Chapter 58: Musculoskeletal Medications

Skeletal muscle relaxants including baclofen, cyclobenzaprine, and dantrolene operate through central nervous system depression and peripheral mechanisms to reduce muscle spasticity and tension, though their use requires vigilant monitoring for adverse effects such as drowsiness, hepatotoxicity, and increased fall risk, particularly in elderly clients and those with cardiac or renal impairment. Antigout medications function through distinct pathways: allopurinol inhibits xanthine oxidase to decrease uric acid production, colchicine reduces inflammation during acute attacks through microtubule disruption, and probenecid enhances renal excretion of uric acid, all requiring adequate hydration, dietary modifications restricting purine intake, and regular renal function assessment. Antiarthritic therapies encompassing disease-modifying antirheumatic drugs such as methotrexate and hydroxychloroquine, along with biologic response modifiers including tumor necrosis factor inhibitors like etanercept and adalimumab, suppress immune activity to slow disease progression but necessitate comprehensive blood work monitoring, vigilance for infectious complications due to immunosuppression, and client education regarding contraindications with live vaccines. Osteoporosis management incorporates multiple medication classes: bisphosphonates that inhibit osteoclast activity and reduce bone resorption while requiring specific administration protocols to prevent esophageal irritation, calcitonin that regulates serum calcium through osteoclast inhibition, selective estrogen receptor modulators such as raloxifene offering bone protection with thrombotic considerations, and teriparatide that stimulates new bone formation through parathyroid hormone activity. Throughout all musculoskeletal pharmacotherapy, nurses must understand drug interactions, monitor laboratory values including liver and renal function tests, complete blood counts, and uric acid levels, educate clients regarding medication timing and potential adverse effects, and identify contraindications and precautions essential for safe therapeutic outcomes.