Pharm - Musculoskeletal, Pain & Inflammation

Musculoskeletal, Pain and Inflammation

Heather Miller, MSN, RN

Objectives

• Explain the expected therapeutic effects of Musculoskeletal System and Pain & Inflammation Medications.

• Summarize the pharmacological action of Musculoskeletal System and Pain & Inflammation Medications.

• Monitor for common adverse effects of Musculoskeletal System and Pain & Inflammation Medications.

• Apply the concept of safe medication administration and dosage calculation when administering Musculoskeletal System and Pain & Inflammation Medications.

• Reinforce client education regarding Musculoskeletal System and Pain & Inflammation Medications.

• Determine if the Musculoskeletal System and Pain & Inflammation Medications are appropriate for the client.

• Monitor for potential interactions that can cause adverse or life-threatening effects when administering Musculoskeletal System and Pain & Inflammation Medications.

Musculoskeletal Disorders

• Rheumatoid Arthritis - autoimmune

• Osteoarthritis - age, injury, heredity

• Osteoporosis - age, lifestyle, heredity

DMARDs

• Slows RA progression & joint degeneration

• Immunosuppress

• Methotrexate

  • Increase risk of infection, bone marrow suppression

  • Avoid NSAIDs, but take folic acid

  • Can take 3-6 weeks for therapeutic effect

  • Hydration

Multiple Choice

A client taking methotrexate for rheumatoid arthritis reports mouth sores and fatigue. Recent labs show:

WBC 2,800/mm³ (normal: 4,500–11,000)

ALT 110 U/L (normal: 7–56)

Which nursing action is most appropriate?

• Administer methotrexate with food to reduce nausea

• Hold the dose and notify the provider

• Encourage the client to drink extra water

• Schedule the next dose as prescribed

​Resorption vs Reabsorption

SERMs

• Prevent and treat postmenopausal osteoporosis

• Raloxifene

  • Activates and blocks estrogen receptors

  • Increases hot flashes and risk for stroke or DVT

  • Take extra calcium and Vitamin D

  • Monitor bone density, for blood clots, and cholesterol

Bisphonates

• Prevent and treat postmenopausal osteoporosis

• Alendronate

  • Decreases bone resorption

  • Esophagitis, vision changes, osteonecrosis of jaw

  • Take with water, sit/stand for 30m, analgesic for mild pain

  • Avoid if difficulty swallowing, unable to sit/stand, renal insufficiency, upper GI disorder

Calcitonin

• Treats postmenopausal osteoporosis and hypercalcemia

• Calcitonin-Salmon

  • Decreases bone resorption; inhibits osteoclasts and increases calcium excretion

  • Hypersensitivity; hypocalcemia; epistaxis; site irritation

  • Allergy test before admin; rotate inj sites and nares

  • Diet high in calcium and Vitamin D

Dropdown

The client should monitor and report a

Select answer

while taking calcitonin.

Calcium Supplements

• Calcium deficiency

• Calcium Citrate

  • Dietary supplement

  • Take with Vitamin D to increase absorption

  • Hypercalcemia -> kidney stones

  • Monitor urine output, flank pain, hematuria, decreased GI motility

Multiple Choice

A nurse is reinforcing teaching with a client who is to start taking calcium citrate as a calcium supplement. Which of the following foods should the nurse instruct the client to consume to increase the absorption of calcium?

• Strawberries

• Spinach

• Fish

• Peanuts

Multiple Choice

A nurse is caring for a client who has osteoporosis and is taking calcium citrate. The nurse should monitor the client for which of the following adverse effects?

• Tinnitus

• Urinary retention

• Hypercalcemia

• Bradycardia

Pain & Inflammation

• Chronic pain

• Gout

• Migraines

Adjuvant Meds for Pain

Adjuvant meds are used with a primary pain medication to increase pain relief.
Reduces the amount of opioids necessary to achieve pain relief, thereby reducing adverse effects (respiratory depression, sedation, constipation).

• NSAIDs - reduces inflammation and pain

  • Ibuprofen

  • Aspirin

  • Celecoxib

• Acetaminophen - relieves pain & fever

​Non-opioid

• Tramadol - analgesic for mild-to-moderate pain

• Morphine - mod - severe pain

• Naloxone - antagonist

​Opioid

Multiple Choice

A 72-year-old client with osteoarthritis is prescribed celecoxib. The client has a history of hypertension and peptic ulcer disease. Which assessment finding requires immediate action before administering the first dose?

• Blood pressure 148/92 mmHg

• Black, tarry stools

• Mild knee swelling

• Occasional headache

Multiple Choice

A nurse is reinforcing teaching with a client who is about to start taking allopurinol to treat gout. Which of the following statements by the client indicates an understanding of the teaching?

• ​"If I get a rash, I will take my usual antihistamine."
  

• "I need to drink at least 3 quarts of water a day."
  

• ​"I should take the medicine on an empty stomach."
  

• "I will expect to develop a fever while taking this medicine."
  

• ​Stops the production of uric acid, reducing future attacks

• Allopurinol

  • Hypersensitivity, GI upset, thrombocytopenia

  • Monitor uric acid, liver & kidney function

  • Drink water!

  • Increases anticoag effects

​Antigout

• ​Delay RA progression; anti-inflammatory effects

• Prednisone

  • Hyperglycemia; immunosuppression; bone loss; cataracts

  • Monitor BS, vitals, K and Na

  • Weight-bearing exercises

  • Report s/s of infection, weight gain & edema

  • Take with food, taper dose slowly

​Glucocorticoid (cortisol)

• ​Prevent inflammation & dilation of intracranial blood vessels

• Sumatriptan

  • Stops migraine or prodromal s/s

  • Chest pressure, dizziness, vertigo

  • Not for those with liver failure, heart disease

  • Not used more than 2x week

  • Dark, quiet room; avoid triggers

​Serotonin Receptor Agonist

Multiple Choice

A client with rheumatoid arthritis has been taking prednisone 10 mg daily for 6 months. The nurse notes:

Weight gain of 10 lbs in 3 months

Blood glucose 220 mg/dL

Occasional back pain

Which nursing intervention is the highest priority?

• Advise the client to reduce sodium intake

• Schedule a DEXA scan to assess for osteoporosis

• Encourage mild exercise to prevent weight gain

• Monitor for hypoglycemia

Dropdown

A client with moderate chronic pain is prescribed tramadol. The client has a history of seizures and occasional dizziness. Which instruction should the nurse emphasize first during teaching?

Select answer

Open Ended

What teaching should the nurse include for the patient newly prescribed sumatriptan?