Nr203 4Th Semester Musculoskeletal And Neurological

Front 1

Hydantoin.
Anticonvulsant, antiarrhythmic.
phenytoin phen-ih-toyn (Dilantin, EpaminJ, Phenytek)

Back 1

Hydantoin.
Anticonvulsant, antiarrhythmic.
phenytoin phen-ih-toyn (Dilantin, EpaminJ, Phenytek)

Indications
Tx of seizures neuralgia

Actions Stabilizes neuronal membranes in motor cortex.

Therapeutic Effect: Limits spread of seizure activity. Stabilizes threshold against hyperexcitability. Decreases post-tetanic potentiation, repetitive discharge. Antiarrhythmic: Decreases abnormal ventricular automaticity. Shortens refractory period, QT interval, action potential duration.

Side
Effects
FREQUENT: Drowsiness, lethargy, confusion, slurred speech, irritability, gingival hyperplasia, hypersensitivity reaction (fever, rash, lymphadenopathy), constipation, dizziness, nausea. OCCASIONAL: Headache, hair growth, insomnia, muscle twitching. Agranulocytosis, aplastic anemia, gingival hyperplasia, ataxia, diplopia, N, rash

Nursing
Implications Anticonvulsant: Review history of seizure disorder (intensity, frequency, duration, LOC). Initiate seizure precautions. Hepatic function tests, CBC, platelet count should be performed prior to beginning therapy and periodically during therapy. Repeat CBC, platelet count 2 wks following initiation of therapy and 2 wks following administration of maintenance dose. Observe frequently for recurrence of seizure activity. Assess for clinical improvement (decrease in intensity/frequency of seizures). Monitor CBC with differential, hepatic/renal function tests, B/P (with IV use). Assist with ambulation. Monitor for therapeutic serum level (10–20 mcg/ml). Therapeutic serum level: 10–20 mcg/ml; toxic serum level: greater than 20 mcg/ml.
Give with food assess oral hygiene use vigorous cleaning

Patient
Teaching
Pain may occur with IV injection. To prevent gingival hyperplasia (bleeding, tenderness, swelling of gums), encourage good oral hygiene care, gum massage, regular dental visits. CBC should be performed every month for 1 yr after maintenance dose is established and q3mos thereafter. Report sore throat, fever, glandular swelling, skin reaction (hematologic toxicity). Drowsiness usually diminishes with continued therapy. Avoid tasks that require alertness, motor skills until response to drug is established. Do not abruptly withdraw medication after long-term use (may precipitate seizures). Strict maintenance of drug therapy is essential for seizure control, arrhythmias.

Front 2

Baclofen antispasticity agents, skeletal muscle relaxants
Lioresal

Back 2

Baclofen
Lioresal

Actions
Inhibits reflexes at the spinal level.
Therapeutic Effects: Decreased muscle spasticity, muscle and bladder function may also be improved

Side Effects
Seizures, dizziness, drowsiness, fatigue, weakness, confusion, depression, headache, insomnia, nasal congestion, tinnitus, edema, hypotension, nausea, constipation, urinary frequency, pruritus, rash, hyperglycemia, weight gain, ataxia, hypersensitivity reaction, sweating

Nursing Implications Assess muscle spasticity before and periodically during therapy. Observe pt for drowsiness, dizziness, or ataxia. May be alleviated by a change in dose. Monitor patient closely during test dose and titration. Resuscitative equipment should be immediately available for life-threatening or intolerable side effects.

Nursing Diagnosis:
Mobility, impaired wheelchair, Injury, risk for

Patient Teaching Instruct patient to take baclofen as directed. Take a missed dose within 1 hour. Do not double doses. Caution pt to avoid abrupt withdrawal of this medication because it may precipitate an acute withdrawal reaction (hallucinations, increased spasticity, seizures, mental changes, restlessness. Should be discontinued gradually over 2 wk or more. Instruct pt to change positions slowly. Avoid use of alcohol or CNS depressants

Front 3

Beta Interferons, Anti-multiple sclerosis agents, interferons
Betaseron

Back 3

Betaseron

Indications
Treatment of spasticity associated with MS, Trigeminal Neuralgia (face pain)

Actions
Antiviral and immunoregulatory properties produced by interacting with specific receptor sites on cell surfaces may explain beneficial effects. Produced by recombinant DNA technology. Reduce incidence of relapse and slow physical disability

Side Effects
Headache, weakness, conjunctivitis, constipation, diarrhea, dyspepsia, nausea, vomiting, sweating, menstrual disorders, neutropenia, injection site reactions, myalgia, chlls, fever, flu-like symptoms, pain (these are the most common) SEIZURES

Nursing Implications Assess frequency of exacerbations of symptoms of multiple sclerosis periodically during therapy. Monitor pt for signs of depression. Monitor hemoglobin, WBCs, platelets, blood chemistries,

Patient Teaching Instruct pt in correct technique for injection and care and disposal of equipment. Caution pt not to reuse needles or syringes and provide pt with a puncture resistant container for disposal
Instruct pt to take medication as directed; do not change dose or schedule without consulting health care professional. Pts should receive a medication guide with each product. Flu like symptoms may occur. Wear sunscreen

Front 4

Edrophonium (Tensilon), Enlon, Reversol

Back 4

Edrophonium (Tensilon), Enlon, Reversol

Actions:
EDROPHONIUM can test muscle response. It can help to diagnose myasthenia gravis, a disease that affects your muscles. It can also help reverse the effects of certain muscle relaxants used during surgery. Generic edrophonium injection is available. In pts with MG myasthenia gravis, there is a significant improvement in muscle strength that lasts approx. 5 minutes

Side Effects Serious side effects: •difficulty breathing •dizziness •difficulty moving •muscle cramps or spasms •slow or irregular heartbeat •vomiting

Not serious side effects
•diarrhea •increase in the need to pass urine
•increased saliva •increased sweating •nausea •stomach pain •unusual weakness or tiredness

Nursing Implications Whenever anticholinesterase drugs are used for testing, a syringe containing 1 mg of atropine sulfate should be immediately available to be given in aliquots intravenously to counteract severe cholinergic reactions which may occur in the hypersensitive individual, whether he is normal or myasthenic. Enlon® should be used with caution in patients with bronchial asthma or cardiac dysrhythmias. The transient bradycardia which sometimes occurs can be relieved by atropine sulfate. Isolated instances of cardiac and respiratory arrest following administration of Enlon® have been reported. It is postulated that these are vagotonic effects.
Patient Teaching Tensilon test is used to differentiate between myasthenic crisis (unsufficient medication improvement in symptoms) and cholinergic crisis (overmedication with no improvement in symptoms.

Front 5

Anti-gout agent
Allopurinol (Zyloprim)

Back 5

Anti-gout agent
Allopurinol (Zyloprim)

Actions
Inhibits the production of uric acid. Lowering the serum uric acid levels

Side Effects
Rash, drowsiness, diarrhea, hepatitis, nausea, vomiting, renal failure, urticaria, bone marrow depression, hypersensitivity reactions

Nursing Implications Monitor intake and output. Maintain fluid intake 2500-3000 ml/day to minimize kidney stone formation. Assess pt for rash or more severe hypersensitivity reactions. Discontinue allopurinol immediately if rash occurs. Gout: monitor for joint pain and swelling. Addition of colchicine or an NSAID may be necessary for acute attacks. Prophylactic doses of colchicine or an NSAID should be administered concurrently during the first 3-6 months of therapy because of an increased frequency of acute attacks of gouty arthritis during each therapy. Serum and uric acid levels should begin to decrease 2-3 days after initiation of oral therapy. May cause hypoglycemia

Patient Teaching Instruct pt to continue taking allopurinol along with an NSAID or colchicine during an acute attack of gout. Allopurinol helps prevent but does not relieve acute gout attacks. Alkaline diet may be ordered. Urinary acidification with large doses of vitamin C or other acids may increase kidney stone formation. May occasionally cause drowsiness. Instruct pt to report skin rash or flu-like symptoms

Front 6

Cox-2 inhibitor
Celebrex (Celecoxib)

Back 6

Cox-2 inhibitor
Celebrex (Celecoxib)

Actions Inhibits the enzyme COX-2. This enzyme is required for the synthesis of prostaglandins. Has analgesic, anti-inflammatory, and antipyretic properties. Decreased pain and inflammation caused by arthritis. Decreased number of colorectal polyps.
Side Effects Dizziness , headache, insomnia, GI bleeding, abdominal pain, diarrhea, dyspepsia, flatulence, nausea, rash
Nursing Implications Assess pt’s ROM, degree of swelling, and pain in affected joints before and periodically throughout therapy. Assess pt for allergy to sulfonamides, aspirin, or NSAIDS. Pts with these allergies should not receive celecoxib. May cause  AST and ALT levels. May cause hypophosphatemia and  BUN
Patient Teaching Advise pt to notify health care professional promptly if signs or symptoms of GI toxicity (abdominal pain, black stools), skin rash, unexplained wt gain or edema occurs. Pts should DC celecoxib and notify health care professional if signs and symptoms of hepatoxicity ( nausea, fatigue, lethargy, pruritius, jaundice, upper right quadrant tenderness, flu-like symptoms) occur.

Front 7

Biologic Response Modifier
Remicade (infliximab) 551

Back 7

Biologic Response Modifier
Remicade (infliximab) 551
Neutralizes and prevents the activity of tumor necrosis factor alpha (TNF-alpha), resulting in anti-inflammatory and antiproliferative activity. Therapeutic effects: Decreased pain and swelling, decreased rate of joint destruction and improved physical function in rheumatoid arthritis. Reduction and maintenance of closure of fistulae in Crohn’s disease
Fatigue, headache, upper respiratory tract infection, abdominal pain, N/V, fever, infusion reactions, chills, flu-like syndrome
Assess pt for infusion-related reactions (fever, chills, urticaria, puritus) during and for 2 hr after infusion. Symptoms usually resolve when infusion is discontinued. Reactions are more common in the 1st or second infusion. Frequency of reactions may be reduced with immunosuppressant agents.
Observe pt for hypersensitivity reactions (urticaria, dyspnea, hypotension) throughout infusion.
Advise pt that adverse reactions (myalgia, rash, fever, polyarthralgia…

Front 8

Biphosphonate, Bone resorption inhibitor
Fosamax (Alendronate Sodium)

Back 8

Biphosphonate, Bone resorption inhibitor
Fosamax (Alendronate Sodium)

Actions
Inhibits resorption of the bone by inhibiting osteoclast activity.
Reversal of the progression of osteoporosis with decreased fractures. Decreased progression of Paget’s disease

Side Effects
Headache, blurred vision, conjunctivitis, eye pain/inflammation, abdominal distention, abdominal pain, acid regurgitation, constipation, diarrhea, dyspepsia, dysphagia, esophageal ulcer, flatulence, gastritis, n/v, photosensitivity, rash

Nursing Implications Assess pts for low bone mass before and periodically during therapy.
Paget’s: Assess for decreased visual and auditory acuity, increased skull size. Monitor Alkaline Phosphatase
Lab tests: assess for serum calcium

Patient Teaching Instruct pt to take drug first thing in the morning, 30 minutes before other medications, beverages, or food. Waiting longer than 30 minutes will improve absorption. Take it with Plain water only. If dose is missed, skip dose and resume the next morning. Do not take two tablets on the same day. Remain upright for 30 minutes following dose to facilitate passage to stomach and minimize esophageal irritation.

Front 9

Hormones, parathyroid hormones
Forteo (Teriparatide) Hormone

Back 9

Hormones, parathyroid hormones
Forteo (Teriparatide) Hormone
Actions Regulates calcium and phosphate metabolism in bone and kidney by binding to specific cell receptors; stimulates osteoblastic activity, increases serum calcium and decreases serum phosphorus. Increased bone mineral density with reduced risk of fractures
Side Effects Orthostatic Hypotension
Nursing Implications Assess bone mineral density before and periodically during therapy
Effects increase serum calcium and decrease serum phosphorus. Maximum effect is within 4-6 hours. May asymptomatically increase serum uric acid concentrations
Patient Teaching Advise pt to administer medication at the same time each day. Instruct pt on proper administration technique and disposal of needles. Pt should read medication guide manual before starting therapy and reread them each time prescription is filled.