Pharmacology Review

Musculeketal 1

100

A truck driver drinks 64 oz of carbonated soda daily to help remain alert. This behavior puts him at risk for osteoporosis due to excessive intake of....

What is phosphorus.

Carbonated sodas contain phosphorus. Excessive intake of phosphorus stimulates a decrease in serum calcium levels. This in turn stimulates the PTH to increase osteoclastic activity.

200

_________ is processed through the liver and activated to it's final form in the kidney. It is vital for calcium absorption from the small intestine.

what is Vitamin D.

Vitamin D is absorbed through the skin, processed through the liver and undergoes final activation in the kidney. It is vital for calcium absorption.

300

It is important to teach patients to drink adequate amount of fluids while taking supplemental calcium in order to prevent this renal problem

kidney stones

calcium is an OTC medication, retiterate the importance of taking this med under physician supervision. Lab work should be monitored

400

This class of medication increases bone mineral density while reducing resorption. It is contraindicated in patients with history of VTE and hepatic disease

Estrogen agonist/ antagonist

Only approved drug in this class is Raloxifene (Evista).

Increased risk of VTE especially in first 4 months of therapy. May increase LFT's which should be monitored, can worsen hepatic disease.

500

dysphagia, esophagitis, esophageal ulcers, and gastric ulcers are adverse effects with this class of drugs for osteoporosis.

 Bisphosphonates

Include alendronate, risedronate, ibandronate.

GI symptoms should be reported to Dr. and med stopped.

Musculoskeletal 2

100

Osteomalacia is resultant from a vitamin D deficiency. ________is an active form of vitamin D that may be taken to treat this deficiency

cholecalciferol or ergocalciferol

200

This class of drugs is utilized to treat mild pain associated with Paget's disease.

NSAIDS

300

________is a monoclonal antibody drug that binds and antagonizes a protein necessary to the formation, function and survival of osteoclasts. This drug is dosed biannually.

Denosumab (Prolia)

common side effects are back pain, UTI, high cholesterol, myalgia.

may cause hypocalcemia, so is contraindicated in hypocalcemic patients.

400

The patient with Paget's is changing from an oral to an injectable bisphosphonate. The nurse knows teaching is effective when the patient states that she will receive her zoledronic acid (Reclast) infusion 1 time each___________

year

Reclast is dosed once per year, Ibandronate (Boniva) the other bisphosphonate is dosed q 3 months

500

This drug is often used in the treatment of Paget's disease for patients that don't tolerated  bisphosphonate therapy. It's purpose is to reduce bone resorption and subsequently relieve pain. It also enhances calcium excretion in the kidney.

calcitonin

 

Musculoskeletal 3

100

Phantom limb pain described as dull and aching may be treated with this class of medications

beta blockers

200

This class of drugs is commonly given to treat phantom limb pain described as burning or sharp.

anti-epileptics

gabapentin or lyrica

300

Lioresal (baclofen) is a drug which works within the spinal cord, having no direct effect on muscle tissue to relieve _______ in a patient below the knee amputation.

muscle spasms

CNS depressant, unknown MOA

400

Iontophoresis is a treatment modality to reduce musculoskeletal inflammation generally performed by a physical therapist. The nurse knows this treatment uses local electric current to drive ________into the tissue. (this is the most commonly used medication for iontophoresis)

dexamethasone

glucocorticoid medication- administration via iontophoresis, very good tissue penetration, minimal systemic effects

500

This NSAID may be given IV prior to kypholoplasty or vertebroplasty to reduce post procedure inflammation.

Ketorlac (toradol

Musculoskeletal 4

100

What class of medications may be utilized along with NSAIDS for medical management of carpal tunnel syndrome?

corticosteroids

200

When discharging a patient with a fractured right humerous, the patient lists foods such as meats, nuts, milk, greek yogurt, cottage cheese as being foods that are good sources of __________ which is necessary for fracture healing.

Protein

300

This drug may be given IV for the treatment of phantom limb pain. (also commonly used to treat Paget's)

Calcitonin

mechanism unknown.

400

Arrythmias, muscle weakness, confusion, fatigue, nausea, vomiting, constipation and abdominal distention are signs and symptoms of___________

hypercalcemia

These patients are also at increased risk of DVT. monitor for calf pain and swelling.

500

IV infusion of Phentolamine (Regitine) may be used as well as or in place of injection of anesthetic next to the spine block sympathetic nerves in this condition.

Complex regional pain syndrome

Other treatments may be neurostimulation, treatment with corticosteroids, and in severe cases sympathectomy

Musculoskeletal 5

100

The patient with phantom limb pain has been treated with calcitonin. The patient now is exhibiting irritability, paresthesias, muscle twitching and spasming. The nurse recognizes these as s/s of_________

hypocalcemia

Other symptoms are nervousness, chvostek and trousseau's signs, seizures and cardiac arrhythmias. Calcitonin reduces resorption of bone and enhances renal excretion of serum calcium putting the patient at risk for hypocalcemia.

200

These are two drugs that are commonly used for PCA

Fentanyl, morphine, dilaudid

These are most commonly seen.

300

Calcium supplements are commonly available as combination supplements with ___________

Vitamin D

400

A 64 year old female pt. presents to the ED with a fractured left femur. This patient is normally healthy and her only regular medication is estradiol. The nurse knows this patient is at elevated risk for________.

Venous thromboembolism (VTE) (PE).

Estrogen therapy is contraindicated if hx of blood clots, stroke, MI or breast cancer.

500

Prior to beginning treatment with zoledronic acid (reclast) or pamidronate (Aredia) a dental exam is recommended due to the potential of these drugs to cause which rare but severe side effect.

Jaw osteonecrosis

Particularly at risk if oral hygiene is poor.