baclofen

carisoprodol

chlorzoxazone

cyclobenzaprine

dantolene

diazpam

metazalone

methocarbamol

orphenadrine

tizanidine

alendronate

etidronate

ibandronate

pamidronate

risedronate

tiludronate

zoledronic acid

Biophosphate Bone Resorption Inhibitors

Fosamax is alendronate

Boniva is ibandronate

Actonerl is risedronate

adalimumab

anakinra

etanercept

hydroxychloroquine

infliximab

leflunomide

methotrexate (MTX)

sulfasalazine

All treat RA

Can be used for other condisiton as well (some)

Are DISEASE MODIFYING ANTIRHEUMATIC DRUGS

allopurinol

colchicine

probenecid

sulfinpyrazone

URIC ACID INHIBITORS

All are used for gout

probenecid is used as an adjuvant to antibiotics

• No baclofen with rheumatisms
• No cyclobenzaprine in recent MI pts and hyperthyroidism, nor with MAOIs
•  Carisoprodol contra in those hypersensitive to meprobamate
• Oral dantrolene contra during lactation, active hepatic disease and muscle spasms from rheumatic disorders

                                                               i.      Preg Cat C (cyclobenz. Is B)

                                                             ii.      Carisprodol caution with severe liver/kidney

• Cyclobenzaprine and MAOIs can lead to high fever and convulsions
• orphenadrin and haloperidol can increase psychosis
• tizanidine and antihypertensives and increase hypotension
• CNS depressants with skeletal muscle relaxants can increase the CNS depressant effect

a.       inhibit bone (normal and abnormal) resorption, increasing mineral density, reversing progression of osteoporosis

a.       mainly osteoporosis in postmenopausal women; also hypercalcemia of malignancies and Paget’s disease (abnormal bone remodeling making bones very susceptible to breaking)

                                                               i.      N/V

                                                             ii.      More or recurrent bone pain

                                                            iii.      Headache

                                                           iv.      Dyspepsia, acid regurgitation and dysphagia

                                                               i.      Fosamax and Actonel contraindicated in hypocalcemia

                                                             ii.      Alendronate in preg cat C

                                                            iii.      All contraindicated in delayed esophageal emptying or renal impairment

                                                           iv.      Not recommended to use with concurrent hormonal replacement therapy

                                                             v.      Use cautiously in GI disorders or renal impairment

                                                               i.      Effectiveness reduced if taken with calcium suppls or antacids with magnesium and aluminum

                                                             ii.      If taken with aspirin will increases risk of bleeding

                                                            iii.      Can make theophyline toxic

NSAIDs

corticosteroids

DMARDs

a.       Actions and Uses – used in RA after NSAIDS and pain relievers don’t work to treat the inflammation in joints;

                                                               i.      are immunosupressants usually for RA and some other autoimmune disorders

                                                             ii.      Can also be used for cancer

                                                               i.      N/V

                                                             ii.      Stomatitis

                                                            iii.      Alopecia

                                                               i.      Hypersensitivity

                                                             ii.      Renal impairment, liver disease, alcohol abuse

                                                            iii.      Enbrel, Humira Remicade not used in cong heart failure or a demyelinating disease (MS)

                                                           iv.      Pregnancy

• obese
• diabetic
• hepatitis B or C
• must take precautions not to become pregnant
•  With some must screen for TB b/c of immunosupression
•  Also monitor for any other infections

                                                               i.      Sulfa antibiotics can risk toxicity

                                                             ii.      Aspirin and NSAIDs can also risk toxicity

a.       some reduce production of uric acid, cochicine unknown, some increases uric acid excretion by kidneys

• N/V diarrhea and abdominal pain
•   Headache and urinary frequency
• Allopurinol can cause a severe skin rash and serious hypersensitivity

Some contraindicated with GI inflammation or ulcers

renal impaired; pregnancy caty B or C, liver impaired, peptic ulcers

• with alum. Based antacids can decrease effectiveness of allopurinol
• with theophylline increases risk of theophyline toxicity
• with ampicillin increases risk of rash

• with NSAIDS can increase serum level of NSAID
•  with salicylates can decrease effectiveness of probenecid
• with certain anti-infectives increases the level of the anti-infective
• with barbituates and bezodiazepines increase serum level of sedative

with oral anticoagulants increases bleeding risk

with tolbutamide for diabetes increases risk of hypoglycemia

with verapamil for heart condition increases effect of verapamil

hydroxychloroquine

what kind of drug

seroius adverse reactions

• DMARD
• is especially monitored closely for skin rash, fever, cough and easy bruising.  Also tinnitus, hearing loss and visual changes; immediately report.  Visual disturbances can be permanent retinal damage.

 may cause skin rash; monitor closely bc may proceed more serious reaction like Steves-Johnson Syndrome  Immediately report rash.

Inform PCP immediately of rash

• potentially toxic
• watch closely for adverse reactions
• liver, kindney and blood are monitored q 1-3 months
• report abnormal labs immediately
• pregnancy categry X, do not become pregnant while on and 8 weeks after therapy

• Notify PCP if following occur:

sore mouth or sores in mouth

diarrhea

fever

sore throat

easy bruising

rash, itching

N/V

a.       For uric acid inhibitors

b.      encourage lots of water

c.       measure I&O – should put out 2 liters

d.      Needed to excrete urates and prevent more uric acid stones

e.       If pt fails to increase water, tellPCP; may be necessary to give IV fluids

f.        Pt needs to drink about 3L a day.

•  For best absorption and reduced GI distress, instruct to take when wake up with 6-8oz water while upright.  Remain upright for at least 30 min
•  etitronate not admined within 2 hours of food, supplements or antacids and usually given once a day
• Many biphosphonates available 1Xweek or 1Xmonth formulas
•    ibandronate, zoledronic acid and pamidronate all come in parenteral form for less frequent dosing; pt must go to clinic for IV admin
•  DMARDs, uric acid inhibitors and skeletal muscle relaxers given with or immediately after food to minimize GI distress

"Risk for Injury rt med-induced drowsiness and associated risk for imbalance and falls”

Re admin of drugs for skeletal disorders

•  Many drugs for skeletal disorders cause drowsiness 
• Pain and deformity may also hamper mobility
• Assist pt as needed
•   If severe drowsiness, notify PCP before next dose
•  Some pts may require assistance with ADLs
•   Some may require position changes q 2 hours

                                                   i.      take with 6-8 oz water first thing AM

                                                 ii.      do not lie down for at least 30 minutes after

                                                iii.      Wait at least 30 min before any more food or drink

                                               iv.      May need calcium and D if not enough in diet

                                                 v.      May take a while for full effect

                                               vi.      Do not take OTC unless approved byPCP

                                                   i.      do not become pregnant with methotrexate, or 8 weeks after therapy

                                                 ii.      Some are self-admin subQ, must teach re this, including rotation of sites and return demonstration   

                                                iii.      Pt must report inflam and pain at injection sites

                                               iv.      May take a while for full effect

                                                 v.      Do not take OTC unless approved byPCP

                                               vi.      NotifyPCP if while taking methotrexate the following occur:

1.      sore mouth or sores in mouth

2.      diarrhea

3.      fever

4.      sore throat

5.      easy bruising

6.      rash, itching

7.      N/V

                                                   i.      Drink at least 10 glasses of water a day until acute attach subsides

                                                 ii.      Take with food to minimize GI upset

                                                iii.      If drowsy, avoitd hazards

                                               iv.      NotifyPCP if pain not relieved in a few days or skin rash

                                                 v.      Do not take OTC unless approved byPCP

                                                   i.      May cause drowsiness – hazardous tasks

                                                 ii.      Is for short-term use, do not take longer than 2-3 weeks

                                                iii.      Avoid alcohol or otherCNS depressants

                                               iv.      Do not take OTC unless approved byPCP

Methotrexate

Type of drug

Adverse reactions

Pregnancy category

DMARD

Can be toxic

Pregnancy category X