Musculoskeletal System

1. Musculoskeletal System EO 003.01 Part 25

2. Overview of Lesson(Insert Dari) • Anti-inflammatory and anti-rheumatic products • Non-steroidal anti-inflammatories (NSAIDS) • Other anti-inflammatories • Topical products for joint and muscular pain • Muscle relaxants • Anti-gout preparations • Drugs for treatment of bone diseases Insert Dari

3. What I need to know as a pharmacy technician(Insert Dari) Insert Dari • In this lecture we will cover the drugs listed in the ANA Formulary which are classified according to the ATC system under • (M) Musculoskeletal System • For each of these medications/classes students must obtain an understanding of: • (1) Mechanism of Action • (2) Indications (Uses) • (3) Efficacy • (4) Side Effects

5. Anti-inflammatory and Anti-rheumatic Products (Insert Dari)

6. Rheumatoid Arthritis التهاب مفاصل روماتوئید • تشوش اتوایمون • غضروف مورد حمله قرار میگیرد • التهاب، اذیما و درد • مرحله آخر فیوژن یا قفل شدن مفصل • Autoimmune disorder • Cartilage attacked • Inflammation, swelling & pain • Final step is fusion of joint

7. Osteoarthritisاوستیوآرتریتس التهاب مفصلی عظمی • Degenerative joint disease • aging, wear & tear • Non-inflammatory---no swelling • only cartilage is affected not synovial membrane • Deterioration of cartilage produces bone spurs • restrict movement • Pain upon awakening--disappears with movement • مرض استحالوی مفاصل • - عمر، سایش • غیر التهابی --- بدون اذیما • - تنها غضروف متاثر میشود نه غشای ساینوویل • صدمه به غضروف یا مفسد شدن آن باعث سپر ها یا برآمده گی های میخ مانند در عظام میشود. • - حرکت را محدود میسازد • درد در هنگام برخواستن از خواب -- با حرکت از بین میرود

9. Non-steroidal Anti-inflammatories (NSAIDS) (Insert Dari) Insert Dari • Mechanism of Action • Decreases inflammationand pain by affecting the body’s immune response to injury/inflammation. • Indications • To ease pain and inflammation (swelling). • To treat arthritis. • All NSAIDs work on the same chemical process in the body, but they do it in different ways. • Some NSAIDs need to be taken more often during the day than others to work for certain kinds of pain.

10. Non-steroidal Anti-inflammatories (NSAIDS) (Insert Dari) Insert Dari • Specific Indications • Ibuprofen – short term treatment of minor painand swelling. • Naproxen – short term treatment of pain and swelling. • Diclofenac – treatment of pain and swelling, generally for an on-going issue/injury or extended period of time. • Celecoxib– to treat on going pain (decreased risk of gastric ulcer). • Ketorolac – administered intravenously for severe pain. • Indomethacin – used to treat pain and swelling associated with gout.

11. Non-steroidal Anti-inflammatories (NSAIDS) (Insert Dari) Insert Dari • Side Effects • May cause stomach irritation. • Risk for gastric ulcer. • Can increase blood pressure. • Can rarely cause kidney and liver problems.

12. Non-steroidal Anti-inflammatories (NSAIDS) (Insert Dari) Insert Dari • Important Points • Should be taken with food to decrease stomach upset/irritation. • Two different NSAIDS should not be taken together as it increases the risk for a gastric ulcer to occur. • Should be avoided in patients with a history of gastric ulcers. • Should be avoided in patients with uncontrolled hypertension (high blood pressure). • Should be avoided in pregnant women.

14. Glucosamine and Chondroitin (Insert Dari) • Mechanism of Action • Proposed to help rebuild joint cartilage. • Indication (Use) • To treat osteoarthritis. • Side Effects • stomach upset • diarrhea Insert Dari

15. Glucosamine and Chondroitin (Insert Dari) Insert Dari • Side Effects • stomach upset • diarrhea • Important Points • Glucosamine and chondroitin are dietary supplements that have received a lot of attention for their potential benefit in reducing pain and in slowing the progression of arthritis. • Research shows that glucosamine and chondroitin have little no benefit in reducing pain or progression of arthritis.

17. Topical Products for Joint and Muscular Pain: Piroxicam (Insert Dari) Insert Dari • Mechanism of Action • Is a topically applied NSAID. Decreases inflammation and pain. • Indications • To treat joint pain due to arthritis. • Side Effects • May cause skin irritation at the site of application. • Important Points • Applied directly to the skin covering the joint that is affected. • Wash hands before and after application. • Tends to be less effective than oral medications.

18. Muscle Relaxants(Insert Dari)

20. Pancuronium and Suxamethonium (Succinylcholine) (Insert Dari) Insert Dari • Mechanism of Action • Blocks neuronal transmission • Indication (Use) • Calms muscles during surgery. • Calm muscles while on a breathing machine. • Side Effects • Pancuronium : Flushing and dizziness. • Suxamethonium : increased pressure within the eye and muscle weakness. • Important Points • Administered intravenously.

21. Anti-gout Preparations (Insert Dari)

22. Gouty Arthritisالتهاب مفاصل نقرس • کرستل های یورات در مفاصل تشکل میکند---درد • - محصولات فضله ناشی از میتابولیزم DNA و RNA • - در خون تشکل میکند • - درغضروف جا به جا میشود و باعث التهاب و اذیما میشود • عظام با هم فیوز یا یکجا میشوند • مرد های میانه سال با جن های غیرنورمال • Urate crystals build up in joints---pain • waste product of DNA & RNA metabolism • builds up in blood • deposited in cartilage causing inflammation & swelling • Bones fuse • Middle-aged men with abnormal gene

24. Allopurinol(Insert Dari) Insert Dari • Mechanism of Action • Decreases uric acid formation which helps to relieve symptoms of gout. • Indications (Use) • To treat gout, as well as to prevent gout flare ups from occurring. • Side Effects • Skin irritation. • Upset stomach or throwing up

25. Allopurinol(Insert Dari) Insert Dari • Important Points • May take 6 weeks to see the full effect of the medication. • Take after a meal • Be sure to drink lots of water with this medication.

26. Drugs for the treatment of Bone Diseases (Insert Dari)

27. Osteoporosis اوستیوپوروزس • Bone resorption is greater than bone deposit • Spongy bone of the spine is most vulnerable • Bones are porous and thin but bone composition is normal • Occurs most often in postmenopausal women • Bones become so fragile that sneezing or stepping off a curb can cause fractures • یک گروپ امراض که دران جذب دوباره عظم نسبت به تحویل دهی عظم پیشی میگیرد • عظم اسفنجی ستون فقرات زیاد آسیب پذیر است • عظام متخلخل اند و نازک ولی ترکیب عظم نورمال است • اکثر اوقات در خانم های بعد از مینوپوز اتفاق میافتد • عظام آنقدر شکنندمیگردندکه حتی عطسه زدن یا پایین شدن از یک پلوان(بلندی) میتواند باعث کسر گردد

29. Alendronate(Insert Dari) • Mechanism of Action • Alendronate is a bisphosphonate. • Decreases rate of bone resorption and maintenance of bone density • Indications • To treat osteoporosis Insert Dari

30. Alendronate(Insert Dari) Insert Dari • Side Effects • Signs of low calcium levels like muscle cramps or spasms, numbness and tingling, or seizures. • This drug may cause jawbone problems. • Dizziness • Upset stomach • Diarrhea • Muscle or joint pain. • Important Points • Patients should inform other healthcare professional (i.e. dentists) if they are taking this medication. • This medication should be taken with a large glass of water 30 min before eating and patients must remain upright for 30 min after taking.

31. Questions?(Insert Dari)

32. In-class Assignment(Insert Dari) This assignment will consist of 3 questions which are to be completed individually. Once complete the instructor will review the answers with the class. Insert Dari

33. 1. True or False? : All NSAIDs work on the same chemical process in the body, are taken the same way and provide the same benefit for all types of pain. (Insert Dari)

34. 1. True or False? : All NSAIDs work on the same chemical process in the body, are taken the same way and provide the same benefit for all types of pain. (Insert Dari) Answer: False, while all NSAIDS do work the same way, they are not taken the same way nor do they have the same benefit for all types of pain. (Insert Dari)

35. 2. Match the following drugs with their indication(Insert Dari) • Alendronate • Glucosamine/chondroitin • Ibuprofen • Pancuronium • To keep muscles under control while performing surgery • To treat minor pain and inflammation • To treat osteoporosis • To prevent the progression of osteoarthritis. • Insert Dari

36. 2. Answer: Match the following drugs with their indication(Insert Dari) • Alendronate (3) to treat osteoarthritis • Glucosamine/chondroitin (4) to prevent the progression of osteoarthritis • Ibuprofen (2) to treat minor pain and inflammation • Pancuronium (1) to keep muscles under control while performing surgery. • Insert Dari

37. 3. Which of the following is NOT true regarding alendronate? (Insert Dari) • Patients should inform other health care professionals that they are taking this medication (i.e. dentists, physicians etc). • Patients should stay in an upright position for 30 min after taking this medication. • Patients should pay attention for signs of low glucose levels. • This medication can cause muscle of joint pain. • Insert Dari

38. 3. Answer: Which of the following is NOT true regarding alendronate? (Insert Dari) • Patients should inform other health care professionals that they are taking this medication (i.e. dentists, physicians etc). • Patients should stay in an upright position for 30 min after taking this medication. • Patients should pay attention for signs of low glucose levels. • This medication can cause muscle of joint pain. • Insert Dari Alendronate causes low calcium levels not glucose. (Insert Dari)