1. PYRAMID POINTS CHAPTER 68: MUSCULOSKELETAL MEDICATIONS

2. 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  Description Act directly on neuromuscular junction or indirectly on central nervous system Act directly on neuromuscular junction or indirectly on central nervous system Contraindicated in clients with severe liver, renal, heart disease Contraindicated in clients with severe liver, renal, heart disease  Side effects Drowsiness Drowsiness Dizziness Dizziness Muscle weakness Muscle weakness Hypotension Hypotension  Interventions Assess involved joints, muscles for pain, mobility Assess involved joints, muscles for pain, mobility Monitor liver and renal function test results Monitor liver and renal function test results Instruct client to take with food Instruct client to take with food Instruct client to report side effects Instruct client to report side effects

3. ADULT HEALTH: Musculoskeletal Medications Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.68-3 PYRAMID POINTS I. Skeletal Muscle Relaxants (continued)  Nursing considerations (continued) Baclofen (Lioresal) Baclofen (Lioresal)  Can be administered by physician via intrathecal infusion Dantrolene (Dantrium) Dantrolene (Dantrium)  Liver damage most serious adverse effect  Instruct client to notify physician if rash, bloody, tarry stool, jaundice develops Cyclobenzaprine (Flexeril) Cyclobenzaprine (Flexeril)  Contraindicated in clients receiving MAO inhibitors within 14 days of initiation of cyclobenzaprine therapy Methocarbamol (Robaxin) 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

4. ADULT HEALTH: Musculoskeletal Medications Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.68-4 PYRAMID POINTS II. Antigout Medications  Description Allopurinol (Zyloprim) can increase effects of warfarin (Coumadin), oral hypoglycemic agents Allopurinol (Zyloprim) can increase effects of warfarin (Coumadin), oral hypoglycemic agents  Side effects Blood dyscrasias Blood dyscrasias Uric acid kidney stones Uric acid kidney stones

5. ADULT HEALTH: Musculoskeletal Medications Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.68-5 PYRAMID POINTS II. Antigout Medications (continued)  Interventions Maintain fluid intake of at least 2000 to 3000 mL/day Maintain fluid intake of at least 2000 to 3000 mL/day Instruct client not to take large doses of vitamin C concurrently Instruct client not to take large doses of vitamin C concurrently Instruct client to avoid foods high in purine Instruct client to avoid foods high in purine Instruct client to take with food Instruct client to take with food Advise client to minimize exposure to sunlight Advise client to minimize exposure to sunlight Advise client to have yearly eye examination Advise client to have yearly eye examination Caution client not to take aspirin concurrently Caution client not to take aspirin concurrently Advise client to use acetaminophen (Tylenol) instead of aspirin Advise client to use acetaminophen (Tylenol) instead of aspirin

6. ADULT HEALTH: Musculoskeletal Medications Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.68-6 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 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

7. ADULT HEALTH: Musculoskeletal Medications Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.68-7 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)

8. ADULT HEALTH: Musculoskeletal Medications Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.68-8 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. Increased muscle tone 2. Increased range of motion 3. Decreased muscle spasms 4. Decreased local pain and tenderness