Download moini_ch29_lecture

Focus on
PHARMACOLOGY
ESSENTIALS FOR HEALTH PROFESSIONALS
CHAPTER
29
Drugs Used to
Treat
Musculoskeletal
Conditions
Figure 29-1
The skeletal system and its functions.
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
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 1–2 kg of calcium,
99% of which is in bones.
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
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
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Table 29-1
Drugs Used to Treat Osteoporosis
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Bisphosphonates: Uses
• Highly selective inhibitor of bone
demineralization and resorption;
appears to increase bone density
• Used to treat osteoporosis; some for
Paget’s disease; some for
hypercalcemia of malignancy; some for
postmenopausal osteoarthritis
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Bisphosphonates:
Adverse Effects
• Bisphosphonates commonly cause
various GI upsets, including:
– Flatulence
– Acid regurgitation
– Dysphagia
– Gastritis
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Bisphosphonates:
Adverse Effects (conditions)
• Other adverse effects include:
– Headache
– Musculoskeletal pain
– Rash
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
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
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
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.
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
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
Paget’s disease
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Calcitonin: Adverse Effects
• Headache
• Eye pain
• Anaphylaxis (reported for human
calcitonin only)
• Urinary frequency
• Chills
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Calcitonin: Adverse Effects
•
•
•
•
Chest pressure
Weakness
Nasal congestion
Shortness of breath
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
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
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
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.
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
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 physician’s guidance.
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
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
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Raloxifene: Adverse Effects
•
•
•
•
•
Hot flashes
Migraines and other types of headache
Flu-like symptoms
Vaginal bleeding
Uterine and urinary tract disorders
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Raloxifene: Adverse Effects
•
•
•
•
Breast pain
Depression
Insomnia
Dizziness
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
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
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Raloxifene:
Patient Information
• Advise patients to report unexplained
calf pain or tenderness.
• Instruct patients to avoid prolonged
restriction of movement during travel.
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Rheumatoid Arthritis (RA)
• Systemic autoimmune disease that
involves inflammation of joint-lining
membranes; also affects internal
organs
• Occurs 2–3 times more often in women
(onset usually at ages 40–60)
• Joints affected include hands, feet,
wrists, spine, shoulders, ankles, and
hips
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Table 29-2
Disease-Modifying Drugs for Rheumatoid Arthritis
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Table 29-2 (continued) Disease-Modifying Drugs for Rheumatoid Arthritis
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Gold Compounds: Uses
• Mechanism of action not clearly
understood
• Used to treat active RA
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Gold Compounds:
Adverse Effects
• Common: syncope, bradycardia,
thickening of tongue, metallic taste in
mouth
• Serious: thrombocytopenia, leukopenia,
aplastic anemia
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Gold Compounds:
Contraindications
• Uncontrolled diabetes
• Renal or hepatic insufficiency
• Hepatitis
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
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.
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Hydroxychloroquine
(Plaquenil): Uses
• Mechanism of action unclear
• Used to treat RA and systemic lupus
erythematosus
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Hydroxychloroquine:
Adverse Effects
• Common: fatigue, headache, mood or
mental changes, anxiety, difficulty
focusing or blurred vision, anorexia,
nausea and vomiting, abdominal
cramps
• Serious: retinopathy
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Hydroxychloroquine:
Contraindications
• Safety in pregnancy and lactation not
established.
• Cautious use in patients with hepatic
disease, alcoholism, impaired renal
function
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
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.
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
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.
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
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
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Methotrexate: Adverse Effects
• Common: GI upset and mouth sores,
amenorrhea
• Serious: bone-marrow suppression,
infertility
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
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
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
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.
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Methotrexate
• Prolonged use of small doses can lead
to hepatotoxicity.
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Sulfasalazine (Azulfidine): Uses
• Locally acting sulfonamide that may
exert an anti-inflammatory effect
• Used to treat RA, juvenile chronic
arthritis, and ankylosing spondylitis
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Sulfasalazine: Adverse Effects
• Common: nausea, vomiting, headache,
rash
• Serious: anemia, oligospermia, blood
dyscrasias, liver injury, allergic
reactions
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
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
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Sulfasalazine:
Patient Information
• Instruct patients that urine and skin
may turn orange-yellow.
• Women should not breast feed.
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
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
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Table 29-3
Anti-Gout Medications
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
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
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Colchicine: Uses
• Patient education: Advise patients to
report severe GI symptoms or signs of
bone-marrow depression.
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Colchicine in Elderly Patients
• Colchicine must be used cautiously in
elderly patients because of its possible
adverse GI, cardiac, renal, and hepatic
effects.
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Allopurinol (Aloprim): Uses
• Improves solubility of uric acid; used to
control chronic, not acute, gout
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Allopurinol: Adverse Effects
• Common: drowsiness, headache,
dizziness, nausea and vomiting,
abdominal pain
• Serious: hepatotoxicity, renal
insufficiency
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
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
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
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.
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Uricosuric Agents: Uses
• Competitively inhibit renal tubular
reabsorption of uric acid to promote its
excretion
• Used to treat severe attacks of gout
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Uricosuric Agents:
Adverse Effects
• GI irritation
• Allergic dermatitis
• Nephrotic syndrome
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
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
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
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).
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Uricosuric Acid:
Patient Information
• Instruct patients to not stop treatment,
or not to take aspirin or OTC
medications without consulting
physician.
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
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
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Table 29-4
Centrally Acting Muscle Relaxants
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Table 29-4 (continued) Centrally Acting Muscle Relaxants
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
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
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Centrally Acting Skeletal
Muscle Relaxants
• Patient information: avoid alcohol,
other CNS depressants. Patients with
diabetes must closely monitor glucose
levels.
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini