Patients with endocrine and musculoskeletal disorders often require long-term treatment and care resulting in the need for extensive patient education. By appropriately educating patients, advanced practice nurses can assist patients with the management of their disorders. In clinical settings, patients with endocrine and musculoskeletal disorders typically seek treatment for symptoms that pose problems to their everyday lives as ordinary tasks may become difficult to complete. For instance, patients might have difficulty walking short distances, preparing meals, or even running errands. To reduce these symptoms and additional health risks, it is essential to develop drug therapy plans with individual patient factors in mind.<\/span>\u00a0<\/span><\/p>\n With these thoughts in mind:<\/span>\u00a0<\/span><\/p>\n Post<\/span><\/b> a description of the endocrine or musculoskeletal disorder you selected including types of drugs that would be prescribed to patients to treat associated symptoms. Then, explain how the factor you selected might impact the effects of prescribed drugs, as well as any measures you might take to help reduce negative side effects.<\/span>\u00a0<\/span><\/p>\n Read<\/span><\/b> a selection of your colleagues\u2019 responses and <\/span>respond <\/span><\/b>to <\/span>at least two<\/span><\/b> of your colleagues on <\/span>two different days<\/span><\/b> who selected a different endocrine or musculoskeletal disorder than you did. Provide recommendations for alternative drug treatments and patient education strategies for treatment and management.<\/span>\u00a0<\/span><\/p>\n Note:<\/span><\/b> For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues\u2019 postings. Begin by clicking on the \u201cPost to Discussion Question\u201d link and then select \u201cCreate Thread\u201d to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on <\/span>Submit!<\/span><\/b>\u00a0<\/span><\/p>\n Submission and Grading Information<\/span><\/b>\u00a0<\/span><\/p>\n Grading Criteria\u00a0<\/span><\/b>\u00a0<\/span><\/p>\n The endocrine and musculoskeletal systems play important roles in the regulation and coordination of activities throughout the body. When alterations of these systems occur, many patients require long-term drug therapies. In addition to drugs prescribed by their health care providers, patients with these disorders also often take herbal and dietary supplements. According to the American Diabetes Association, 22 percent of diabetic patients use herbal therapy and 31 percent use dietary supplements (American Diabetes Association, 2009). This may impact the effects of prescribed drugs, as well as pose a concern of adverse drug reactions in patients. When treating patients with endocrine and musculoskeletal disorders, it is important to educate patients on associated risks. As an advanced practice nurse prescribing drugs, you must carefully consider all drug, herbal, and dietary therapies prior to finalizing treatment plans.<\/span>\u00a0<\/span><\/p>\n This week you examine types of drugs prescribed to patients with endocrine and musculoskeletal disorders, as well as the impact of patient factors on the effects of drugs. You also explore ways to improve patient treatment plans including suggested drug therapies. Finally, you examine types of diabetes and the impact of diabetes drugs on patients.<\/span>\u00a0<\/span><\/p>\n By the end of this week, students will:<\/span><\/b>\u00a0<\/span><\/p>\n Photo Credit: Mark Hatfield\/iStock \/ Getty Images Plus\/Getty Images<\/span>\u00a0<\/span><\/p>\n Note:<\/span><\/b> To access this week\u2019s required library resources, please click on the link to the Course Readings List, found in the <\/span>Course Materials<\/span><\/b> section of your Syllabus.<\/span>\u00a0<\/span><\/p>\n This page contains the Learning Resources for this week. Be sure to scroll down the page to see all of this week’s assigned Learning Resources. To access select media resources, please use the media player below.<\/span>\u00a0<\/span><\/p>\n In the United States there is and average of 3.9% of the adult population that report gout symptoms each year (Fuerst, 2015). Gout occurs due to an elevated level of urate that eventually leaves deposits of monosodium urate crystals in the joints. This deposit causes an inflammatory reaction within the joints. This condition is called gouty arthritis (Schumacher, 2008). The inflammatory response is a result of macrophages phagocyting the urate crystals within the joint space. This in turn cause the release and activation of the IL-1B that bind to the synovial endothelium. This binding causes the release of proinflammatory cytokines and additional IL-1B (Arcangelo et al, 2017). While patients may be treated with anti-inflamatories to manage the pain and inflammation, the only real treatment is to lower the urate levels (Fuerst, 2015).\u00a0<\/span>\u00a0<\/span><\/p>\n Gout occurs acutely and chronically. Treatment of the condition will vary based on which form of the condition is needing to be treated. When treating chronic gout, the goal is to maintain a urate level less than 6 mg\/dL or 5 mg\/dL in patients with frequent gout attacks. The acute gout goal is to manage pain and inflammation. Maintaining joint function as well as stopping the attack is the predominant focus in acute gout.\u00a0<\/span>\u00a0<\/span><\/p>\n Xanthine oxidase inhibitors work in just the way they sound, they inhibit xanthine oxidase. By doing so, the conversion of hypoxanthine into uric acid does not occur. With this medication, it will take at least 2 weeks to see results. Patients on this medication will need to have uric acid levels drawn every 2-5 weeks to titrate the medication to maintain a therapeutic level. Patients with liver dysfunction of any kind should not take this medication. Those with healthy liver function should be monitored throughout the therapy for any increases in liver enzymes. The medication should not be given to those who are also taking azathioprine and mercaptopurine due to it\u2019s inhibiting of the metabolization of those drugs that could lead to toxic levels of them. Elevated levels of allopurinol can occur if taken with ACE inhibitors, thiazide and loop diuretics (Arcangelo et al, 2017). The medication can also interact with many antineoplastic. Increased risk of bleeding can occur in patients taking warfarin due to its interference in warfarin metabolization. \u202f<\/span>\u00a0<\/span><\/p>\n Probenecid inhibits the reabsorption of uric acid causing it to be excreted instead at the convoluted tubule. This medication begins to diminish uric acid levels within 2 weeks of initiation (Arcangelo et al, 2017). This medication is often used with colchichine so both the chronic and acute condition is treated. Metabolism of warfarin may be increased when taken with this medication. When taken with thiazoldinedione, the therapeutic effects of the thiazoldinedione can be increased (Drugbank, 2018). Patients with a history of uric acid kidney stones should not take this medication. Children over two and adults may take this medication. With patients who have a G6PD deficiency, anaphylaxis, or hepatic necrosis should not take this medication due to the risk of aplastic and hemolytic anemia. Increased concentrations of penicillins, cephalosporins and fluoroquinolones can occur when taken concurrently with probenecid. Prolonged QT waves can occur if taken with citalopram. Lorazepam toxicity can occur if taken together. When taken with aspirin or other salicylates, the effects of probenecid may be reversed. It should not be taken with pegloticase due to the increased risk of anaphylaxis (Arcangelo et al, 2017).\u00a0<\/span>\u00a0<\/span><\/p>\n Pegloticase is only used if all other interventions to treat chronic gout have been unsuccessful due to being available only in intravenous form. It functions by introducing uricase to the system that then converts uric acid into allantoin rendering it water-soluble and inactive so that may be easily excreted by the kidneys. Results are seen on day one and can remain effective for up to 6 months. Patients with G6PD deficiencies should not be given this medication. Increased levels of pegloticase occur when given with any other gout medication. If this treatment is started, all other gout medications should be discontinued. Since the enzyme this medication introduces to the body is not found in the human body, 92% of patients receiving the medication will develop antipegloticase antibodies. The development of the antibodies can render the treatment ineffective as early as 4 months (Arcangelo et al, 2017).<\/span>\u00a0<\/span><\/p>\n NSAIDs function to control and diminish pain and inflammation that occur during gout attacks. Patients taking this medication during a gout attack will need to continue the medication for an additional 24 hours after symptoms disappear (Arcangelo et al, 2017). Patients with renal dysfunction or transplantation should not take NSAIDs (Horl, 2010).<\/span>\u00a0<\/span><\/p>\n Systemic corticosteroids decrease inflammation that occurs during a gout attack by the suppression of the migration of the polymorphonuclear leukocytes. There is a diminished systemic effect in patients with uncontrolled hypertension, diabetes, immunosuppressed, psychiatric disorders, and cardiovascular disease (Arcangelo et al, 2017). Patients with diabetes who take this medication should expect elevations in their blood glucose levels that may require additional treatments to maintain normal levels while on this medication (Tamez-Perez et al, 2015). Due to the effect of this medication and fluid retention, patients with HTN, CHF and edema issues need to be monitored for exacerbation of these conditions (Arcangelo et al, 2017).<\/span>\u00a0<\/span><\/p>\n Colchicine works by inhibiting the migration, degranulation, and the activation of neutrophils in the joints that are having the acute attack. Relief with use of this medication come within 18-24 hours. Caution should be used when given to patients with renal or hepatic dysfunction. Patients with either of these conditions and taking either a P-gp or CYP3A4 inhibitor should not be given this medication. When given with these meds, a fatal toxicity level of colchicine can occur.\u00a0<\/span>\u00a0<\/span><\/p>\n Evaluation of patient needs when prescribing treatment is important. Monitoring for medications interactions when initiating therapy is incredibly important and should be done careful to prevent any harm to the patient. Lifestyle changes should be addressed such as exercise and diet in relation to treating the condition and diminishing the number of attacks. The use of vitamin C may be beneficial for patient to diminish their levels of uric acid so as to avoid taking medications that may interact with other conditions or medications. Each patient is different and will need to have a treatment plan specially tailored to them and monitored for effectiveness.\u00a0<\/span>\u00a0<\/span><\/p>\n Arcangelo, V., Peterson, A., Wilbur, V., and Reinhold, J. (2017). <\/span>Pharmacotherapeutics for advanced practice: A practical approach. <\/span><\/i>(4<\/span>th<\/span> edition). Philadelphia, PA: Wolters \u202f\u202f\u202f\u202f Kluwer<\/span>\u00a0<\/span><\/p>\n DrugBank (2018). Probenecid. <\/span>DrugBank. <\/span><\/i>Retrieved from: https:\/\/www.drugbank.ca\/drugs\/DB01032\u00a0<\/a><\/span>\u00a0<\/span><\/p>\nTo prepare:<\/span><\/b>\u00a0<\/span><\/h2>\n
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By Day 3<\/span><\/b>\u00a0<\/span><\/h2>\n
By Day 6<\/span><\/b>\u00a0<\/span><\/h2>\n
Learning Objectives<\/span><\/b>\u00a0<\/span><\/h2>\n
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Learning Resources<\/span><\/b>\u00a0<\/span><\/h2>\n
A Sample Answer For the Assignment: NURS 6521 Week 6: Endocrine and Musculoskeletal System\u00a0<\/strong><\/h2>\n
Title: NURS 6521 Week 6: Endocrine and Musculoskeletal System\u00a0<\/strong><\/h2>\n
Chronic gout medications:<\/span>\u00a0<\/span><\/h2>\n
Acute gout medications:<\/span>\u00a0<\/span><\/h2>\n