Pharm 4- RA & Bones
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. What would you like to do?
______ slow the progression of RA, they do not treat symptoms.
- (more toxic than NSAIDS, which only provide relief of SYMPTOMS)
Drug that is good for RA & malaria, but not for osteoarthritis.
- hyroxychloroquine (Plaquenil)
- -injection is painful*
What is important to teach pts taking hyroxychloroquine (Plaquenil)?
- periodic eye exams if on long-term therapy
- (causes retinopathy, if not treated = blindness)
4 major AE of hyroxychloroquine (Plaquenil).
- aplastic anemia
_______ acts faster than all other NMARDS (therapeautic effects 3-6 wks).
What to monitor in pts taking Methotrexate (Rheumatrex).
- CBC, platelet, BUN & creatinine, liver fxn
- (hepatic fibrosis, bone marrow suppression, GI ulceration, pneumotitis)
Administer Methotrexate (Rheumatrex) once per week with ______ to reduce toxicity.
Most common reason for stopping sulfasalazine (Azulfidine). How to minimize?
- GI rxns
- use enteric coated form & divide daily dose
What to monitor with Methotrexate (Rheumatrex).
- CBC, platelet, liver enzymes
- (hepatitis, bone marrow suppression=rare)
The "-cept" and "-mab" drugs.
- (biologic, work through immune system)
What to watch for with DMARDS.
- infection (suppressing immune system)
- TB (can be reactivated after treatment)
- Hep-B reactivation
DMARDs can cause _____ toxicity.
Lung, liver, & bone marrow
Used when other agents have not worked for RA.
AE of gold salts.
- kidney damage,
- severe blood dyscrasias,
- profound hypOtension
- (Stop drug!)
Med used for osteoarthritis, injected directly into joint once/week for 3-5 weeks.
- (acetaminophen is intitial drug of choice)
What meds are used for acute flare up of arthritis?
What is Allopurinol used to treat?
maintenance (& prophylaxis) of Gout
What is something important to teach pts with gout?
drink 2-3 LITERS of fluid per day to prevent renal calculi (from build up of uric acid)
Drugs for acute Gouty Arthritis
- NSAIDs - first choice
- glucocorticoids (prednisone)
- colchicine (lg dose, anti-inflam, works w/in hrs)
Low doses of _____ are prophylaxis of gouty arthritis, decrease frequency & intensity of attacks.
What should a pt be advised to do if GI symptoms develop while taking colchicine?
STOP med immediately
Drug of choice for chronic tophaceous gout.
Pt teaching with antigout meds.
- *avoid alcohol (increases uric acid level & AE)
- *increase fluid intake to 3-4 L per day
AE of calcium salts.
- Hypercalcemia, esp w/ lg doses of Vit D
- CNS effects
- cardiac dysrhythmias
Parenteral uses of calcium salts.
- Severe hypocalcemia
Contraindications for calcium salts.
- digoxin toxicity (increased risk of dysrhythmias)
Calcium salts decrease absorption of ?
How is IV calcium administered?
- SLOWLY (usually dripped over 15-30 min) to avoid:
- *cardiac arrest*
Why is calcium gluconate (Kalcinate) given?
to protect heart against hyperexcitability from excessive K+ or Mg++ levels
What should pts report while taking calcium?
- facial twitching, weakness of extremity
- muscle spasms
Pt teaching for calcium.
- Eat calcium-rich foods (salmon, dark leafs, soybeans)
- Avoid or limit zinc-rich foods (nuts, legumes, seeds, sprouts, & tofu)
Things that decrease Ca++ absorption.
- zinc-rich foods
- carbonated beverages
What is calcitriol?
- prototype for Vit D
- -elevates Ca++ levels
- -decreases PO4 levels
- -promotes intestinal & renal absorption or Ca++
What would you need to monitor in pts taking calcitriol?
renal fxn & serum Ca++
Meds that enhance effects of Vit D & cause hypercalcemia.
- Thiazide diuretics
- (don't combine calcitriol with thiazide diuretics, or caution/monitor)
For treatment of established postmenopausal osteoporosis, NOT for prevention.
- Calcitonin (from Salmon)
- -calcimar, miacalcin, fortical
- -injection or nasal spray
What tests should be OBTAINED prior to initiation of Vit D therapy?
Most common drug class for treating (postmenopausal) Osteoporosis.
AE of biphosphonates.
- osteonecrosis of jaw
- bone pain (pelvic girdle, femur)
- a-fib (if given IV)
How is Fosamax administered?
AE with alendronate (Fosamax), a biphosphonate.
- metallic taste
- abdom pain, flatulence
How to prevent GI AE with alendronate (Fosamax), a biphosphonate.
- take w/ at least 8 oz water
- walk or sit upright for 30-60 min after taking
- take on empty stomach 1st thing in morning
- do not eat for at least 30-60 min after taking
- swallow WHOLE
What is Boniva?
- a biphosphonate
- lower risk of esophagitis
Drug that can normalize serum Ca++ levels within 10 days of one IV injection & for postmenopausal osteoporosis, can be given once/yr IV.
- (Reclast for osteoporosis,
- Zometa for hypercalcemia)
- *would have BONE PAIN for a few weeks
What 3 things can estrogen therapy do?
- preserve bone mineral density
- reduce plasma levels of cholesterol
- protect against breast & endometrium cancer
- prototype = EVISTA
What is Forteo?
- Parathyroid hormone
- only drug for osteoporosis that increases BONE FORMATION
- AE: sycope, angina
Headache, dizziness, and blurred vision are all early symptoms of toxicity to ________.
How does colchicine work?
prevents the accumulation of uric acid crystals in the joints
______ toxicity may occur in the client receiving calcitriol. Symptoms to assess include _______, fatigue, nausea, vomiting, and changes in _________.
- Vitamin D
- muscle weakness,
- color or amount of urine
The risk of _________ is a prominent adverse effect of hydroxychloroquine.
What would you like to do?
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