pharmacology - columbia southern university · focus on pharmacology: essentials for health...
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Focus on
PHARMACOLOGYESSENTIALS FOR HEALTH PROFESSIONALS
CHAPTER
Drugs Used to Treat Musculoskeletal Conditions
29
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Focus on Pharmacology: Essentials for Health Professionals, Second EditionJahangir Moini
Multimedia Directory
Slide 6 Osteoporosis Video
Slide 25 Arthritis Video
Slide 38 Mechanism of Action of Methotrexate Animation
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Focus on Pharmacology: Essentials for Health Professionals, Second EditionJahangir Moini
Figure 29-1 The skeletal system and its functions.
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Focus on Pharmacology: Essentials for Health Professionals, Second EditionJahangir 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.
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Focus on Pharmacology: Essentials for Health Professionals, Second EditionJahangir 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
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Focus on Pharmacology: Essentials for Health Professionals, Second EditionJahangir Moini
Osteoporosis Video
Click here to view a video on the topic of osteoporosis.
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Focus on Pharmacology: Essentials for Health Professionals, Second EditionJahangir Moini
Table 29-1 Drugs Used to Treat Osteoporosis
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Focus on Pharmacology: Essentials for Health Professionals, Second EditionJahangir 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
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Focus on Pharmacology: Essentials for Health Professionals, Second EditionJahangir Moini
Bisphosphonates: Adverse Effects
• Bisphosphonates commonly cause various GI upsets, including:
– Flatulence
– Acid regurgitation
– Dysphagia
– Gastritis
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Focus on Pharmacology: Essentials for Health Professionals, Second EditionJahangir Moini
Bisphosphonates: Adverse Effects (conditions)
• Other adverse effects include:
– Headache
– Musculoskeletal pain
– Rash
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Focus on Pharmacology: Essentials for Health Professionals, Second EditionJahangir 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
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Focus on Pharmacology: Essentials for Health Professionals, Second EditionJahangir 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.
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Focus on Pharmacology: Essentials for Health Professionals, Second EditionJahangir 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
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Calcitonin: Adverse Effects
• Headache
• Eye pain
• Anaphylaxis (reported for human calcitonin only)
• Urinary frequency
• Chills
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Focus on Pharmacology: Essentials for Health Professionals, Second EditionJahangir Moini
Calcitonin: Adverse Effects
• Chest pressure
• Weakness
• Nasal congestion
• Shortness of breath
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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
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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.
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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.
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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
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Raloxifene: Adverse Effects
• Hot flashes
• Migraines and other types of headache
• Flu-like symptoms
• Vaginal bleeding
• Uterine and urinary tract disorders
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Raloxifene: Adverse Effects
• Breast pain
• Depression
• Insomnia
• Dizziness
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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
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Raloxifene: Patient Information
• Advise patients to report unexplained calf pain or tenderness.
• Instruct patients to avoid prolonged restriction of movement during travel.
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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
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Arthritis Video
Click here to view a video on the topic of arthritis.
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Table 29-2 Disease-Modifying Drugs for Rheumatoid Arthritis
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Table 29-2 (continued) Disease-Modifying Drugs for Rheumatoid Arthritis
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Gold Compounds: Uses
• Mechanism of action not clearly understood
• Used to treat active RA
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Gold Compounds: Adverse Effects
• Common: syncope, bradycardia, thickening of tongue, metallic taste in mouth
• Serious: thrombocytopenia, leukopenia, aplastic anemia
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Gold Compounds: Contraindications
• Uncontrolled diabetes
• Renal or hepatic insufficiency
• Hepatitis
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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.
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Hydroxychloroquine (Plaquenil): Uses
• Mechanism of action unclear
• Used to treat RA and systemic lupus erythematosus
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Focus on Pharmacology: Essentials for Health Professionals, Second EditionJahangir 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
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Hydroxychloroquine: Contraindications
• Safety in pregnancy and lactation not established.
• Cautious use in patients with hepatic disease, alcoholism, impaired renal function
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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.
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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.
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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
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Mechanism of Action of Methotrexate Animation
Click here to view an animation showing the mechanism of action of methotrexate.
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Methotrexate: Adverse Effects
• Common: GI upset and mouth sores, amenorrhea
• Serious: bone-marrow suppression, infertility
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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
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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.
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Methotrexate
• Prolonged use of small doses can lead to hepatotoxicity.
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Sulfasalazine (Azulfidine): Uses
• Locally acting sulfonamide that may exert an anti-inflammatory effect
• Used to treat RA, juvenile chronic arthritis, and ankylosing spondylitis
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Sulfasalazine: Adverse Effects
• Common: nausea, vomiting, headache, rash
• Serious: anemia, oligospermia, blood dyscrasias, liver injury, allergic reactions
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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
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Sulfasalazine: Patient Information
• Instruct patients that urine and skin may turn orange-yellow.
• Women should not breast feed.
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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
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Table 29-3 Anti-Gout Medications
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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
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Focus on Pharmacology: Essentials for Health Professionals, Second EditionJahangir Moini
Colchicine: Uses
• Patient education: Advise patients to report severe GI symptoms or signs of bone-marrow depression.
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Focus on Pharmacology: Essentials for Health Professionals, Second EditionJahangir Moini
Colchicine in Elderly Patients
• Colchicine must be used cautiously in elderly patients because of its possible adverse GI, cardiac, renal, and hepatic effects.
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Focus on Pharmacology: Essentials for Health Professionals, Second EditionJahangir Moini
Allopurinol (Aloprim): Uses
• Improves solubility of uric acid; used to control chronic, not acute, gout
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Focus on Pharmacology: Essentials for Health Professionals, Second EditionJahangir Moini
Allopurinol: Adverse Effects
• Common: drowsiness, headache, dizziness, nausea and vomiting, abdominal pain
• Serious: hepatotoxicity, renal insufficiency
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Focus on Pharmacology: Essentials for Health Professionals, Second EditionJahangir 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
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Focus on Pharmacology: Essentials for Health Professionals, Second EditionJahangir 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.
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Focus on Pharmacology: Essentials for Health Professionals, Second EditionJahangir Moini
Uricosuric Agents: Uses
• Competitively inhibit renal tubular reabsorption of uric acid to promote its excretion
• Used to treat severe attacks of gout
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Focus on Pharmacology: Essentials for Health Professionals, Second EditionJahangir Moini
Uricosuric Agents: Adverse Effects
• GI irritation
• Allergic dermatitis
• Nephrotic syndrome
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Focus on Pharmacology: Essentials for Health Professionals, Second EditionJahangir 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
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Focus on Pharmacology: Essentials for Health Professionals, Second EditionJahangir 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).
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Focus on Pharmacology: Essentials for Health Professionals, Second EditionJahangir Moini
Uricosuric Acid: Patient Information
• Instruct patients to not stop treatment, or not to take aspirin or OTC medications without consulting physician.
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Focus on Pharmacology: Essentials for Health Professionals, Second EditionJahangir 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
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Focus on Pharmacology: Essentials for Health Professionals, Second EditionJahangir Moini
Table 29-4 Centrally Acting Muscle Relaxants
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Focus on Pharmacology: Essentials for Health Professionals, Second EditionJahangir Moini
Table 29-4 (continued) Centrally Acting Muscle Relaxants
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Focus on Pharmacology: Essentials for Health Professionals, Second EditionJahangir 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
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Focus on Pharmacology: Essentials for Health Professionals, Second EditionJahangir Moini
Centrally Acting Skeletal Muscle Relaxants
• Patient information: avoid alcohol, other CNS depressants. Patients with diabetes must closely monitor glucose levels.