Title: Drugs%20Used%20to%20Treat%20Musculoskeletal%20Conditions
129
Drugs Used to Treat Musculoskeletal Conditions
2Multimedia Directory
- Slide 6 Osteoporosis Video
- Slide 25 Arthritis Video
- Slide 38 Mechanism of Action of Methotrexate
Animation
3Figure 29-1 The skeletal system and its
functions.
4Calcium
- 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.
5Osteoporosis
- 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
6Osteoporosis Video
Click on the screenshot to view a video on the
topic of osteoporosis.
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7Table 29-1 Drugs Used to Treat Osteoporosis
8Bisphosphonates 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
9Bisphosphonates Adverse Effects
- Bisphosphonates commonly cause various GI upsets,
including - Flatulence
- Acid regurgitation
- Dysphagia
- Gastritis
10Bisphosphonates Adverse Effects (conditions)
- Other adverse effects include
- Headache
- Musculoskeletal pain
- Rash
11Bisphosphonates 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
12Bisphosphonates 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.
13Calcitonin 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
14Calcitonin Adverse Effects
- Headache
- Eye pain
- Anaphylaxis (reported for human calcitonin only)
- Urinary frequency
- Chills
15Calcitonin Adverse Effects
- Chest pressure
- Weakness
- Nasal congestion
- Shortness of breath
16Calcitonin 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
17Calcitonin 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.
18DMSO
- 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.
19Raloxifene (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
20Raloxifene Adverse Effects
- Hot flashes
- Migraines and other types of headache
- Flu-like symptoms
- Vaginal bleeding
- Uterine and urinary tract disorders
21Raloxifene Adverse Effects
- Breast pain
- Depression
- Insomnia
- Dizziness
22Raloxifene 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
23Raloxifene Patient Information
- Advise patients to report unexplained calf pain
or tenderness. - Instruct patients to avoid prolonged restriction
of movement during travel.
24Rheumatoid 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
25Arthritis Video
Click on the screenshot to view a video on the
topic of arthritis.
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26Table 29-2 Disease-Modifying Drugs for
Rheumatoid Arthritis
27Table 29-2 (continued) Disease-Modifying Drugs
for Rheumatoid Arthritis
28Gold Compounds Uses
- Mechanism of action not clearly understood
- Used to treat active RA
29Gold Compounds Adverse Effects
- Common syncope, bradycardia, thickening of
tongue, metallic taste in mouth - Serious thrombocytopenia, leukopenia, aplastic
anemia
30Gold Compounds Contraindications
- Uncontrolled diabetes
- Renal or hepatic insufficiency
- Hepatitis
31Gold 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.
32Hydroxychloroquine (Plaquenil) Uses
- Mechanism of action unclear
- Used to treat RA and systemic lupus erythematosus
33Hydroxychloroquine Adverse Effects
- Common fatigue, headache, mood or mental
changes, anxiety, difficulty focusing or blurred
vision, anorexia, nausea and vomiting, abdominal
cramps - Serious retinopathy
34Hydroxychloroquine Contraindications
- Safety in pregnancy and lactation not
established. - Cautious use in patients with hepatic disease,
alcoholism, impaired renal function
35Hydroxychloroquine 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.
36Hydroxychloroquine
- 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.
37Methotrexate (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
38Mechanism of Action of Methotrexate Animation
Click on the screenshot to view an animation
showing the mechanism of action of methotrexate.
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39Methotrexate Adverse Effects
- Common GI upset and mouth sores, amenorrhea
- Serious bone-marrow suppression, infertility
40Methotrexate 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
41Methotrexate 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.
42Methotrexate
- Prolonged use of small doses can lead to
hepatotoxicity.
43Sulfasalazine (Azulfidine) Uses
- Locally acting sulfonamide that may exert an
anti-inflammatory effect - Used to treat RA, juvenile chronic arthritis, and
ankylosing spondylitis
44Sulfasalazine Adverse Effects
- Common nausea, vomiting, headache, rash
- Serious anemia, oligospermia, blood dyscrasias,
liver injury, allergic reactions
45Sulfasalazine 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
46Sulfasalazine Patient Information
- Instruct patients that urine and skin may turn
orange-yellow. - Women should not breast feed.
47Gout 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
48Table 29-3 Anti-Gout Medications
49Colchicine 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
50Colchicine Uses
- Patient education Advise patients to report
severe GI symptoms or signs of bone-marrow
depression.
51Colchicine in Elderly Patients
- Colchicine must be used cautiously in elderly
patients because of its possible adverse GI,
cardiac, renal, and hepatic effects.
52Allopurinol (Aloprim) Uses
- Improves solubility of uric acid used to control
chronic, not acute, gout
53Allopurinol Adverse Effects
- Common drowsiness, headache, dizziness, nausea
and vomiting, abdominal pain - Serious hepatotoxicity, renal insufficiency
54Allopurinol 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
55Allopurinol 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.
56Uricosuric Agents Uses
- Competitively inhibit renal tubular reabsorption
of uric acid to promote its excretion - Used to treat severe attacks of gout
57Uricosuric Agents Adverse Effects
- GI irritation
- Allergic dermatitis
- Nephrotic syndrome
58Uricosuric 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
59Uricosuric 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).
60Uricosuric Acid Patient Information
- Instruct patients to not stop treatment, or not
to take aspirin or OTC medications without
consulting physician.
61Muscle 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
62Table 29-4 Centrally Acting Muscle Relaxants
63Table 29-4 (continued) Centrally Acting Muscle
Relaxants
64Centrally 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
65Centrally Acting Skeletal Muscle Relaxants
- Patient information avoid alcohol, other CNS
depressants. Patients with diabetes must closely
monitor glucose levels.