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VN140 Muscoskeletal

VN140 Muscoskeletal Pharm

QuestionAnswer
Muscoloskeletal pharm includes the medications helpful in treating the problems affecting the bones, joints, muscles and ligaments. It is selected based on severity of problem. Variety of muscoskeletal disorders that cause varying degrees of pain, disability and deformity
what are the 3 phases of inflammation? 1) acute, brief, local vasodilation & increased capillary permeability 2) delayed, subacute inflitration of leukocytes and phagocytic cells into tissue 3) chronic proliferation tissue degeneration and fibration
what are the 3 properties of NSAIDs analgesic, antiinflamatory and antipyretic
NSAIDs the activation of the arachidonic acid pathway causes pain, headache, fever and inflammation
NSAIDs - Mech of Action - ANALGESIA treatment of headaches and pain. It blocks undesirable effects of prostaglandins which causes headaches
what are the prostaglandins useful functions? protecting the mucosa of the GI, maintain normal renal function, platelet aggression, consciousness and mental functions of the brain.
what are the prostaglandins bad functions? can cause erythema and an increase in local blood flow, can remove the vasoconstricor effects of substances such as norepinephrine and angiotensin.
NSAIDs - Mech of Action - ANTIPYRETIC it reduces fever. It inhibit prostaglandin E2 within the area of the brain that controls temperature
NSAIDs - Mech of Action - ANTIinflamatory relief of inflammation. It inhibits the leukotriene pathway, the prostaglandin pathway or both
what are the 6 structurally related groups of NSAIDs acetic acids, carboxylic acids, propionic acids, enolic acids, fenamic acids and nonacidic compounds
NSAIDs- ACETIC ACID - drugs etodolac (LODINE)
NSAIDs- CARBOXYLIC ACIDS - drugs - ACETYLATED aspirin (ASA), choline magnesium salicylate (Trilisate) and diflunisal (Dobolid)
NSAIDs- CARBOXYLIC ACIDS - drugs - NONACETYLATED salicylamide, salsalate (Disalcid), sodium salicylate and ACETAMINOPHEN (TYLENOL)
ASPIRIN NSAIDs- CARBOXYLIC ACIDS - drugs - ACETYLATED. Greatest antiinflamatory action than other salicylate and in many problems. It is the preferred drug. Given 4 to 6 times for hip and knee pain.
ASPIRIN possible GI bleed. Should be taken with food
NSAIDs - OTHER AGENTS- drugs celecoxib (Celebrex) and refecoxib (Vioxx)
NSAIDs - OTHER AGENTS - COX-2 INHIBITORS reduce inflammatory response to tissue without GI tract side effect. Long term use will cause heart attack and stroke. Must assess for cardiac disease
NSAIDs - DRUG EFFECTS analgesic, antigout, antiinflamatory, antipyretic, relief of vascular headaches, platelet inhibition (ASA)
NSAIDs - THERAPEUTIC USES relief of mild to moderate pain, acute gout, various bone, joint and muscle pain, osteoarthritis, rheumatoid arthritis, juvenile rheumatoid arthritis, dysmenorrhea and fever
NSAIDs - SPECIFIC AGENTS - SALICYLATES (aspirin) not recommended for young children for antipyretic. Will cause RYE SYNDROME.
if high dose of salicylate is given… check serum level of med
NSAIDs - SPECIFIC AGENTS - SALICYLATES (aspirin) more potent effect on platelet aggregation and thermal regulatory center in the brain (analgesic, antipyretic and antiinflamatory). It has ANTITHROMBOTIC EFFECT -used in treatment of MI & other thromboembolic disorders
NSAIDs - SPECIFIC AGENTS - PHENYLBUTAZONE (Butazolidin) greater effects on uric acid production and excretion, in addition to antiinflamatory effects. It is more commonly used for treatment of gout
what are the side effects of NSAIDs GI, dyspepsia, heartburn, epigastric distress, nausea, mucosal lessions
what can be used to reduce dangerous effects of NSAIDs misoprostol (Cytotec)
what are the OTHER side effects of NSAIDs RENAL (reduction in creatinine clearance & acute tubular necrosis w renal failure) & CARDIOVASCULAR (noncardiogenic pulmonary edema)
NSAIDs - SALICYLATE TOXICITY adults (tinnitus and hearing loss) kids (hyperventilation and CNS effects) metabolic acidosis and respiratory alkalosis may be present
effects will arise when serum levels exceed… 300ug/mL
NSAIDs - Nursing Implication before beginning therapy, assess for conditions that may be contraindications to therapy especially GI Lessions or PUD and bleeding disorders. perform a medication history to assess for potential drug interactions.
SKELETAL MUSCLE RELAXANT reduce muscle tone & involuntary movement w/o loss of voluntary motor function. limits transmssion or movement of impulses in motor pathways at level of spinal cord & brainstem or interfere w the mech that shortens skeletal muscle fibers so they conract
SKELETAL MUSCLE RELAXANT mild sedation, reduction of anxiety & tension & change in pain perception.
SKELETAL MUSCLE RELAXANT - USES muscle strain or sprain, arthritis, bursitis, cerebral palsy, multiple sclerosis, low back syndrome, cervical syndrome, tension headache
SKELETAL MUSCLE RELAXANT - Adverse Reaction flushing, hypotension, syncope, tachycardia, ataxia, blurred vision, confusion, DROWSINESS
SKELETAL MUSCLE RELAXANT - Drug interaction increase effect of CNS depressants, increase the effect of general anesthetics, MAO inhibitors and antidepressants. CAN BE HABIT FORMING!!!
SKELETAL MUSCLE RELAXANT - Drug diazepam (Valium) baclofen (Lioresal)
ARTHRITIC salicylates & NSAIDs are the first line of drugs for treatment of arthritis
ARTHRITIC - SAARDs (Slow acting antirheumatic drugs) gold compounds, hydroxichloroquine Sulfate, infliximab, leflunamide, methotrexate, penicillamine
ARTHRITIC - SAARDs (Slow acting antirheumatic drugs) does not treat the disease but it slows or halt joint destruction and so may prevent greater deformity.
Osteoarthritis a more localized form of joint destruction, particularly in weight-bearing joints or stressed joints, that progresses gradually over time from overuse and increasing age
Rheumatoid arthritis a systemic disease that involves an autoimmune response caused by failure of the body to recognize its own tissue; this results in destruction of joints
ARTHRITIC-drug- GOLD COMPOUND (GOLD SALTS) Therapy is called CHRYSOTHERAPY. IM should be given into gluteous maximus to minize irritation
ARTHRITIC-drug- GOLD COMPOUND exact mechanism of action is not known. It inhibits lysosomal enzyme activity in macrophages & decrease phagocytic activity, affects autoimmune response in RA, stop sinuvitis of active RA
ARTHRITIC-drug- GOLD COMPOUND -side effect gold dermatitis, pruritis, rash periorbital & on the hands &dorsa of the hands
ARTHRITIC-drug- HYDROXYCHLOROQUINE SULFATE Plaquenil - also an antimalarial drug & lupus erythematosus. Takes about 12 wks before you see improvement. If after 6 months, with no effect then stop it.
ARTHRITIC-drug- HYDROXYCHLOROQUINE SULFATE - mechanism of action not known. It stops the formation of antigen in the body. DO NOT USE with other SAARDs
ARTHRITIC-drug- HYDROXYCHLOROQUINE SULFATE - adverse effect Retinopathy - may progress even if the drug is stopped. Need to have optalmology check eyes before and after. Check every 3 to 6 months
ARTHRITIC-drug- INFLIXIMAB Ramicade- used in combination w methotrexate to decrease symptoms of rheumatoid arthritis & limit the worsening of damage to joints. Also used in Chron's disease & other orthopedic inflammatory or destructive process
ARTHRITIC-drug- INFLIXIMAB - adverse reaction may activate TB!! If tested positive before, must be treated before taking this med
ARTHRITIC-drug- INFLIXIMAB given by IV. dyspnea, flushing, headache and rash may occur within 1 to 2 hours of the infusion.
ARTHRITIC-drug- LEFLUNAMIDE Arava- it has an antiinflammatory effect, reduces s/sx of rheumatoid arthritis & slows structural damage in joints
ARTHRITIC-drug- LEFLUNAMIDE category "x" drug that is contraindicated during pregnancy
ARTHRITIC-drug- LEFLUNAMIDE - adverse reaction it may produce hepatotoxicity, increase risk of cancer of the lymph system
ARTHRITIC-drug- METHOTREXATE Amethopterin, Rheumatrex - med used for years in rheumatoid arthritis. It may affect immune function, reduces swelling & tenderness but does not cause remission or limits bone erosion; has been used to treat various cancerous & psoriatic condition
ARTHRITIC-drug- METHOTREXATE - adverse reaction toxic bone marrow, liver, kidney & lungs; death. LAB: decrease WBC
ARTHRITIC-drug- PENICILLAMINE chemical breakdown product of penicillin. It is a chelating agent that is used to bind heavy metals in conditions such as lead and copper poisoning. Only 30% of pts may benefit!!!!
ARTHRITIC-drug- PENICILLAMINE- therapeutic effect will be seen in 3 to 6 months
ARTHRITIC-drug- PENICILLAMINE- nursing implications blood and urine follow up should continue every 2 weeks for 6 months and then monthly thereafter for as long as the pt receives medication.
ARTHRITIC-drug- PENICILLAMINE- adverse effects blood dyscrasias & skin reactions are dangerous. Pts w history of renal impairment or active renal disease should not receive this drug because of its risk for toxic effects on the kidneys.
ANTIGOUT used to treat gout vary in their method of action. Those used to treat acute attacks act to relive pain and inflammation.
uric acid a metabolite of protein. High levels cause the excess to form crystals, ususally in the kidneys and in joint spaces. These crystals have very lony, sharp, and jagged edges. The result is a syndrome called GOUT.
ANTIGOUT - 2 categories URICOSIC AGENTS & ANTIGOUT PREPARATIONS
ANTIGOUT - URICOSIC AGENT - Drugs probenecid (Benemid, Benuryl, Probenecid) Sulfinpyrazone (Anturane)
ANTIGOUT - ANTIGOUT PREPARATION- Drugs allopurinol (Purinol, Zyloprim) & colchicine (Colchicine)
ANTIGOUT - URICOSIC AGENT increase the excretion of urate salts in the urine by blocking tubular reabsorption of these salts in the kidney. They do not have significant antiinflammatory or analgesics properties & therefore are of little help during an acute episode of gout
diagnosis of gout serum uric acid level greater than 7 mg/100 mL. 24 hr urine test for uric acid of less than 800 mg per day
ANTIGOUT - URICOSIC AGENT - Adverse Effects drug fever, dizziness, pruritis, rashes, anorexia, constipation, diarrhea, n/v, exacerbation of acute gout attack
ANTIGOUT - ANTIGOUT PREPARATION - ALLOPURINOL inhibits the production of uric acid by decreasing the production of xanthine oxidase. Maybe given with uricosuric agent. This is a PROPHYLACTIC therapy for gout; uric nephropathy, primary or secondary hyperuricemia
ANTIGOUT - ANTIGOUT PREPARATION - ALLOPURINOL - adverse reaction drowsiness, alopecia, rash, purpura, abd pain, n/v, blood dyscrasias, fever, chills, arthralgia,
ANTIGOUT - ANTIGOUT PREPARATION - COLCHICINE treat acute gouty attak. It inhibits leukocyte migration & phagocytosis. Decreases uric acid deposits in the tissues. This is not an antiinflammatory, analgesic or uricosuric agent. May be used in combination w other antigout meds
ANTIGOUT - ANTIGOUT PREPARATION - COLCHICINE - adverse reaction abd pain, severe diarrhea, n/v, bone marrow depression, peripheral neuritis, purpura
Created by: jekjes