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Harvard University Module 4 Musculoskeletal Medications & NMBD Worksheet

Harvard University

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I’m stuck on a Nursing question and need an explanation.

Please complete the attached worksheet on musculoskeletal medication. Answers may be found in the powerpoint attached, however some may need to be searched. Answers must be in 25 words or less if possible. Please write the answers in your own words. No plagiarizing.

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Musculoskeletal Medications Do not change the format of this handout. Save your name to the document to receive credit and for easier verification. Answer in 25 words or less if possible. Use your own words only. 1) Explain the difference between non-depolarizing and depolarizing neuromuscular blocking agents. 2) Give an example of a non-depolarizing medication and the specific nursing care you would provide. 3) Give an example of a depolarizing medication and the specific nursing care you would provide. 4) How does calcium work in the body? What is one contraindication of its use? 5) What foods would you recommend to your patient to increase calcium intake? 6) What is rheumatoid arthritis and how does it affect the musculoskeletal system? 7) Name one therapeutic effect that an anti-rheumatoid medication provides. 8) What nursing assessment should be done for patients taking skeletal muscle relaxers? 9) What is the mechanism of action for skeletal muscle relaxers? 10) What is Botox, its use and how it works in the musculoskeletal system? 11) What is a serious contraindication of Botox? 12) What is the mechanism of action of benzodiazepines? 13) Give two examples of a benzodiazepine. 14) What is a contraindication for an elderly patient taking a benzodiazepine? Name one nursing diagnosis and an associated nursing intervention for elderly patients taking benzodiazepines. 15) What is TNF’s mechanism of action and one contraindication? 16) What patient should you use caution with when administering TNF? 17) What patient education do you provide for patients taking Enbrel? 18) Describe the mechanism of action for colchicine. 19) Describe osteoporosis and how it affects the body. 20) Name one nursing diagnosis and nursing intervention related to osteoporosis. Describe each medication using the tables below: Gengraf Classification Generic Name Indications Action Therapeutic Effect Most frequent side effect Nursing intervention Descriptions Miacalcin Classification Generic Name Indications Action Therapeutic Effect Most frequent side effect Nursing intervention Descriptions Flexeril Classification Generic Name Indications Action Therapeutic Effect Most frequent side effect Nursing intervention Descriptions Elitek Classification Generic Name Indications Action Therapeutic Effect Most frequent side effect Nursing intervention Descriptions Fosamax Classification Generic Name Indications Action Therapeutic Effect Most frequent side effect Nursing intervention Descriptions Managing musculoskeletal conditions MODULE 4A Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. MEDICATION CLASSIFICATION: CALCIUM SUPPLEMENTS Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Medication Classification: Calcium Supplements Prototype Medication: calcium citrate (Citracal)  Other Medications:  Calcium carbonate (Tums, Rolaids)  Calcium acetate (PhosLo)  For IV administration:  Calcium chloride  Calcium gluconate Purpose  Maintenance of normal musculoskeletal, neurological, and cardiovascular function. Therapeutic Uses Oral calcium supplements are used for clients with hypocalcemia, or deficiencies of parathyroid hormone, vitamin D, or dietary calcium.  Oral dietary supplements are used for adolescents, older adults, and women who are postmenopausal, pregnant or breastfeeding.  Intravenous medications are used for clients with critically low levels of calcium. Calcium Supplements Side/Adverse Effects Nursing Interventions/Client Education Hypercalcemia (Calcium level greater than 10.5 mg/dL) • Findings include tachycardia and elevated blood pressure leading to bradycardia and hypotension, muscle weakness and hypotonia, constipation, nausea, vomiting and abdominal pain, lethargy, and confusion. • Instruct clients to monitor for symptoms and report to the provider. • Monitor serum calcium levels to maintain between 9.0 to 10.5 mg/dL. Contraindications/Precautions Calcium supplements are contraindicated in clients who have hypercalcemia, bone tumors, and hyperparathyroidism. Use cautiously in clients with kidney disease or a decrease in GI function. ● ● Medication/Food Interactions Interventions/Client Education Concurrent use of glucocorticoids reduces absorption of calcium Concurrent use of calcium decreases absorption of tetracyclines and thyroid hormone Concurrent administration of thiazide diuretics increases risk of hypercalcemia. Spinach, rhubarb, bran, and whole grains may decrease calcium absorption. Give medications at least 1 hr apart IV calcium precipitates with phosphates, carbonates, sulfates, and tartrates Concurrent use of digoxin and parenteral Ensure 1 hr between administration of medications Assess clients for hypercalcemia. • Avoid concurrent use. Do not administer calcium with foods that decrease absorption. • Instruct clients to avoid consuming these foods at the same time as taking calcium Do not mix parenteral calcium with compounds that cause precipitation IV injection of calcium must be given slowly Nursing Administration  Instruct clients to take a calcium supplement at least 1 hr apart from glucocorticoids, tetracyclines, and/or thyroid hormone.  Chewable tablets provide more consistent bioavailability  Recommended doses of oral calcium vary widely depending on the specific calcium preparation. Instruct client to follow provider prescription.  Prior to administration, warm IV infusions of calcium to body temperature.  Administer IV injections at 0.5 to 2 mL/min.  Nursing Evaluation of Medication Effectiveness  Depending on therapeutic intent, effectiveness may be evidenced by: Serum calcium level within expected reference range: 9.0 to 10.5 mg/dL. MEDICATION CLASSIFICATION: SELECTIVE ESTROGEN RECEPTOR MODULATORS/SERM S Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Select Prototype Medication: raloxifene (Evista)  Purpose  Works as endogenous estrogen in bone, lipid metabolism, and blood coagulation  Decreases bone resorption(osteoclasts break down bone), which results in slowing down of bone loss and preservation of bone mineral density  Works as an antagonist to estrogen on breast and endometrial tissue  Can decrease plasma levels of cholesterol Therapeutic Uses  Used in female clients to prevent and treat postmenopausal osteoporosis and to prevent spinal fractures  Used to protect against breast cancer Complications Increases the risk for pulmonary embolism and deep vein thrombosis (DVT) Hot flashes • Medication should be stopped prior to scheduled immobilization such as surgery. • Medication can be resumed when the client is fully mobile. • Discourage long periods of sitting and inactivity. Inform clients that the medication may exacerbate, rather than reduce, hot flashes. Contraindications/Precautions ●Raloxifene is Pregnancy Risk Category X. ●This medication is contraindicated in clients with a history of venous thrombosis. The medication should be stopped three days before periods in which risk of DVT is high (such as before surgical procedures). Interactions ●No significant interactions Nursing Administration  For maximum benefit of the medication, encourage clients to consume adequate amounts of calcium (such as from dairy products) and vitamin D (such as from egg yolks). Inadequate amounts of dietary calcium and vitamin D cause release of parathyroid hormone, which stimulates calcium release from the bone.  Medication may be taken with or without food once a day.  Monitor the client’s bone density; clients should undergo a bone density scan every 12 to 18 months.  Monitor the client’s serum calcium. Expected reference range is 9.0 to 10.5 mg/dL.  Monitor liver function tests. Raloxifene levels may be increased in clients with hepatic impairment.  Encourage clients to perform weight-bearing exercises daily, such as walking 30 to 40 min each day. Nursing Evaluation of Medication Effectiveness  Depending on therapeutic intent, effectiveness may be evidenced by:  Increase in bone density  No fractures NEUROMUSCULAR BLOCKING AGENTS Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Neuromuscular blocking agents  Neuromuscular-blocking drugs block neuromuscular      transmission at the neuromuscular junction,causing paralysis of the affected skeletal muscles. Neuromuscular blocking agents are used as adjuncts to general anesthesia to promote muscle relaxation These agents are used to control spontaneous respiratory movements in clients receiving mechanical ventilation These agents are used as seizure control during electroconvulsive therapy Used during endotracheal intubation and endoscopy Reduce intensity of muscle contractions in tetany, botulism, and electroconvulsive therapy Neuromuscular blocking agents 1. Types: non-depolarizing and depolarizing Non-Depolarizing a. action: competes with acetylcholine (ACh) at cholinergic receptor sites to block nerve impulse transmission; histamine releasing properties b. examples - see Epocrates Online for greater detail i. tubocurarine chloride ii. atracurium besylate (Tracrium) loading dose 0.3-0.5 mg/kg IV followed by continuous infusion 0.25-0.35 mg/kg IV iii. Vecuronium , Pancuronuim Drug Uses Tubocurarine Chloride Neuromuscular blocking agents Non-depolarizing blocking agent - muscle relaxant - long lasting -competitive antagonists -reversible • Tubocurarine (also known as D-tubocurare or DTC), used adjunctively in anesthesia to provide skeletal muscle relaxation during surgery or mechanical ventilation. Overdose Management:Treatment: Overdosage chiefly treated by artificial respiration, although neostigmine, atropine, and edrophonium chloride should also be on hand How Supplied:Injection: 3 mg/mL Dosage IV, IMAdjunct to surgical anesthesia. Adults, IM, IV, initial • • Adjunct to mechanical ventilation Muscle relaxation during general anesthesia Reduce intensity of muscle contractions in tetany, botulism, and electroconvulsive therapy(ECT Adverse Reactions Contraindications Nurse Care Adverse effects: life-threatening • Histamine release: bronchospasm-paralyzed muscles causing difficulty breathing • hypotension, excessive secretions • Malignant hyperthermia is a rare life-threatening condition that is usually triggered by exposure to certain drugs used for general anesthesia and neuro –blocking drugs which overwhelms the body's capacity to supply oxygen, remove carbon dioxide, and regulate body temperature, eventually leading to circulatory collapse and death if not treated quickly. Tubocurarine (Cl) is contraindicated in conditions like 1.Hypovolaemia-labs indicate – is a state of decreased blood volume; more specifically, decrease in volume of blood plasma 2. 2.Myasthenia gravis, 3.Renal failure, 4.Malignant hyperthermia. • • • cardiopulmonary arrest hyperkalemia • • • Special Concerns:Use with caution during pregnancy and lactation and in children. If repeated doses are used before delivery, the newborn may manifest decreased skeletal muscle activity. Children up to 1 month of age may be more sensitive to the effects of tubocurarine. Use with extreme caution in clients with renal dysfunction, liver disease, or obstructive states • • Observe RN establish baseline data monitor assessment Monitor electrolytes, renal function tests, V/S, EKG, SaO2 Muscle function usually restored within 90 minutes after therapy Promptly report any muscle weakness(retained in the body long after the effects have worn off) RN must implement client teaching plan. Report immediately any muscle weakness. Drug Uses Atracurium(tracrium) Neuromuscular blocking agents Loading dose 0.3-0.5 mg/kg IV followed by continuous infusion 0.250.35 mg/kg IV Antagonizes acetylcholine receptors at the motor end plate, producing paralysis Immediate acting -Non depolarizer -Competitive Atracurium (Tracrium) - Onset: 3-5 min (dose dependent) - Duration: 20-35 min Safer than Tubocurarine Same as Tubocurarine but safer and used more commonly than Tubocurarine Adverse Reactions Contraindications -histamine • release (hypoTN, • tachycardia, bronchoconstrict • ion) -laudanosine may cause CNS excitation or seizure in pts w/ liver failure • Acidosis, renal dysfunction When histamine release is a hazard Hyperthermia, electrolyte imbalances Nurse Care • • • Cardio pulmonary arrest Monitor electrolytes, renal function tests, V/S, EKG, SaO2 Muscle function usually restored within 90 minutes after therapy Promptly report any muscle weakness(retained in the body long after the effects have worn off) Hypovolaemia-labs • Reversal agent Neostigmine Depolarizing a. Action: competes with acetylcholine (ACh) for ACh-receptor sites resulting in muscle cell depolarization, initial contraction, and flaccid paralysis; ultra-short acting b. example: Succinylcholine (Anectine) - dosage should be individualized (see Epocrates Online for greater detail) c. uses i. muscle relaxation during surgery ii. adjunct to mechanical ventilation iii. facilitate intubation, electroconvulsive therapy iv. postoperative shivering when meperidine chloride is contraindicated and myocardial oxygen consumption must be minimized Side Adverse Succinylcholine Low pseudocholinesterase activity can lead to prolonged apnea Reversal Agent: Pseudocholinesteras e Test continuous cardiac and respiratory monitoring Have equipment ready for resuscitation and mechanical ventilation Monitor clients for return of respiratory function when medication is discontinued. Monitor the clients vital signs Signs of malignant hyperthemia include muscle rigidity accompanied by increased temperature , reaching levels as high as 43c (109.4f) Stop succinylcholine and other anesthetics Ice or infusion of iced saline can be used to cool the clients Administer dantrolene to decrease metabolic activity of skeletal muscle After 12 to 24 hr postoperative clients may experience muscle pain in the upper body and back Hyperkalemia Advise clients that this response is not unusual and eventually will subside Notify the provider to consider short-term use of muscle relaxant Monitor potassium levels Nursing care i. Establish baseline data and continually monitor vital signs, EKG, airway, ventilation, and SaO2 ii. Establish baseline data and monitor neuromuscular response to stimuli, fasciculations, serum electrolytes iii. Remain at bedside during infusion •keep emergency equipment and drugs at the bedside •maintain oxygenation and ventilation while client is being treated iv. Administer sedation and analgesia to clients while being treated - client is conscious and alert without sedation v.Fasciculations subside rapidly after initial administration Depolarizing Client Teaching • etiology of muscle pain • reassurance about drug-induced, temporary paralysis Contraindications i.History or family history of malignant hyperthermia ii.After reversal of competitive blockade with neostigmine Skeletal Muscle Relaxants Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Skeletal Muscle Relaxants  A muscle relaxant is a drug which affects skeletal muscle function and decreases the muscle tone.  It may be used to alleviate symptoms such as muscle spasms, pain, and hyperreflexia. The term "muscle relaxant" is used to refer to two major therapeutic groups: neuromuscular blockers and spasmolytics.  Act to relieve pain associated with skeletal muscle spasms  Majority are central-acting  CNS is the site of action  Similar in structure and action to other CNS depressants  Direct-acting  Act directly on skeletal muscle Common Muscle Relaxants       baclofen (Lioresal) cyclobenzaprine (Flexeril) dantrolene (Dantrium) metaxalone (Skelaxin) tizanidine (Zanaflex) Others Skeletal Muscle Relaxants  These drugs act directly on the neuromuscular junction or indirectly on the CNS.  Centrally acting muscle relaxants depress neuron activity in the spinal cord or brain.  Peripherally acting muscle relaxants act directly on skeletal muscle.  They are used to prevent or relieve muscle spasms, to treat spasticity associated with spinal cord disease or lesions, for painful musculoskeletal conditions, and for chronic debilitating disorders (e.g., multiple sclerosis, cerebral palsy). Skeletal Muscle Relaxants  Skeletal muscle relaxants should not be taken with CNS depressants        (e.g., barbiturates, opioids, alcohol, sedatives, hypnotics, or tricyclic antidepressants). Side effects include dizziness and hypotension, drowsiness, dry mouth, GI upset, photosensitivity, and hepatic toxicity. Safety is a priority; assess the client for his or her risk of injury. Assess involved joints and muscles for pain and mobility. Monitor liver function parameters; hepatotoxicity may occur. Instruct the client to take the medication with food to help prevent GI upset. Instruct the client to avoid activities requiring alertness, because drowsiness may occur. Instruct the client to implement measures to alleviate photosensitivity if it occurs (e.g., by wearing sunglasses). Skeletal muscle relaxing agents 1. Type: cyclobenzaprine a. centrally acting i. action: acts on CNS at the brain stem to relieve muscle spasm without loss of function; similar in structure to tricyclic antidepressant ii. examples - see Epocrates Online for greater detail • cyclobenzaprine (Flexeril) 10-20 mg by mouth 3 times daily • carisoprodol (Soma) 350 mg by mouth 3 times daily • OTHER – Baclofen , Metaxalone, Tizanidine, Diazepam Cyclobenzaprine • is used with rest, physical therapy, • and other measures to relax muscles and relieve pain and • discomfort caused by strains, sprains, and other muscle injuries. Cyclobenzaprine: 2 subtypes(central ly acting and direct acting Cyclobenzaprine (Flexeril): 10-20 mg po TID Carisoprodol(So ma): 350 mg po TID Short term therapy Painful musculoskelet al conditions, tetanus Spasticity associated with nerve compression or irritation, and degenerative neuromuscula r disease(MS) Serious Reactions • seizures • cardiac conduction disturbances • • • • Hyperthyroidism Hepatic or renal dysfunction Spasticity due to rheumatic conditions Acute MI, dysrhythmias, heart block, heart failure elderly pts • • • • • arrhythmias • MI • stroke • hepatic impairment • heat stroke • MI, acute recovery • anaphylaxis • • psychosis cardiac conduction disturbances • • • hepatitis • arrhythmias • Common Reactions • heart block • CHF • hyperthyroidism • drowsiness • dry mouth • dizziness • fatigue • headache • constipation • caution in elderly pts • nausea • • dyspepsia caution if hepatic impairment • taste changes • caution if urinary retention • blurred vision Caution. • avoid abrupt withdrawal (long-term use) • • Monitor heart rate, airway, EKG, lovel of consciousness, liver and renal tests, muscle strength, pain level, bowel pattern Provide frequent oral care Withhold drug for rash, pruritis Carefully administer opioid analgesia with concurrent use of muscle relaxants Collaborate with PT for adjunct therapy to decrease need for muscle relaxers Change positions slowly Avoid alcohol or other CNS depressants Establish regular bowel habits including fluids, fiber, and activity Avoid dangerous activity centrally acting Metaxalone , Tizanidine Relief of muscle spasm related to muscle injury Star ...
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Final Answer

Please find the attached

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Running head: MUSCULOSKELETAL MEDICATIONS

Musculoskeletal Medications
Name
Institution

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MUSCULOSKELETAL MEDICATIONS
Musculoskeletal Medications
Musculoskeletal Medications

1) Explain the difference between non-depolarizing and depolarizing neuromuscular blocking agents.
Depolarizing neuromuscular blocking agents acts as an acetylcoline (Ach) receptor agonist while nondepolarizing neuromuscular blocking agents acts as antagonists (Hull, C. J. (2016).
2) Give an example of a non-depolarizing medication and the specific nursing care you would provide.
The neuromuscular blocking drugs(NMBD) such as gallamine and d-tubocurarine are available. They work by
competing with Ach to bind sites on nicotinic alpha subunits. They provide skeletal muscle relaxation that
reduces patient’s movement and optimize operation conditions.
3) Give an example of a depolarizing medication and the specific nursing care you would provide.
Succinylcholine is the well-known depolarizing neuromuscular blocking agent used in emergency departments
rapid sequence intubation (RSI) even though controversial. It provides optimal conditions for the critically ill.
4) How does calcium work in the body? What is one contraindication of its use?
Calcium maintains normal musculoskeletal, cardiovascular and neurological functions in the body. One
contraindications are in clients with bone tumors or hypercalcemia.
5) What foods would you recommend to your patient to increase calcium intake?
The best foods are dairy products such as yoghurt, cheese and milk. Fortified beverages such as soy and almond
milk would be recommended.
6) What is rheumatoid arthritis and how does it affect the musculoskeletal system?
It is a chr...

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