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Chap - 21


drugs used to treat disorders of the musculoskeletal system are classified as skeletal muscle relaxants & NSAIDs
structural defect of the musculoskeletal system ruptured disk
some disorders of the musculoskeletal system require __ intervention rather than medication surgical
musculoskeletal system disorders associated w/pain, spasm, abnormal contraction, or impaired mobility do respond to skeletal muscle relaxants
backaches & neck strains are treated w/combination of muscle relaxants, PT, & mild __ analgesics
muscle relaxants are given on a short-term basis
most muscle relaxant drugs affect the spinal cord & brain
most muscle relaxant drugs have no direct effect on skeletal muscles
reduces muscle spasm, causes alterations in perception of pain, & produces sedative effect, promoting rest & relaxation of affected part resulting actions of muscle relaxant drugs
used to treat acute, painful musculoskeletal conditions diazepam (Valium) & methocarbamol (Robaxin)
different kind of muscle relaxant causing direct effect of skeletal muscles & used in treatment of spasticity resulting from upper motor neuron disorders (MS, or cerebral palsy) dantrolene
dantrolene is ineffective for amyotrophic lateral sclerosis & not indicated for treatment of muscle spasms resulting from rheumatic disorders or musculoskeletal trauma
neuromuscular blocking agents (NMBAs) used during surgical, endoscopic, or orthopedics procedures succinylcholine & tubocurarine
are only administered by anesthesiologists or specially trained personnel skilled in intubation & CPR NMBAs
NMBAs can cause serious CNS problems
neostigmine (Prostigmin) or edrophonium (Tensilon) are __ for NMBAs antidotes
used in treatment of myesthenia gravis Prostigmin
used in diagnosis of myesthenia gravis Tensilon
used to treat disorders in which musculoskeletal system is not functioning properly due to inflammation anti-inflammatory drugs
arthritis, bursitis, spondylitis, gout & muscle strains conditions treated w/anti-inflammatory drugs
corticosteroids are not used for extended periods time because of serious side effects
frequently given for lengthy periods of time in maintenance doses as low as possible NSAIDs
substance responsible for producing much of the inflammation & pain of rheumatic conditions, sprains & menstrual cramps prostaglandins
older adults are particularly susceptible to __ __ from NSAIDs silent bleeding
if chronic anti-inflammatory therapy must be continued despite ulceration, the patient should be switched to __ __ NSAIDs or selective __ __ partially selective; CO-2 inhibitor
etodolac, meloxicam, or nambutone are considered partially selective NSAIDs
Arthrotec combines Voltaren w/ Cytotec to protect __ mucosa gastric
used in strict accordance w/label directions & if needed for longer than 10 days, a physician should be consulted OTC non-selective NSAIDs
NSAID; exhibits anti-inflammatory, analgesic, & antipyretic activities by selectively inhibiting COX-2 (cyclooxygenase-2) celecoxib (Celebrex)
cyclooxygenase-2 (CO-2) synthesizes prostaglandin
since celecoxib (Celebrex) does not inhibit COX-1, it does not inhibit platelet aggregation (clotting)
Celebrex does not pose the __ __ of other non-selective NSAIDs bleeding risk
celecoxib (Celebrex) has potential to cause fewer __ problems gastric
selective COX-2 inhibitor; voluntarily withdrawn from market due to subjects experiencing twice the rate of MI/stroke compared w/subjects receiving placebos rofecoxib (Vioxx)
selective COX-2 inhibitor; withdrawn from market due to causing severe/fatal skin reactions Bextra
as far as the heart is concerned there are __ __ & __ prostaglandins both good & bad
non-selective NSAIDs __ both good & bad prostaglandins suppress
selective COX-2 inhibitors shut down only the __ prostaglandins, which raises BP & risk for atherosclerosis & clotting good
until cardio safety studies for Celebrex are complete the __ __ __ of this drug & pain relief vs. cardio/GI safety must be weighed on individual basis risks and benefits
includes: GI ulceration/bleeding, epigastric pain, nausea, heartburn, GERD, rash, allergic reactions, bronchospasm, blood dyscrasias, >prolonged bleeding time, liver toxicity non-selective NSAID side effects
contraindication/extreme caution of NSAIDs for those w/asthma can manifest __ __ as bronchospasm aspirin sensitivity
medications should be taken w/meals/milk to reduce GI side effects; enteric-coated, timed-release caps/buffered aspirin also recommended to reduce gastric irritation non-selective NSAIDs
NSAIDs potentiate possibility of GI bleeding is considered an interaction with alcohol
NSAIDs potentiate possibility of bleeding when taken with anticoagulants or vitamin E
NSAIDs potentiate hyperglycemia when taken with sulfonylureas
NSAIDs increase GI effects when taken with __ for prolonged administration of NSAIDs corticosteroids
__ + NSAIDs = increased GI effects aspirin
when aspirin is taken w/NSAIDs it will __ GI risk reducing effects of COX-2 diminish
NSAIDs cause attenuated (lessens) response when taken with antihypertensives
NSAIDs decrease clearance when taken taken with lithium
NSAIDs potentiate & increase risk of toxicity from, when taken with methotrexate
__ action is antagonized by salicylates, NSAID interaction uricosurics (Benemid/Anturane)
non-selective (traditional NSAID) diclofenac brand name(s) Voltaren & Voltaren XR
non-selective (traditional NSAID) ibuprofen brand name(s) Motrin & Advil
non-selective (traditional NSAID) indomethacin brand name(s) Indocin & Indocin SR
non-selective (traditional NSAID) ketorolac brand name(s) Toradol
non-selective (traditional NSAID) naproxen brand name(s) Naprosyn, Anaprox, Aleve
non-selective (traditional NSAID) oxaprozin brand name(s) Daypro
non-selective (traditional NSAID) sulindac brand name(s) Clinoril
partially-selective NSAID etodolac brand name(s) Lodine & Lodine XL
partially-selective NSAID meloxicam brand name(s) Mobic
partially-selective NSAID nambutone brand name(s) Relafen
combination anti-inflammatory diclofenac/misoprostol band name(s) Arthrotec
combination anti-inflammatory lansoprazole/naproxen band name(s) Prevacid NapraPAC
non-steroidal anti-inflammatory specifically used to relieve inflammation in acute gouty arthritis; can also be used as prophylaxis colchicine
__ or __ __ of NSAIDs for those w/cardio disorders, such as hypertension or CHF contraindication or extreme caution
contraindication/extreme caution of __ __ for those w/kidney/thyroid disease, liver dysfunction, GERD, & history of GI bleed/IBD NSAID use
contraindication/extreme caution of NSAID use for those w/blood dyscrasias, especially __ __ or __ clotting disorders; anemia
NSAIDs pose a danger to children w/viral infections, due to possibility of Reye's syndrome with salicylates
contraindication/extreme caution for those with __ hypersensitivity; they should not taken Celebrex sulfonamide
metabolic disorder characterized by accumulation of uric acid crystals in various joints, especially big toe, knee, & elbow w/resultant pain/swelling gout
rash, GI upset, diarrhea, and blood disorders are __ __of gout medications side effects
encouraging large fluid intake, for those on gout meds, facilitates __ of uric acid crystals excretion
patients should be instructed to DC NSAIDs 10-14 days __ of any kind, to reduce risk of __ __ surgery; serious bleeding
disease characterizes by low bone mass & deterioration of bone tissues; leads to bone fragility & > susceptibility to fracture osteoporosis
osteoporosis means porous bone
includes several prescription meds treatment of osteoporosis
recommended for post-menopausal __ __ osteoporosis prevention
estrogen w/without progestin, only when unable to take other agents, & benefits outweigh risks hormone replacement therapy (HRT)
if started soon after menopause, HRT estrogen prevents accelerated phase of __ __ occurring in 1st 5yrs of onset bone loss
selective estrogen receptor modifier (SERMs) w/estrogen antagonist activity on bone & lipids & estrogen antagonist activity of breast & uterine tissues Evista
SERM properties resulted in >__ __ __ & reduced fracture risk w/out promoting breast/endometrial cancer bone mineral density
incidence of vaginal bleeding & breast tenderness is< w/Evista than with HRT
Evista can cause __ __ & muscle cramps in the legs hot flashes
Evista contraindicated in pregnancy & women w/history of __ disorders thromboembolic
synthetic form of hormone; available in nasal spray for treatment of post-menopausal osteoporosis in women >5 yrs past menopause onset calcitonin-salmon (Miacalcin)
Miacalcin increases spinal bone density & provides __ __ in acute vertebral fractures analgesic effect
reserves for women who refuse/cannot tolerate HRT, or in whom HRT is contraindicated calcitonin-salmon
local nasal effects including: irritation, redness, rhinitis, & epistaxis are the most common __ __ from Miacalcin adverse effects
Miacalcin should be stores in the refrigerator prior to opening
once Miacalcin pump has been activated it should be stored at room temperature
all __ bottle of Miacalcin should be discarded after 30 days unrefrigerated
non-hormonal agents that act directly to inhibit bone resorption, thereby > bone mineral density at spine/hip, as well as <incidence of 1st & future fractures bisphosphonates
Fosamax & Actonel are both approved for prevention & treatment of osteoporosis & considered __ __ first-line therapy
bisphosphonates are indicated for management of __ __ of the bone, chronic disorder characterized by fractures, skeletal abnormalities, & significant bone pain Paget's disease
includes: GI distress (nausea, dyspepsia, esophagitis) & abdominal/chest pain side effects of bisphosphonates
bisphosphonates carry a caution for those with active __ __ problems upper GI
bisphosphonates are contraindicated for those with renal insufficiency and __ hypocalcemia
bisphosphonates are contraindicated for those unable to __ __ for 30 minutes after taking drug sit upright
patients should be advised of importance of taking w/full glass of water, at least 30 min before first food, beverage, or medication of the day Fosamax or Actonel
when taking Fosamax or Actonel, not lying down for at least 30 min will __ __ to the stomach & avoid esophageal irritation speed delivery
those taking Fosamax or Actonel should take __ calcium & vitamin D supplemental
those taking Fosamax or Actonel should be instructed about __ exercise weight-bearing
modification of __ & __ should be advised for those taking Fosamax or Actonel smoking; alcohol
bisphosphonate; ibandronate brand name Boniva
patients taking skeletal muscle relaxants should be instructed to move slowly & have support available because __ is a common side effect hypotension
skeletal muscle relaxants should only be taken as long as absolutely necessary because prolonged use can lead to physical or psychological dependence
abrupt withdrawal of muscle relaxants, such as Valium, after prolonged use can cause seizures
represents appropriate care for musculoskeletal injuries to extremities rest, ice, compression, elevation
oldest non-steroidal anti-inflammatory drug w/analgesic & antipyretic effects is aspirin
aspirin is contraindication for patients with asthma because it can cause bronchospasm
partially selective NSAID; nambutone brand name Relafen
skeletal muscle relaxant; carisoprodol brand name Soma
skeletal muscle relaxant; cyclobenzaprine brand name Flexeril
skeletal muscle relaxant; diazepam brand name Valium
skeletal muscle relaxant; methocarbamol brand name Robaxin
skeletal muscle relaxant; dantrolene brand name Dantrium
skeletal muscle relaxant; baclofen brand name Lioresal
skeletal muscle relaxant; tizanidine brand name Zanaflex
bisphosphonate; alendronate brand name Fosamax
bisphosphonate; risedronate brand name Actonel
SERM; raloxifene brand name Evista
patients who use NSAIDs, particularly on long-term basis, can develop silent bleeding
NMBAs must be used with caution because they can produce respiratory arrest