Transcript The Examination

PYRAMID POINTS
CHAPTER 68:
MUSCULOSKELETAL
MEDICATIONS
PYRAMID POINTS
I. Skeletal Muscle Relaxants

Description
• Act directly on neuromuscular junction or indirectly on central
nervous system
• Contraindicated in clients with severe liver, renal, heart disease


Side effects
• Drowsiness
• Dizziness
• Muscle weakness
• Hypotension
Interventions
• Assess involved joints, muscles for pain, mobility
• Monitor liver and renal function test results
• Instruct client to take with food
• Instruct client to report side effects
ADULT HEALTH:
Musculoskeletal Medications
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
68-2
PYRAMID POINTS
I. Skeletal Muscle Relaxants (continued)

Nursing considerations (continued)
• Baclofen (Lioresal)

Can be administered by physician via intrathecal infusion

Liver damage most serious adverse effect
Instruct client to notify physician if rash, bloody, tarry stool,
jaundice develops
• Dantrolene (Dantrium)

• Cyclobenzaprine (Flexeril)

Contraindicated in clients receiving MAO inhibitors within 14 days
of initiation of cyclobenzaprine therapy
• Methocarbamol (Robaxin)



Parenteral form can cause hypotension, bradycardia, anaphylaxis,
seizures
May turn urine brown, black, or green
Inform client to notify physician if blurred vision, nasal congestion,
urticaria, rash develops
ADULT HEALTH:
Musculoskeletal Medications
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
68-3
PYRAMID POINTS
II. Antigout Medications

Description
• Allopurinol (Zyloprim) can increase effects of warfarin
(Coumadin), oral hypoglycemic agents

Side effects
• Blood dyscrasias
• Uric acid kidney stones
ADULT HEALTH:
Musculoskeletal Medications
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
68-4
PYRAMID POINTS
II. Antigout Medications (continued)

Interventions
• Maintain fluid intake of at least 2000 to 3000 mL/day
• Instruct client not to take large doses of vitamin C
•
•
•
•
•
•
concurrently
Instruct client to avoid foods high in purine
Instruct client to take with food
Advise client to minimize exposure to sunlight
Advise client to have yearly eye examination
Caution client not to take aspirin concurrently
Advise client to use acetaminophen (Tylenol) instead of
aspirin
ADULT HEALTH:
Musculoskeletal Medications
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
68-5
PYRAMID POINTS
III. Antiarthritic Medications






Inflammation control in rheumatoid arthritis key to preserving
joint function
Nonsteroidal anti-inflammatory medications (NSAIDs)
Disease-modifying antirheumatic drugs (DMARDs)
Hydroxychloroquine sulfate (Plaquenil)
Methotrexate
Gold salts
• Interventions



Monitor client for 30 minutes after injection for anaphylaxis,
allergic reaction
Teach client about signs and symptoms of gold toxicity
If toxicity develops, dimercaprol (BAL in Oil) may be prescribed
ADULT HEALTH:
Musculoskeletal Medications
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
68-6
PYRAMID POINTS
IV. Medications to Prevent and Treat
Osteoporosis

Description
 Calcium and vitamin D supplementation
 Calcitonin
 Teriparatide (Fortéo)
 Alendronate (Fosamax)
 Ibandronate (Boniva)
 Raloxifene (Evista)
 Risedronate (Actonel)
ADULT HEALTH:
Musculoskeletal Medications
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
68-7
Baclofen (Lioresal) is prescribed for the client with multiple
sclerosis. The nurse determines that the medication is having
the intended effect if which of the following is noted in the client?
1.
2.
3.
4.
Increased muscle tone
Increased range of motion
Decreased muscle spasms
Decreased local pain and tenderness
ADULT HEALTH:
Musculoskeletal Medications
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.
68-8