Drugs%20Used%20to%20Treat%20Musculoskeletal%20Conditions - PowerPoint PPT Presentation

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Drugs%20Used%20to%20Treat%20Musculoskeletal%20Conditions

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Title: Drugs%20Used%20to%20Treat%20Musculoskeletal%20Conditions


1
29
Drugs Used to Treat Musculoskeletal Conditions
2
Multimedia Directory
  • Slide 6 Osteoporosis Video
  • Slide 25 Arthritis Video
  • Slide 38 Mechanism of Action of Methotrexate
    Animation

3
Figure 29-1 The skeletal system and its
functions.
4
Calcium
  • Most abundant mineral in body
  • Proper balance and interaction with other
    minerals and hormones is essential to optimal
    function of several body system.
  • Typical body has 12 kg of calcium, 99 of which
    is in bones.

5
Osteoporosis
  • Bones become thinner and weaker during aging
    osteopenia
  • Osteoporosis bone mass is reduced enough to
    cause abnormal functioning
  • Increased incidence of fracture
  • Occurs more often in women than men, often in
    postmenopausal women because of reduced estrogen
    levels

6
Osteoporosis Video
Click on the screenshot to view a video on the
topic of osteoporosis.
Back to Directory
7
Table 29-1 Drugs Used to Treat Osteoporosis
8
Bisphosphonates Uses
  • Highly selective inhibitor of bone
    demineralization and resorption appears to
    increase bone density
  • Used to treat osteoporosis some for Pagets
    disease some for hypercalcemia of malignancy
    some for postmenopausal osteoarthritis

9
Bisphosphonates Adverse Effects
  • Bisphosphonates commonly cause various GI upsets,
    including
  • Flatulence
  • Acid regurgitation
  • Dysphagia
  • Gastritis

10
Bisphosphonates Adverse Effects (conditions)
  • Other adverse effects include
  • Headache
  • Musculoskeletal pain
  • Rash

11
Bisphosphonates Contraindications
  • Contraindicated in severe renal impairment,
    hypocalcemia, lactation, pregnancy
  • Used cautiously in patients with congestive heart
    failure, hypophosphatemia, liver disease, fever
    or infection, peptic ulcer

12
Bisphosphonates Patient Information
  • Review the correct administration with patients.
  • Advise patients to report fever accompanied by
    arthralgia and myalgia.
  • Instruct patients to take 30 minutes before food,
    beverages, or other medications.

13
Calcitonin Uses
  • Derived from salmon, lowers serum calcium and
    phosphate levels by action on bones and kidneys
    inhibits bone resorption, thereby increasing bone
    density
  • Used to treat osteoporosis in postmenopausal
    women, hypercalcemia, and symptomatic Pagets
    disease

14
Calcitonin Adverse Effects
  • Headache
  • Eye pain
  • Anaphylaxis (reported for human calcitonin only)
  • Urinary frequency
  • Chills

15
Calcitonin Adverse Effects
  • Chest pressure
  • Weakness
  • Nasal congestion
  • Shortness of breath

16
Calcitonin Contraindications
  • Avoid in patients with history of allergy
    (especially to fish)
  • Safe use in children, pregnancy, and lactation
    not established
  • Cautious use in patients with renal impairment or
    pernicious anemia

17
Calcitonin Patient Information
  • Advise patients to report redness, warmth, or
    swelling at injection site.
  • Instruct patients to check with physician before
    taking OTC preparations such as supervitamins and
    antacids.

18
DMSO
  • Dimethyl sulfoxide, known as DMSO, is a topical
    agent that can help reduce pain and inflammation
    in various musculoskeletal disorders. Only use
    under a physicians guidance.

19
Raloxifene (Evista) Uses
  • A selective estrogen-receptor modulator (SERM)
    acts by combining with estrogen receptors to
    decrease bone resorption and increase bone mass
    and density
  • Used to prevent and treat osteoporosis and to
    reduce risk of breast cancer in postmenopausal
    women

20
Raloxifene Adverse Effects
  • Hot flashes
  • Migraines and other types of headache
  • Flu-like symptoms
  • Vaginal bleeding
  • Uterine and urinary tract disorders

21
Raloxifene Adverse Effects
  • Breast pain
  • Depression
  • Insomnia
  • Dizziness

22
Raloxifene Contraindications
  • Contraindicated in women who may become pregnant
    and in those with venous thromboembolic disease
  • Not to be used with systemic estrogen replacement
    therapy
  • Should be used cautiously with diazepam,
    lidocaine, and diazoxide

23
Raloxifene Patient Information
  • Advise patients to report unexplained calf pain
    or tenderness.
  • Instruct patients to avoid prolonged restriction
    of movement during travel.

24
Rheumatoid Arthritis (RA)
  • Systemic autoimmune disease that involves
    inflammation of joint-lining membranes also
    affects internal organs
  • Occurs 23 times more often in women (onset
    usually at ages 4060)
  • Joints affected include hands, feet, wrists,
    spine, shoulders, ankles, and hips

25
Arthritis Video
Click on the screenshot to view a video on the
topic of arthritis.
Back to Directory
26
Table 29-2 Disease-Modifying Drugs for
Rheumatoid Arthritis
27
Table 29-2 (continued) Disease-Modifying Drugs
for Rheumatoid Arthritis
28
Gold Compounds Uses
  • Mechanism of action not clearly understood
  • Used to treat active RA

29
Gold Compounds Adverse Effects
  • Common syncope, bradycardia, thickening of
    tongue, metallic taste in mouth
  • Serious thrombocytopenia, leukopenia, aplastic
    anemia

30
Gold Compounds Contraindications
  • Uncontrolled diabetes
  • Renal or hepatic insufficiency
  • Hepatitis

31
Gold Compounds Patient Information
  • Instruct patients to report adverse effects.
  • Advise patient to report unusual color or odor of
    urine, and to avoid contact with anyone who has a
    cold, has had a recent vaccination, or has been
    exposed to a communicable disease.

32
Hydroxychloroquine (Plaquenil) Uses
  • Mechanism of action unclear
  • Used to treat RA and systemic lupus erythematosus

33
Hydroxychloroquine Adverse Effects
  • Common fatigue, headache, mood or mental
    changes, anxiety, difficulty focusing or blurred
    vision, anorexia, nausea and vomiting, abdominal
    cramps
  • Serious retinopathy

34
Hydroxychloroquine Contraindications
  • Safety in pregnancy and lactation not
    established.
  • Cautious use in patients with hepatic disease,
    alcoholism, impaired renal function

35
Hydroxychloroquine Patient Information
  • Advise patients to follow drug regimen exactly as
    prescribed and to keep drug out of reach of
    children.
  • Instruct patients to get regular eye exams.
  • Instruct patients to avoid breast feeding.

36
Hydroxychloroquine
  • Acute or chronic diseases that affect liver
    architecture or function also affect hepatic
    metabolism of some drugs.
  • Elderly patients may therefore have markedly
    affected drug elimination and need dosage
    adjustment.

37
Methotrexate (Folex, Mexate) Uses
  • Folic-acid blocker and immunosuppressant that
    affects lymphocyte and macrophage function
  • Used to treat severe psoriasis, psoriatic
    arthritis, and RA also to maintain remission in
    neoplastic disease

38
Mechanism of Action of Methotrexate Animation
Click on the screenshot to view an animation
showing the mechanism of action of methotrexate.
Back to Directory
39
Methotrexate Adverse Effects
  • Common GI upset and mouth sores, amenorrhea
  • Serious bone-marrow suppression, infertility

40
Methotrexate Contraindications
  • Contraindicated in pregnancy and lactation, men
    and women of childbearing age, hepatic and renal
    insufficiency, preexisting blood dyscrasias
  • Cautious use in patients with infections, peptic
    ulcer, colitis, poor nutritional status

41
Methotrexate Patient Information
  • Advise patients of the dangers of this drug and
    explain symptoms to immediately report.
  • Warn patients to avoid alcohol.
  • Tell patients to avoid sunlight and UV light and
    to wear sunglasses.

42
Methotrexate
  • Prolonged use of small doses can lead to
    hepatotoxicity.

43
Sulfasalazine (Azulfidine) Uses
  • Locally acting sulfonamide that may exert an
    anti-inflammatory effect
  • Used to treat RA, juvenile chronic arthritis, and
    ankylosing spondylitis

44
Sulfasalazine Adverse Effects
  • Common nausea, vomiting, headache, rash
  • Serious anemia, oligospermia, blood dyscrasias,
    liver injury, allergic reactions

45
Sulfasalazine Contraindications
  • Contraindicated in patients with agranulocytosis,
    intestinal and urinary tract obstruction, or
    porphyria pregnancy and lactation
  • Cautious use in severe allergy or bronchial
    asthma, hepatic or renal impairment, or in
    children younger than 6 years

46
Sulfasalazine Patient Information
  • Instruct patients that urine and skin may turn
    orange-yellow.
  • Women should not breast feed.

47
Gout and Gouty Arthritis
  • Characterized by crystal deposits in and around
    joint spaces, leading to acute inflammation of
    joint
  • Gout commonly affects men after age 50.
  • Three manifestations hyperuricemia, acute gouty
    arthritis, chronic gouty arthritis

48
Table 29-3 Anti-Gout Medications
49
Colchicine Uses
  • Uses anti-inflammatory agent used to treat gout
    inhibits formation of white blood cells
  • Adverse effects Common GI disturbances
    decreased absorption of vitamin B12
  • Contraindications severe cardiac, renal,
    hepatic, blood, and GI diseases

50
Colchicine Uses
  • Patient education Advise patients to report
    severe GI symptoms or signs of bone-marrow
    depression.

51
Colchicine in Elderly Patients
  • Colchicine must be used cautiously in elderly
    patients because of its possible adverse GI,
    cardiac, renal, and hepatic effects.

52
Allopurinol (Aloprim) Uses
  • Improves solubility of uric acid used to control
    chronic, not acute, gout

53
Allopurinol Adverse Effects
  • Common drowsiness, headache, dizziness, nausea
    and vomiting, abdominal pain
  • Serious hepatotoxicity, renal insufficiency

54
Allopurinol Contraindications
  • Contraindicated children (except in those with
    hyperuricemia secondary to cancer and
    chemotherapy)
  • Safety in pregnancy and lactation not
    established.
  • Cautious use in patients with impaired hepatic or
    renal function, history of peptic ulcer, lower GI
    tract disease, and bone-marrow suppression

55
Allopurinol Patient Information
  • Advise patients to drink 3 quarts of fluid per
    day.
  • Instruct patients to report diminishing urine
    output, cloudy urine, unusual color or odor to
    urine, pain or discomfort during urination,
    itching and rash.
  • Patients should avoid driving and sun exposure.

56
Uricosuric Agents Uses
  • Competitively inhibit renal tubular reabsorption
    of uric acid to promote its excretion
  • Used to treat severe attacks of gout

57
Uricosuric Agents Adverse Effects
  • GI irritation
  • Allergic dermatitis
  • Nephrotic syndrome

58
Uricosuric Agents Contraindications
  • Contraindicated in patients with blood dyscrasias
    and uric-acid kidney stone
  • Safety in pregnancy, lactation, or in children
    younger than 2 years not established.
  • Cautious use in patients with peptic ulcer

59
Uricosuric Acid Patient Information
  • Advise patients to drink 3 quarts of fluid per
    day.
  • Physicians may advise patients to restrict intake
    of high-purine foods (organ meats, meat soups,
    and gravy).

60
Uricosuric Acid Patient Information
  • Instruct patients to not stop treatment, or not
    to take aspirin or OTC medications without
    consulting physician.

61
Muscle Spasms and Pain
  • Often associated with traumatic injuries and
    spasticity from disorders such as cerebral palsy,
    stroke, or head and spinal cord injuries
  • Two types of muscle spasms tonic and clonic

62
Table 29-4 Centrally Acting Muscle Relaxants
63
Table 29-4 (continued) Centrally Acting Muscle
Relaxants
64
Centrally Acting Skeletal Muscle Relaxants
  • Uses treat local spasms to reduce pain and
    increase range of motion
  • Adverse effects sedation, weakness, fatigue
  • Contraindications some contraindicated in liver
    disease, porphyria, children, pregnancy, lactation

65
Centrally Acting Skeletal Muscle Relaxants
  • Patient information avoid alcohol, other CNS
    depressants. Patients with diabetes must closely
    monitor glucose levels.
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