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

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Drugs Used to Treat Musculoskeletal Conditions
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Multimedia Directory

• Slide 6 Osteoporosis Video
• Slide 25 Arthritis Video
• Slide 38 Mechanism of Action of Methotrexate
  Animation

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Figure 29-1 The skeletal system and its
functions.
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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.

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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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Osteoporosis Video
Click on the screenshot to view a video on the
topic of osteoporosis.
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Table 29-1 Drugs Used to Treat Osteoporosis
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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

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Bisphosphonates Adverse Effects

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

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Bisphosphonates Adverse Effects (conditions)

• Other adverse effects include
• Headache
• Musculoskeletal pain
• Rash

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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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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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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

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Calcitonin Adverse Effects

• Headache
• Eye pain
• Anaphylaxis (reported for human calcitonin only)
• Urinary frequency
• Chills

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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 physicians 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 23 times more often in women (onset
  usually at ages 4060)
• Joints affected include hands, feet, wrists,
  spine, shoulders, ankles, and hips

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Arthritis Video
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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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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 on the screenshot 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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Colchicine Uses

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

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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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Allopurinol (Aloprim) Uses

• Improves solubility of uric acid used to control
  chronic, not acute, gout

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Allopurinol Adverse Effects

• Common drowsiness, headache, dizziness, nausea
  and vomiting, abdominal pain
• Serious hepatotoxicity, renal insufficiency

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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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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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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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Uricosuric Agents Adverse Effects

• GI irritation
• Allergic dermatitis
• Nephrotic syndrome

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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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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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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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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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Table 29-4 Centrally Acting Muscle Relaxants
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Table 29-4 (continued) Centrally Acting Muscle
Relaxants
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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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Centrally Acting Skeletal Muscle Relaxants

• Patient information avoid alcohol, other CNS
  depressants. Patients with diabetes must closely
  monitor glucose levels.