Musculoskeletal

Block cyclooxygenase to relieve pain, inflammation, and fever — at the price of GI bleeding, cardiovascular, and renal risk. They carry a two-part boxed warning.

Ease muscle spasm and spasticity — mostly by sedating the CNS. The defining risks are drowsiness/falls and additive depression with opioids, benzodiazepines, and alcohol.

Slow osteoclast bone breakdown to build bone density in osteoporosis. The exacting oral-administration protocol is central to nursing care — it protects the esophagus and rescues a <1% absorption.

Beyond the bisphosphonates, three kinds of drug treat bone and calcium. Teriparatide, abaloparatide and romosozumab build bone. Denosumab, raloxifene and calcitonin slow bone loss in other ways. Cinacalcet and calcitriol reset the calcium–parathyroid balance. Serum calcium runs through the nursing care of nearly all of them, and three carry boxed warnings: denosumab (Prolia) for severe hypocalcemia in advanced kidney disease, romosozumab for heart attack and stroke, and raloxifene for blood clots and death from stroke.

Two different jobs: stop an acute attack vs lower uric acid long-term. Don’t stop urate-lowering therapy for a flare.