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Drugs Used to Treat Musculoskeletal Conditions

29. Drugs Used to Treat Musculoskeletal Conditions. Multimedia Directory. Slide 6 Osteoporosis Video Slide 25 Arthritis Video Slide 38 Mechanism of Action of Methotrexate Animation. Figure 29-1 The skeletal system and its functions. Calcium. Most abundant mineral in body

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Drugs Used to Treat Musculoskeletal Conditions

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  1. 29 Drugs Used to Treat Musculoskeletal Conditions

  2. Multimedia Directory Slide 6 Osteoporosis Video Slide 25 Arthritis Video Slide 38 Mechanism of Action of Methotrexate Animation

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

  4. 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.

  5. 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

  6. Osteoporosis Video Click on the screenshot to view a video on the topic of osteoporosis. Back to Directory

  7. Table 29-1 Drugs Used to Treat Osteoporosis

  8. 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

  9. Bisphosphonates: Adverse Effects • Bisphosphonates commonly cause various GI upsets, including: • Flatulence • Acid regurgitation • Dysphagia • Gastritis

  10. Bisphosphonates: Adverse Effects (conditions) • Other adverse effects include: • Headache • Musculoskeletal pain • Rash

  11. 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

  12. 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.

  13. 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

  14. Calcitonin: Adverse Effects • Headache • Eye pain • Anaphylaxis (reported for human calcitonin only) • Urinary frequency • Chills

  15. Calcitonin: Adverse Effects • Chest pressure • Weakness • Nasal congestion • Shortness of breath

  16. 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

  17. 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.

  18. 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.

  19. 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

  20. Raloxifene: Adverse Effects • Hot flashes • Migraines and other types of headache • Flu-like symptoms • Vaginal bleeding • Uterine and urinary tract disorders

  21. Raloxifene: Adverse Effects • Breast pain • Depression • Insomnia • Dizziness

  22. 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

  23. Raloxifene: Patient Information • Advise patients to report unexplained calf pain or tenderness. • Instruct patients to avoid prolonged restriction of movement during travel.

  24. 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

  25. Arthritis Video Click on the screenshot to view a video on the topic of arthritis. Back to Directory

  26. Table 29-2 Disease-Modifying Drugs for Rheumatoid Arthritis

  27. Table 29-2 (continued) Disease-Modifying Drugs for Rheumatoid Arthritis

  28. Gold Compounds: Uses • Mechanism of action not clearly understood • Used to treat active RA

  29. Gold Compounds: Adverse Effects • Common: syncope, bradycardia, thickening of tongue, metallic taste in mouth • Serious: thrombocytopenia, leukopenia, aplastic anemia

  30. Gold Compounds: Contraindications • Uncontrolled diabetes • Renal or hepatic insufficiency • Hepatitis

  31. 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.

  32. Hydroxychloroquine (Plaquenil): Uses • Mechanism of action unclear • Used to treat RA and systemic lupus erythematosus

  33. Hydroxychloroquine: Adverse Effects • Common: fatigue, headache, mood or mental changes, anxiety, difficulty focusing or blurred vision, anorexia, nausea and vomiting, abdominal cramps • Serious: retinopathy

  34. Hydroxychloroquine: Contraindications • Safety in pregnancy and lactation not established. • Cautious use in patients with hepatic disease, alcoholism, impaired renal function

  35. 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.

  36. 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.

  37. 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

  38. Mechanism of Action of Methotrexate Animation Click on the screenshot to view an animation showing the mechanism of action of methotrexate. Back to Directory

  39. Methotrexate: Adverse Effects • Common: GI upset and mouth sores, amenorrhea • Serious: bone-marrow suppression, infertility

  40. 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

  41. 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.

  42. Methotrexate • Prolonged use of small doses can lead to hepatotoxicity.

  43. Sulfasalazine (Azulfidine): Uses • Locally acting sulfonamide that may exert an anti-inflammatory effect • Used to treat RA, juvenile chronic arthritis, and ankylosing spondylitis

  44. Sulfasalazine: Adverse Effects • Common: nausea, vomiting, headache, rash • Serious: anemia, oligospermia, blood dyscrasias, liver injury, allergic reactions

  45. 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

  46. Sulfasalazine: Patient Information • Instruct patients that urine and skin may turn orange-yellow. • Women should not breast feed.

  47. 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

  48. Table 29-3 Anti-Gout Medications

  49. 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

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

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