Term
| Goal of drug therapy for RA |
|
Definition
decrease pain and inflammation
prevent disabling deformities such as ulnar deviation
Through: NSAIDs, glucocorticoids, DMARDs |
|
|
Term
| Goal of drug therapy for MG |
|
Definition
increase amount of acetylcholine for muscle contraction in order to decrease muscle weakness and fatigue
through: cholinesterase inhibitors and neuromuscular blocking agents |
|
|
Term
| goal of drug therapy for Osteoporosis |
|
Definition
prevent excessive loss of Ca from bones
prevent fractures: OA esp - hip, wrist and spinal vertebra
through: SERMS, biphosphonates, calcitonin and calcium supplements |
|
|
Term
| DMARD I prototype and other |
|
Definition
methotrexate (Rhuematrex)*
leflunomide (Arava) |
|
|
Term
| DMARD I side/adverse effects |
|
Definition
Hepatotoxicity
Bone marrow suppression
Increased infection risk
GI ulceration -Meth
Pulmonary fibrosis
PregD: metho
PregX: Leflu |
|
|
Term
| DMARD I PT Teaching and Admin |
|
Definition
No pregnancy of 6 months after
LFT - yellowing
PLT, RBC, WBC - bruising, petechia, melena, hemapotysis
Watch: SOB, resp dis, DEC sp02
once per week oral subQ or IM with a folic acid to reduce tox |
|
|
Term
| DMARD II Protoype and others |
|
Definition
etanercept (Enbrel)*
Infliximab (Remicade)
Adalimumab (Humira)
tumor necrosis factor antagonists - prevents inflamm reaction in joints - immunosuppression |
|
|
Term
| DMARDS II side/adverse effects |
|
Definition
infection susceptibility
heart failure
reactivation of latent TB or worsening of active
Severe skin reactions:
- SJ syndrome, toxic epidermal necrolysis, erythema multiforme |
|
|
Term
| DAMRDS II PT teaching and Admin |
|
Definition
monitor for infection
monitor skin/inj site
monitor for HF: cough, SOP, INC BP or HR, pink sputum
give TB test
subQ twice weekly |
|
|
Term
|
Definition
not used frequently to treat RA anymore due to side effects - only in SEVERE cases
prototyle aurothioglucose (Solganal)/gold salt |
|
|
Term
| Cholinesterase inhibitor use/prototype |
|
Definition
prolong action of acetylcholine by inhibiting acetylcholinesterase to improve muscle strength and improve endurance in MH
Neostigmine (Prostigmine) and pyridostigmine (Mestinine) |
|
|
Term
| Cholinesterase Inhibitor adverse effects |
|
Definition
Low levels: muscle weakness and resp paralysis THREE hours after administrationg
High levels:
bradycardia (hold under 60)
increased intestinal motility
increased salivation (that is severe, also a SE)
muscle weakness and resp paralysis within ONE HOUR of administration (Cholinergic Crisis)
- make a schedule and give 45-60m before food to strengthen eating |
|
|
Term
| Neuromuscular Blocking Agents |
|
Definition
IV
depolarizing: succinycholine (Anectine)
which causes paralysis during anesthesia
pancuronium (Pavulon): prevents muscle contraction by muscle fiber
control seizures during ECT and suppress spontaneous resp and gag reflex during intubation |
|
|
Term
| Neuromuscular blocking agents effects/teaching |
|
Definition
post-op pain when used for induction: neck/upper back - analgestic
Hyperkalemia - monitor
Hypotension from histamine release - freq check and give anti-histamine
bradycardia, cardiac/resp effect adverse from dep - have resus equip
Malignant hyperthermia
- inj given by weight for short and titrated by level of paralysis desired for long |
|
|
Term
|
Definition
Selective Estrogen Receptor Modulators
- prevention and treatment of postmenopausal osteoporosis, reduce estrogen dep cancer
- by activating estrogen receptors to decrease bone resorption/loss
raloxifene (Evista)* less uterine cancer
tamoxifen (Nolvadex) |
|
|
Term
| SERMS side/adverse effects |
|
Definition
Increased risk due to estrogen receptor activation
- Endometrial cancer
- Pulmonary embolism
- DVT
- Hot flashes
- Pregnancy X: contraception |
|
|
Term
|
Definition
take orally daily with or without food
- comsume adequate Ca and VitD
use contraception
watch for PE and DVT s/sx - d/c
Daily weight bearing exercises |
|
|
Term
|
Definition
prevent/treat postmeno osteoporosis, age related in men and glucocorticoid related by decreasing bone resporting by decreasing #/action of osteoclasts
alendronate (Fosamax)*
Ibandronate (Boniva)
Risedronate (Actonel) |
|
|
Term
| Bisphosphonates side/adverse effects |
|
Definition
Esophagitis if not taken correctly
GI disturbances
Muscle and joint pain that may need d/c or drug holidays
eye pain and vision changes that are uncommon |
|
|
Term
| Bisphosphonates administration |
|
Definition
30 minutes before breakfast with a full glass of water to prevent esophagitis
then sit/stand 30 minutes and don't eat/drink anything but water or take any antacid or calcium supplements
report pain that persists or changes in vision |
|
|
Term
|
Definition
treat postmenopausal osteoporosis and hyperCa from hyperparathyroidism and Paget's disease by providing thyroid gland like actions - decrease serum Ca, increase excretion, inhibit osteoclasts and decrease bone resorption
Oral: Calcimar
Intranasal: Miacalcin |
|
|
Term
| Calcitonin effects/teaching |
|
Definition
Hypersensitivity from fish/salmon allergy so perform intradermal allergy test prior and allert of itching/rash
HypoCa if excre exceeds intake
- so hae diet high in Ca and vit D and report muscle spasms or tingling
decrease in therapeutic effect over time
nasal dryness/irritation - assess
- one nostril, alternate nostrils
store subQ/IM in refridgerator |
|
|
Term
|
Definition
calcium citrate (Citracal)
calcium carbonate (tums) |
|
|
Term
| Calcium supplement long term effects |
|
Definition
hyperCa risk: n/v, constipation, polyuria, depression
Kidney stones: watch for flank pain and blood in the urine |
|
|
Term
| calcium supp administration |
|
Definition
one hour before or 1-2 hours after: glucocortioids, thyroid supplements, tetracycline/quinolone antibiotics
calcium based antacids one hour after meals and at bedtime with a glass of water |
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