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VN140 Muscoskeletal
VN140 Muscoskeletal Pharm
| Question | Answer |
|---|---|
| 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
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