Chapter 62: Adult Musculoskeletal Medications

Skeletal muscle relaxants function through central nervous system depression of spinal cord and brain activity or peripheral mechanisms that inhibit calcium release in muscle tissue, thereby reducing involuntary contractions associated with conditions like multiple sclerosis and spinal cord injury. Key medications in this class include baclofen, which requires specialized implantable pump administration and careful monitoring to prevent withdrawal complications; cyclobenzaprine, which carries contraindications with monoamine oxidase inhibitors and anticholinergic side effects; dantrolene, notable for hepatotoxicity risks requiring frequent liver function assessment; and agents causing benign urine discoloration. Antigout pharmacotherapy targets hyperuricemia through uric acid reduction or increased renal excretion, requiring substantial daily fluid intake and dietary modification to prevent kidney stone formation and gout exacerbation. Disease-modifying antirheumatic drugs represent the cornerstone of rheumatoid arthritis management, with both biologic and non-biologic variants suppressing immune function to slow joint deterioration while necessitating vigilant monitoring for serious infection risk and screening for organ-specific toxicities such as retinal damage from hydroxychloroquine and hepatic fibrosis from methotrexate. Osteoporosis medications employ two distinct mechanisms: antiresorptive agents like bisphosphonates that inhibit bone breakdown, and anabolic agents like teriparatide that stimulate osteoblast activity. Bisphosphonate administration requires precise protocols including morning dosing on an empty stomach with full water volume and prolonged upright positioning to prevent esophageal injury. Additional osteoporosis agents include calcitonin-salmon with hypocalcemia risk and raloxifene, which demands preoperative discontinuation to mitigate thromboembolism complications. Throughout all musculoskeletal pharmacotherapy, nursing priorities center on adverse effect monitoring, medication interaction awareness, patient safety education regarding central nervous system depression and drug interactions, and optimization of therapeutic outcomes through adherence to administration protocols and lifestyle modifications.