Pharm 4- RA & Bones

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Pharm 4- RA & Bones
2014-04-26 20:39:26
Pharm 4
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  1. ______ slow the progression of RA, they do not treat symptoms.
    • DMARDS
    • (more toxic than NSAIDS, which only provide relief of SYMPTOMS)
  2. Drug that is good for RA & malaria, but not for osteoarthritis.
    • hyroxychloroquine (Plaquenil)
    • -injection is painful*
  3. What is important to teach pts taking hyroxychloroquine (Plaquenil)?
    • periodic eye exams if on long-term therapy
    • (causes retinopathy, if not treated = blindness)
  4. 4 major AE of hyroxychloroquine (Plaquenil).
    • retinopathy
    • agranulocytosis
    • aplastic anemia
    • seizures
  5. _______ acts faster than all other NMARDS (therapeautic effects 3-6 wks).
    Methotrexate (Rheumatrex)
  6. What to monitor in pts taking Methotrexate (Rheumatrex).
    • CBC, platelet, BUN & creatinine, liver fxn
    • (hepatic fibrosis, bone marrow suppression, GI ulceration, pneumotitis)
  7. Administer Methotrexate (Rheumatrex) once per week with ______ to reduce toxicity.
    FOLIC acid.
  8. Most common reason for stopping sulfasalazine (Azulfidine). How to minimize?
    • GI rxns
    • use enteric coated form & divide daily dose
  9. What to monitor with Methotrexate (Rheumatrex).
    • CBC, platelet, liver enzymes
    • (hepatitis, bone marrow suppression=rare)
  10. The "-cept" and "-mab" drugs.
    • DMARDS
    • (biologic, work through immune system)
  11. What to watch for with DMARDS.
    • infection (suppressing immune system)
    • SJS
    • TB (can be reactivated after treatment)
    • Hep-B reactivation
    • lymphoma
  12. DMARDs can cause _____ toxicity.
    Lung, liver, & bone marrow
  13. Used when other agents have not worked for RA.
    Gold salts
  14. AE of gold salts.
    • kidney damage,
    • severe blood dyscrasias, 
    • profound hypOtension 
    • (Stop drug!)
  15. Med used for osteoarthritis, injected directly into joint once/week for 3-5 weeks.
    • Hyalgan
    • (acetaminophen is intitial drug of choice)
  16. What meds are used for acute flare up of arthritis?
  17. What is Allopurinol used to treat?
    maintenance (& prophylaxis) of Gout
  18. 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)
  19. Drugs for acute Gouty Arthritis
    • NSAIDs - first choice
    • glucocorticoids (prednisone)
    • colchicine (lg dose, anti-inflam, works w/in hrs)
  20. Low doses of _____ are prophylaxis of gouty arthritis, decrease frequency & intensity of attacks.
  21. What should a pt be advised to do if GI symptoms develop while taking colchicine?
    STOP med immediately
  22. Drug of choice for chronic tophaceous gout.
    Allopurinol (Zyloprim)
  23. Pt teaching with antigout meds.
    • *avoid alcohol (increases uric acid level & AE)
    • *increase fluid intake to 3-4 L per day
  24. AE of calcium salts.
    • Hypercalcemia, esp w/ lg doses of Vit D
    • CNS effects
    • nephrolethiasis
    • cardiac dysrhythmias
  25. Parenteral uses of calcium salts.
    • Severe hypocalcemia
    • tetany
  26. Contraindications for calcium salts.
    • v-fib
    • digoxin toxicity (increased risk of dysrhythmias)
  27. Calcium salts decrease absorption of ?
    • tetracycline
    • fluoroquinolones
  28. How is IV calcium administered?
    • SLOWLY (usually dripped over 15-30 min) to avoid: 
    • hypotention,
    • dysrhythmias,
    • *cardiac arrest*
  29. Why is calcium gluconate (Kalcinate) given?
    to protect heart against hyperexcitability from excessive K+ or Mg++ levels
  30. What should pts report while taking calcium?
    • lethargy
    • facial twitching, weakness of extremity
    • muscle spasms
    • seizures
  31. Pt teaching for calcium.
    • Eat calcium-rich foods (salmon, dark leafs, soybeans)
    • Avoid or limit zinc-rich foods (nuts, legumes, seeds, sprouts, & tofu)
  32. Things that decrease Ca++ absorption.
    • zinc-rich foods
    • alcohol
    • caffeine
    • carbonated beverages
  33. What is calcitriol?
    • prototype for Vit D
    • -elevates Ca++ levels 
    • -decreases PO4 levels
    • -promotes intestinal & renal absorption or Ca++
  34. What would you need to monitor in pts taking calcitriol?
    renal fxn & serum Ca++
  35. Meds that enhance effects of Vit D & cause hypercalcemia.
    • Thiazide diuretics
    • (don't combine calcitriol with thiazide diuretics, or caution/monitor)
  36. For treatment of established postmenopausal osteoporosis, NOT for prevention.
    • Calcitonin (from Salmon)
    •        -calcimar, miacalcin, fortical
    • -injection or nasal spray
  37. What tests should be OBTAINED prior to initiation of Vit D therapy?
    • liver fxn
    • UA
  38. Most common drug class for treating (postmenopausal) Osteoporosis.
  39. AE of biphosphonates.
    • osteonecrosis of jaw
    • bone pain (pelvic girdle, femur)
    • a-fib (if given IV)
  40. How is Fosamax administered?
    • PO
    • (a biphosphonate drug)
  41. AE with alendronate (Fosamax), a biphosphonate.
    • esophagitis
    • metallic taste
    • abdom pain, flatulence
  42. 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
  43. What is Boniva?
    • a biphosphonate
    • lower risk of esophagitis
  44. Drug that can normalize serum Ca++ levels within 10 days of one IV injection & for postmenopausal osteoporosis, can be given once/yr IV.
    • Zoledronate 
    • (Reclast for osteoporosis,
    • Zometa for hypercalcemia)
    • *would have BONE PAIN for a few weeks
  45. What 3 things can estrogen therapy do?
    • preserve bone mineral density
    • reduce plasma levels of cholesterol
    • protect against breast & endometrium cancer
    • prototype = EVISTA
  46. What is Forteo?
    • Parathyroid hormone
    • only drug for osteoporosis that increases BONE FORMATION
    • AE: sycope, angina
  47. Headache, dizziness, and blurred vision are all early symptoms of toxicity to ________.
  48. How does colchicine work?
    prevents the accumulation of uric acid crystals in the joints
  49. ______ 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
  50. The risk of _________ is a prominent adverse effect of hydroxychloroquine.
    visual disturbances