may experience effects similar to estrogen hormone treatment
True or False: the prototype drug we learned this week as a "muscle relaxer" for localized treatment of muscle spasms, cyclobenzaprine (Flexeril), cannot also be used for the treatment of the condition known as "spasticity"
TRUE. See under Uses: "Ineffective for the treatment of spasticity"
Both alendronate (Fosamax) and raloxifene (Evista) are used to treat this serious condition of bone degeneration that is frequently experienced by people assigned female at birth after they go through menopause
osteoporosis. Note that raloxifene (Evista) seems more specifically targeted to treat "post-menopausal osteoporosis," while alendronate (Fosamax) lists that as only one of SEVERAL types of osteoporosis that it is approved to treat.
When taking raloxifene (Evista), patients should be told to get up and move around frequently when traveling, and also to DC taking the med during any period of "prolonged immobility" (such as perioperatively). Explain why
Because one of the key AEs of this drug are increased risk for thromboembolic events, and keeping one's legs mobile will hopefully help to avoid the formation of a DVT that being on the drug makes more likely
This drug "prevents or lowers uric acid levels that build up as tumors breakdown in certain types of cancer in clients who are being treated with chemotherapy"
allopurinol (Zyloprim)
By reducing the influx of Calcium and thus reducing neurotransmitter release from presynaptic axon terminals, baclofen (Gablofen, Lioresal) causes THIS net effect in patients
who have MS or a SCI
The reduction of impulse transmission from the spinal cord to skeletal muscles, resulting in decreased muscle spasms and/or fewer hyperactive reflexes
True of False: A patient taking allopurinol (Zyloprim) to lower uric acid levels in their body may sometimes experience a metallic taste in their mouth.
TRUE (see that drug under AE)
In her explanation of the complications of gout, Sue explains that the "joint pain" caused by advanced stages of this disease process is due to THIS happening to the affected bones. Bonus points: also mention the name of the drug that may help keep gout from progressing that far
Articular cartilage initially develop a "pannus" from the inflammation in the synovial space caused by high levels of uric acid, while in advanced stages, the synovial space increasingly narrows, leading to bone on bone friction, and eventually to the affected bones fusing together completely. The prototype we were given as tx for gout is allopurinol (Zyloprim)
Part of the Patient Teaching for allopurinol (Zyloprim) includes "Drink lots of water" [~10-12 glasses/day], and one hopes to see a large Urine Output (UO) as a result. In her video lecture, Sue mentioned that the nurse should monitor UO and report if it's low. Why?
Because one wants to clear the uric acid "crystals" from the body, e.g. crystals kept from forming into kidney stones, or resulting from cancer tumor breakdown as a result of chemotherapy. If one drinks a lot of H2O yet their UO still remains low, the nurse suspects a blockage, perhaps due to the lodging of stones.
Patients taking this drug are taught to watch out for s/s of malignancy: splenomegaly, hepatomegaly, night sweat, weight loss, and persistent fever.
etanercept (Enbrel).
Note that this drug's AE's mentions that "children, adolescents, and young adults" are the people who are especially at "increased risk for lymphoma and other malignancies"
Normally one wants to have active T and B lymphocytes circulating in one's body as part of our acquired immunity, but the main benefit of methotrexate (Oxtrexup, Trexall) is to reduce their activity/circulation. What specific diseases does that help treat?
Small doses are used to treat autoimmune disorders such as RA and juvenile RA. May also be used to treat severe psoriasis or in transplant therapy (to seek to avoid transplant rejection).
High doses of this drug used to as part of cancer treatment work likely on the blockage of folate necessary for cellular replication, rather than by lowering the body's acquired immunity.
True or False: When using methotrexate (Otrexup, Trexall) for RA, this therapy is generally part of a larger drug treatment regimen that also includes NSAIDs and glucocorticoids/corticosteroids.
TRUE. See the PPT/lecture just preceding this drug, as well as the end of the section of the chart talking about "Rheumatoid Arthritis" under "Treatment." The reason for using NSAIDs and corticosteroids is to offer the patient some relief while one endures the 3-6 weeks for the therapeutic effects of the drug to appear.
This drug on this week's unit may "increase the risk for bone marrow dysfunction if given with another drug that also may cause bone marrow dysfunction" (listed on the chart under "Drug Interactions"). Name the drug
methotrexate (Otrexup, Trexall), the "conventional DMARD" that is the 1st line drug for tx of RA. Note that on the "concept map" key, Sue explains in more detail how such bone marrow dysfunction increases RF infection
Patients taking this Gabba-Aminobutyric Acid (GABA) derivative should be taught not to stop taking this medicine abruptly, especially if it's being administered through the intrathecal (CSF) route. Name the drug, then list complications that could occur on abrupt withdrawal from PO and intrathecal routes.
baclofen (Gablofen, Lioresal).
PO abrupt DC: visual hallucinations, paranoid ideation, seizures;
intrathecal abrupt DC: hyperthermia, rebound spasticity, rhabdomyolysis, Multiple Organ Dysfunction Syndrome (MODS), or death
The drug raloxifene (Evista) may help to reduce the risk for these two different kinds of cancer
(1) breast cancer and
(2) uterine/endometrial cancer
The drug etanercept (Enbrel) is contraindicated in patients who have these TWO specific kinds of infections for fear that their body's lowered immunity when taking this drug could lead to a re-activation of the infection and/or systemic spread
(1) Tuberculosis (TB)
(2) Hepatitis B (HBV)
Note someone with poorly controlled DM would also be at higher RF infection (of any sort), but that's not the same as a latent bacteria (TB) or virus (HBV) that the immunocompromised body may fall greater prey to
True or False: Among the "injection site reactions" and "skin reactions" that may result from subQ injection with etanercept (Enbrel) for the treatment of RA and other conditions, Sue said that a major concern is to be on the lookout for "fungal infections"
TRUE. Part of the video lecture.
A rare but serious potential SE of long term therapy with alendronate (Fosamax) is that it can cause specific types of damage to these particular bones
(1) osteonecrosis of the jaw and
(2) atypical femur fractures.
It can also rarely cause ocular inflammation, but that does not appear to be directly related to the bones around the eyes but rather its effect on certain inflammatory mediators.
On her video lecture (only), Sue suggested that patients taking this drug, which may potentially cause inflammation of the gums, should include THIS specific teaching for patients who may have that AR. Name both the drug and the teaching
methotrexate (Otrexup, Trexall), which can cause oral mucositis;
on the video, Sue added to the list of Patient Teachings for methotrexate that patients on that drug should be told to "use a soft toothbrush"
When taking this drug, this patient teaching is aimed to help the patients avoid developing skin melanomas. Name the drug and the teaching
methotrexate (Otrexup, Trexall):
wear sunscreen, since the drug causes heightened sensitivity to the sun (and that condition over time could lead to greater risk for development of skin malignancies, if the patient does not take proper precautions...)
The exact MOA of cyclobenzaprine (Flexeril) is unknown, but the drug's use in treating muscle spasm seems to result from THIS effect
the reduction of tonic motor activity in the brain stem and spinal cord, leading to the relaxation of muscle
True or False: According to Sue's lecture, a patient taking methotrexate (Otrexup, Trexall) should expect to experience both nausea/vomiting as well as hair loss.
TRUE. While not listed as AEs on our student handout chart, these negative effects do appear at the bottom of the AE list for that drug on her PPT slides, and Sue reiterated, "Nausea/vomiting and alopecia are to be expected."