Ortho Pharm
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| Describe Spasms | Involuntary muscle contractions of sudden onset, short term, and acute.
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| Muscle spasms result from… | Excessive use of skeletal muscle, cramp, and local trauma to skeletal muscle.
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| Other causes of Muscle Spasms are… | Over medication with antipsychotic drugs, epilepsy, hypocalcemia, and pain.
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| What are some nonpharmacologic treatments for spasms? | Heat (promte healing of spasms), hydrotherapy, ultrasound, splinting, Stretching exercises (prevent contractures r/t spasticity), massage, and manipulation.
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| what is the goal of pharmacotherapy r/t spasms? | Relieve muscular stiffness and rigidity; Improve mobility.
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| what kinds of pharmacotherapy can be used r/t spasms? | Analgesics, anti-inflammatory agents (NSAIDs), antispasmodic drugs (muscle relaxants), centrally-acting antispasmodic drugs.
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| describe spasticity… | Muscular hypertonicity with resistance to stretching, continuous state of contraction, movements require great effort and coordination is poor, usually chronic.
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| What are the causes of spasticity | Debilitating neurological disorders (multiple sclerosis, stroke, spinal cord injury, dystonia - involuntary movement and postures).
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| What often contributes to contractures? | spasticity often contributes to the development of contractures (neurogenic).
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| What is the treatment for spasticity? | Physical therapy, surgery - severe cases (tendon releases, and Rhizotomy); medications - central acting.
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| What are central-acting antispasmodics? | same meds used for spasms and spasticity.
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| What are some examples of Antispasmodics? | Cyclobenzaprine (Flexeril), Baclofen (Lioresal)-usually just for spasticity, Diazempam (Valium), Lorazepam (Ativan).
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| What does "Upper Motor Neuron" mean with regards to antispasmodics? | Talking about the brain.
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| What is the action of Cyclobenzaprine (Flexeril)? | For local / acute muscle spasms. Taken for 2-3 weeks.
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| What is the the Alert for Cyclobenzaprine (Flexeril)? | May take 1-2 wk for max effect.
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| What are the side effects of Cyclobenzaprine (Flexeril)? | Drowsiness, blurred vision, dry mouth, rash, tachycardia.
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| What are the interactions of cyclobenzaprine (Flexeril)? | alcohol, phenothiazines, other CNS depressants, MAOIs
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| what is the Patient Education for cyclobenzaprine (Flexeril)? | avoid driving and other hazardous activities requiring mental alertness until effect is known, report change in sensorium (floaty feeling), slurred speech and confusion, report chestpain, dyspnea, weakness, or visual disturbances.
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| what does the treatment of spasticity at the cord level inhibit? | reflexes at brain and/or spinal cord.
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| what meds are used in treatment of spasticity at the cord level? | baclofen (Lioresal), tizanidine (zanaflex), and Benzodiazepines. (Used alone or with other medications).
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| What are some direct-acting antispasmodic meds for treatment at the muscle level? | Dantrolene sodium (Dantrium), Botulinum toxin A (Botox, Dysport) and botulinum toxin type B (Myoblocare)
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| What problems may there be with high doses of botulinum toxin A and B? | high doses act as a poison, given with central-acting oral medications, injected directly into muscle (usually facial muscles), drawbacks
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| Nursing considerations for all antispasmodics | Monitor patient's condition and with central-acting drugs look for contraindications.
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| Patient education with antispasmodics | avoid hazardous activities, avoid alcohol, benzodiazepines, opioids, and antihistamines, do not withdraw abruptly.
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| What are the actions for dantolene sodium (Dantrium)? | for spasticity (esp after a stroke; cerebral palsy; multiple sclerosis
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| What are alerts for dantrolene sodium (Dantrium)? | IV form is very irritating to a vein (give diluted into a large vein)
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| what are the adverse effects of Dantrium? | weakness, drowsiness, N, D, tachycardia, urinary retention.
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| what is the patient education for Dantrolene? | avoid hazardous activities; avoid alcohol, antihistamines, CNS depressants; precautions if taken with calcium channel blockers. (inc risk of v-fib)
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| What does Hypocalcemia contribute to? | contributes to muscle spasms.
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| What are the signs and symptoms of Hypocalcemia? | Calcium is needed for nerve and muscle function. Cell membranes become very excitable (muscle spasms, convulsions/seizures), and Tetany (continuous spasm).
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| What is the treatment for hypocalcemia? | Calcium supplements.
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| What is Calcium essential for? | essential for bone formation
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| What does the parathyroid gland secrete? | parathyroid hormone
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| What does PTH stimulate? | stimulates osteoclasts
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| What do osteoclasts accelerate? | accelerate bone resorption
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| Where does calcium go once it's released from the bones? | goes into the blood
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| What is the role of the thyroid in bone formation? | higher levels of Ca in the bldstrm cause the thyroid gland to release calcitonin and causes the addition of Ca to bone and dec absorption of Ca in the sm intestine; this causes lower lvls of Ca in the bldstrm
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| What does calcitonin do when secreted from the Thyroid gland? | Calcitonin stimulates bone deposition, calcium is removed from the blood and depositied in bones.
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| What is the role of the parathyroid gland? | lower lvls of Ca in bldstrm -> release of PTH -> causes release of Ca from bones, inc Ca reabsorption from kidneys, and inc absorption of Ca in sm intestine (w/ help of Calcitrol or vit D); this causes higher lvls of Ca in bldstrm
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| If someone has hypothyroid and does not want to take meds for it, how will it affect her bones? | she will get osteoporosis, she won't have calcitonin to build bone
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| What hormone helps control calcium levels in the blood? | parathyroid hormone
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| What is involved in maintaining calcium homeostasis? | regulated through a hormonal system that controls calcium transport in the gut, kidney, and bone. The GI tract absorbs Vit D. The liver produces vit D absorbed by sunlight (UV) and the skin.
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| What are some dietary sources of calcium? | dark green veggies, canned salmon (with bones), fortified foods- OJ, Milk, tofu
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| What is proper calcium balance important for? | nerve conduction (including electrical conduction in the heart), blood coagulation, and muscle contraction (including muscle spasms)
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| What are some calcium-related disorders? | hypocalcemia, osteomalacia, osteoporosis, Paget's disease
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| Hypocalcemia is usually a sign of what? | usually a sign of an underlying disorder
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| What are causes of hypocalcemia? | low PTH (parathyroid hormone)secretion, malabsorption, vit D deficiencies
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| What are symptoms of hypocalcemia? | nerve and muscle excitability (muscle twitching, tremor, cramping, numb/ tingling extremities, confusion/ abnormal behavior, seizure
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| How are severe cases of hypocalcemia treated? | IV admin of calcium salts (must monitor heart rhythm during admin, high Ca could stop the heart)
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| How are mild cases of hypocalcemia treated? | oral calcium supplements
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| What are examples of calcium supplements? | calcium gluconate, calcium carbonate (Tums), calcium citrate (Citracal)
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| What is the action of calcium gluconate? | treats osteoporosis and Paget's
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| what are alerts for calcium gluconate? | give PO with meals; if IV, admin slowly w/cardiac monitor (RN would admin IV push); reduce dose in renal insufficiency
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| What are adverse effects of Calcium gluconate? | hypercalcemia: drowsiness, lethargy, wkness, HA, N, V, inc thirst and urination; IV: hypotension, bradycardia, dysrhythmia, cardiac arrest
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| What interacts with calcium gluconate? | magnesium, tetracycline, cardiac glycosides
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| What is patient education for Calcium Gluconate? | S&S of hyper and hypo calcemia, report palpitations or dyspnea; pain at IV site (extravasation/ necrosis)
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| What should patients taking Calcium Gluconate increase intake of? | increase intake of dietary Ca and AVOID zinc (don't want in the stomach at the same time)
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| What are side effects for Calcitrol? | HA, wkness, dry mouth, thirst, increased urination, muscle or bone pain
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| What may thiazide diuretics contribute to r/t pt taking Calcitrol? | may contribute to hypercalcemia
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| What are adverse effects of Calcitrol? | dysrhythmia in pt receiving cardiac glycosides, do not give Magnesium concurrently
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| What is osteomalacia (rickets) related to? | r/t low calcium and vit D in diet, renal failure, malabsorption
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| What are signs and symptoms of osteomalacia (rickets)? | bone pain, muscle weakness and spasms, hypocalcemia
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| What are tests for osteomalacia? | CT, serum Ca, phosphate, vit D levels
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| What is the treatment for osteomalacia? | calcium and vit D, surgery to correct disfigured limbs
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| What are some causes of osteoporosis? | diet, disrupted homeostasis
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| How is osteoporosis diagnosed? | a bone density test
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| What are risk factors for osteoporosis? | menopause; low testosterone and estrogen; alcohol, tobacco, caffeine consumption; inactivity; some meds: cortocosteroids, some anticonvulsants, and immunosuppressants
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| What types of treatment are used for osteoporosis? | Hormone replacement therapy (HRT), Calcitonin, SERMS and biphosphonates
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| What treatment for osteoporosis was a common treatment but is no longer recommended? | Hormone replacement therapy (HRT)
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| Who is Calcitonin approved for and how is it taken? | approved for women over 5 years past menopause, given by nasal spray or SC inj (usually one spray in one nare per day, alternate nares each day)
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| How does Calcitonin help someone with osteoporosis? | it reduces the risk of vertebral fractures
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| What kind of med is raloxifene (Evista)? | a SERM-selective estrogen receptor modulator
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| raloxifene (Evista) is highly bound to what? | highly protein bound
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| What are the actions of raloxifene (Evista)? | decreases resorption and increases density of bone, used to PREVENT osteoporosis, also decreases tl cholesterol and LDL
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| What are alerts for raloxifene (Evista)? | give with or without food, pregnancy category X (fetus wouldn't develp bones properly)
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| What are adverse effects of raloxifene (Evista)? | hot flashes, migraines, flu-like aches, breast pain, vaginal bleeding
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| What are interactions of raloxifene (Evista)? | do not take HRT or lipid lowering meds concurrently; monitor warfarin (coumadin) closely; ampicillin, ibuprofen and other highly protein bound meds (they would compete)
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| What do bisphosphonates do? | inhibit bone resorption
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| What are adverse effects of bisphosphonates? | GI (N, V, abd pain), esophageal irritation
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| What are some examples of bisphosphonates? | Etidronate (Didronel), Alendronate (Fosamax), Tiludronate (Skelid), Pamidronate (Aredia)
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| What is the action of etidronate (Didronel)? | slows bone resorption, effect begins w/in 1-3 months, lowers serum alkaline phosphatase
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| What is etidronate (Didronel) used for? | osteoporosis, bone cancer, Paget's disease
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| What are alerts for etidronate (Didronel)? | take on an empty stomach 2 hours before meals
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| What are adverse effects of etidronate (Didronel)? | D, N, V, esophageal irritation, altered taste: metallic
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| What are interactions for etidronate (Didronel)? | Ca supplements decrease absorption; iron and antacids decrease effectiveness
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| What is patient education for bisphosphonates? | report N, D, change in urination, sudden bone or joint pain or swelling, sx of hypo or hyper calcemia
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| what diet should pt's have when on bisphosphonates? | inc calcium, phosphate, and Vit. D
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| What is the max amount of time someone would take a bisphosphonate? | prescribed for 6 months max
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| Bisphosphonates help build bones throughout the body, but they demineralize what? | demineralize the mandible, cause teeth problems- they get loose and start to fall out
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| How is Paget's disease diagnosed? | high alk phos, Ca++, eventual arthritis, kidney stones, heart disease
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| What is the treatment for Paget's disease? | Bisphosphonates-drugs of choice; calcitonin nasal spray; adequate calcium and Vit. D in diet; surgery/ ORIF-open reduction, internal fixation
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| How is Paget's disease described? | chronic, progressive; increased rate of bone formation and resorption; new bone is weak and brittle
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| Meds for Paget's disease treat what symptoms? | hip and femur pain; joint inflammation; HA, facial pain, hearing loss, pinched spinal nerves
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| What kind of disease is osteoarthritis (OA)? | a degenerative disease ('wearing out of joint cartilage')
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| What are symptoms of OA? | localized pain and stiffness; knee, spine, and hip are most affected joints; it's very common
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| Information about glucosamine and chondroitin used for OA? | natural substance, OTC supplement, safe but not proven effective
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| What are meds for OA? | Analgesics, Anti-inflammatory drugs, and biologic meds
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| What are examples of analgesics for OA? | acetaminophen (Tylenol), topical meds (capsaicin, menthol based creams)
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| What are examples of anti-inflammatory drugs for OA? | NSAIDs, COX-2 inhibitors (prescription only)
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| What is an example of a biologic med for OA? | sodium hyaluronate (Hyalgan)- injected once a week into knee for 3-5 wks
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| What is the etiology of rheumatoid arthritis (RA)? | autoimmune disease, chronic, systemic inflamm of multiple joints
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| What does Rheumatoid arthritis (RA) affect? | joints, muscles, ligaments, tendons, lungs, heart, etc.
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| What are symptoms of RA? | disfiguring, bilateral, symmetrical
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| What are meds for RA? | analgesics and anti-inflammatory drugs (may take wks to reach full effect); glucocorticoids; disease modifying drugs; immunosuppressants; Tumor necrosis factor (TNF) blockers
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| What is an example of a glucocorticoid for RA? | prednisone
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| What are some examples of disease-modifying drugs for RA? | hydroxycholoroquine (Plaquenil), gold salts, sulfasalazine, penicillamine
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| What are some examples of imunosuppressants for RA? | methotrexate (a cancer drug that also treats RA), cyclosporine, Imuran, Cytoxan
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| What are some examples of tumor necrosis factor (TNF) blockers for RA? | Enbrel, Remicade
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| What are nonpharmacologic treatments for pain of arthritis? | non-impact exercise and PROM, splinting, hot/cold, imagery, meditation, massage, distraction, PT and OT, surgery/ joint replacement
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| What are actions for hydroxychloroquine sulfate (Plaquenil)? | for RA and lupus pts who have not responded to other anti-inflamm meds, used in conjuction w/salicylates and glucocorticoids, also used to treat malaria
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| What med is also used to treat malaria? | hydroxychloroquine sulfate (Plaquenil) (it treats malaria, DOES NOT PREVENT it)
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| What are alerts for hydroxychloroquine sulfate (Plaquenil)? | take with milk at the same time each day, store safely, very toxic to children
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| What are adverse effects of Plaquenil? | eyes-blurred vision, photophobia, blacked out areas of the visual field, HA, GI, mood and mental changes, loss of hair
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| What are interactions for Plaquenil? | antacids w/aluminum and magnesium prevent absorption, alcohol and hepatotoxic meds, increased digitalis lvls
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| What is gout? | "hyperuricemia" too much uric acid in the blood. Increased production of uric acid (genetic, esp. Pacific Islanders) and reduced excretion of uric acid by the kidneys
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| What are the types of gout? | Primary gout and secondary gout
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| What is acute gouty arthritis? | the sudden onset of joint pain from uric acid deposits that frequently start at night.
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| What are goals of treatment for gout? | relieve pain and inflammation of acute attks, prevent future attks
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| What is pharmacotherapy for acute gout attacks? | NSAIDs, COX-2 inhibitors, Uric acid inhibitors, glucocorticoids
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| What measures can be taken for prophylaxis of gout? | avoid high-purine foods; use drugs that lower uric acid; inc excretion of uric acid; inhibit formation of uric acid
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| What foods contain high-purine? | milk, fruits, most veggies, carbonated drinks, molasses, baking soda, alcohol, organ meats (ex: liver)
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| What are the actions for colchicine? | reduces pain and inflamm; prevents gout attk by preventing uric acid deposits
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| What are adverse effects for colchicine? | N, V, D, GI upset; interferes with B12 absorption
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| What information should you obtain for baseline data? | Health history, medication history, lab studies, vital signs, contraindications, precautions
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