Alendronate (Fosamax), Risedronate (Actonel) 

Class-Bisphosphonates

Uses- post menopausal osteoporosis, glucocorticoid induced OP, Paget's disease, hypercalcemia of malignancy. 

Contraindications- pt w/ GERD or esophageal disorders, unable to swallow, can not sit or stand for 30 mins. 

Instructions- Take in AM before food w/ full glass of water, do not chew or suck tablet, remain upright for at least 30 mins, postpone eating for 30 mins, notify MD with decreased ability to swallow, pain w/ swallowing, or worsening heartburn. 

Calcitonin (Miacalcin) 

derived from Human or Salmon

Both- used for antiresorptive horomone that decreases risk of spinal fractures by 20% in patients with osteoporosis, and can help with back pain. 

decreases bone resorption but promotes tubular excretion of Ca by kidneys. 

uses- osteoporosis, treatment not prevention, Paget's disease, hypercalcemia ( not preferred). 

Salmon- comes as metered dose spray, approve only for postmenopausal osteoporosis. 

Contra- allergy to salmon. 

Dosage- 1 spray daily, alternating nostrils. 

SE- nasal dryness and irritation are common complaints. 

Can be given IM and SQ- side effects are nausea, flushing of face and hands. ( antibodies develope after 1 year, prevents therapuetic effects). 

Vitamin D

(Calcitrol) 

Uses- increases bloow levels of Ca and P (phosphorus) through increase in intestination absorption. 

Sources- sunligh, foods such as milk fortified with Vit D, Bile is essential to the abosorption through the GI tract, if absense can be given IM. 

Toxicity d/t excessive intake- symptoms are weakness, fatigue, nausea and vomiting, constipation, and decreased kidney function. -treated by increasing fluids, low Ca diet, glucocorticoids. 

(If severe, IV NS and Lasix)

Raloxifene

( Evista) 

Class- selective estrongen receptor modulator

uses- increases BMD ( bone mineral density) and decrease risk for spinal fractures by 40%. 

-no effect to decrease other osteoporosis related fractures. 

- can be taken with food or after meals. 

SE- hot flashes, DVT. 

Teriparatide

( Forteo) 

class- synthetic form of PTH

Newest drug class to treat OP. 

given by SQ daily, up to 24 months. 

-effective for 2 years after med is DC'd. 

- for patients at risk for OP fractures. 

-promotes bone growth by increasing osteoblast activity. 

- reduces risk for spin fracture by 65% and decreases risk for nonspinal fractures by 54%. 

Drugs given for Osteoarthristis 

Acetamenophen- given initially. up 1 gm 4x's a day. Max is 4,000 mgs. --if patient has liver problems no more than 2,500mg or 2.5 gms per day.

NSAIDS- Ibuprofen or Naproxen

Do not alter course of disease, given for minor to moderate pain. 

Adverse- gastritis, gastrodudenal ulcers, renal insufficiency, high BP. 

TRAMADOL (Ultram)- contraindicated if pt is at risk for seizures. give w/ stool softner. 

Oxycotin or Fentanyl- long acting opiods. 

will need stool softner. 

swallow tablets whole. decrease avtivites that require mental activities. 

Glucosamine and Chrondrotine sulfate- may decrease joint inflammation and alter cartilage metabolism. 

Corticosteroids- given by injection when lower oral meds are ineffective. 

Contra- infected or unstable joint. 

Max dosage is 3 or 4 injections in same joint per year. 

- can cause joint damage and necrosis. 

Colchicine 

-an anti-inflammatory specific for gout, not active against other inflammatory diseases. 

-recommended that Chronic gout pt's always have some on hand to abort impending attacks. 

- does nbot influence production or excretion of uric acid. 

Adverse- GI toxicity, nausea, vomiting, diarrhea, abdominal pain. DC IMMEDIATELY with ab pain. 

Uses- treat acute attacks. reduce flares in chronic gout. abort impending attack when taken 1 gm doses q2hr=dramate relief during acute attack. 

IV OR ORAL- IV minimal GI effects but can cause necrosis with inflitration. 

Indocin

Uses- an NSAID to treat acute gouty arthrisitis. Does not decrease hyperuricemia, only suppresses inflammation.

No severe GI effects. 

SE- frontal HA, can promote gastric ulceration like all NSAIDS. 

Contra- pt's with history of peptic ulcer disease. 

Interactions- dosage may need to be reduced if used with Probenecid, which delays excretion of Indocin=toxic effects. 

Allopruinol

Uses- drug choice for Chronic tophaceous gout (4th stage)

- reduces blood levels of uric acid. 

-inhibits uric acid production by blocking the production of xanthine oxidase. 

- used for hyperuricemia d/t gout and secondary hyperuricemia d/t  Chemotherapy and blood dyscrasias (luekemia)

SE- most serious and rare hypersenativity, characterized by rash, fever, eosinohilia, dysfunction of liver and kidneys. 

DC immediately if rash or fever develop. 

Mild SE- N&V, diarrhea, ab pain, drowsiness, HA, metallic taste. 

-prolonged use over 3 years can cause cataracts. 

- can precipitate gouty attacks when 1st administered, should be given with Colchicine. 

Interactions- can inhibit hepatic drug matabolizing enzymes, and delat the inactivation of other drugs.

-pt's on Coumadin should have dosages reduced. 

- Chemotherapy agents such as mercaptopurine and azathioprine may need doses lowered by as much as 25% to 75%.

- combination of allopurinol and ampicillin is associated with a high incidence of rash, DC immediately. 

Probenecid ( Benemid, Benuryl) 

Uses- a uricosuric agent

- acts of tubules to inhinit reabsorption of uric acids= increase excretion of uric acid.

- may be used to prolong the effects of penicillins and cephalosporins by delating their excretion in the kidneys. 

SE- mild to moderate  GI effects- n&v, anorexia, should be administered with food. 

- Renal damage can occur from deposition of urate in the kidney, decrease this risk by alkalinizing the urine nu drinking 2.5 to 3 Liters of fluids per day during the first few days of treatment. 

- Therapy should not be inititated during an acute gouty attack, may exacerbate. 

- during initial months of therapy, may cause acut attacks of gout. take with colchicine or Indocin. 

Interactions- do not take with ASA- can interfere with probenecid action. 

- inhibits the rena; excretion of several drugs, whose dosages may need reduction, ex. Indocin and sulfonamides. 

Drugs for Treatment of SLE

NSAIDS- acetaminophen, indocin, naproxen, ASA ( Ibuprofen). 

- for muscle and joint pain

- take with food or milk to decrease gastric irritation. 

- report signs of bleeding, tinitis

Corticosteroids- anti-inflammatory

- take w/ food to decrease gastric irritation. 

- dont suddenly stop taking, wean gradually. 

- report bruising or bleeding. 

- have regular BP checks and daily weights, regular eye exams. 

Antimalarials for treatment of SLE

Chloquine (Aralen) 

hydroxychloroquine (Plaquenil) 

- often prescribed for skin and joint symptoms. 

-report changes of vision, have regular eye exams. 

- regular CBC and liver function tests. 

Immunomodulating Drugs for treatment of SLE

Azathoprine (Imuran) 

cyclophosphamide (Cytoxan)

Methotrexate

Cyclosporin

- group of drugs known as cytotoxic or immunosuppresive drugs. 

- similar to coriticoid drugs, used to supress inflammation and the immune system. 

SE- anemia, low WBC, and increase risk for infection. 

-may predipose pt to developing cancer later in life. 

Anticoagulants for the treatment of SLE complications

- Indicated if experiences embolus or thromobses.

- pt should learn to recognize symptoms of a flair early to decrease the risk of developing complications that require anticoagulant therapy. 

- flairs may occur several times a year, symptoms are fever, increased fatigue, pain HA, and feeling ill. 

- the early a flair is detected the less change of permanent organ and tissue damage.