Pharmacology of musculoskeletal system

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Pharmacology of musculoskeletal system
2016-06-27 00:46:16
Nur 106
1st Year Nursing Pharm
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  1. Calcium
    Important for nerve impulses, provides stability and movement, prevention of muscle spasms-proper metabolism works with vitamin D, PTH, calcitonin
  2. Vitamin D
    Necessary for Calcium absorption, Vita D gets converted into Cholecalciferol from the sun, dairy products, etc.
  3. Hypocalcemia
    • is a symptom not a disease
    • inadequate sun exposure
    • poor nutrition-Inadequate calcium intake
    • Digestive malabsorption issues
    • Hypoparathyroidism

    • Cell membranes become hyperexcitable
    • Side effects
    • Prolongation of QT interval on EKG
    • Increases risk of arrhythmias
    • Nerve impulse excitability
    • cramping/tremors
    • paraesthesia
    • convulsions, confusion, abnormal behavior
  4. Calcium carbonate/ citrate
    Pharm Class: Hypocalcemia agent
    • Therapeutic class: Calcium supplement.
    • MOA: correct hypocalcemia-two most common salts for routine supplementation. Pharmacokinetics very depending on the route of administration. 
    • Preg Cat: B
    • Indications: Hypocalcemia, osteoporosis, paget's disease, osteomalacia, chronic hypoparathyroidism, rickets, pregnancy, lactation and rapid childhood growth.
    • Contraindications: Hypercalcemia, ventricular fibrillation, metastatic bone cancer, renal calculi. 
    • ALERT: When given through IV give slowly to avoid dysrhythmias and cardiac arrest.
    • Adverse effects: potential for dysrhythmias with any imbalance of calcium in blood. IV administration of Calcium can lead to a fast increase and higher risk of side effects. 
    • Interactions: may increase dysrhythmias when administered with digoxin, may antagonize the effects of calcium channel blockers. Can decrease serum phosphate and potassium levels and magnesium levels.
  5. Vitamin D3
    • fat soluble, over dose resulting in hypercalcemia
    • 400 units normal dose
  6. calcitriol (Calcijex, Rocaltrol)
    Pharm Class: Bone resorption inhibitor
    • Therapeutic class: Vitamin D
    • MOA: active form of vitamin D, promotes intestinal absorption of calcium, elevates serum levels of calcium. Usually prescribed with a calcium supplement.
    • Preg. Cat: C
    • Indications: impaired kidney function or hypoparathyroidism, treatment of rickets.
    • Contraindications: Hypercalcemia, VItamin D Toxicity.
    • Adverse effects: Can cause hypercalcemia and lead to S&S of Hypercalcemia. 
    • Interactions: Thiazide diuretics may enhance the effects of vitamin D causing hypercalcemia and leading to dysrhythmias.
  7. *alendronate sodium (Fosamax)
    Pharm Class: Bisphosphonate; bone resorption inhibitor.
    • Therapeutic Class: Drug for osteoporosis
    • MOA: Lowers serum alkaline phosphatase; enzyme associated with bone turnover. May take up to 1-3 months to reach therapeutic effect.
    • Preg Cat. C
    • Indications: Osteoporosis and Paget's disease.
    • Alert: Should be taken on empty stomach for max absorption, patient should remain in upright position for at least 30 mins after administration.
    • Contraindication: osteomalacia, esophagus abnormalities, caution: for renal impairment, heart failure, Hyperphosphatemia, liver disease, infections, GI problems, and pregnancy.
    • Adverse effects: GI upset, esophageal irritation, osteonecrosis of the jaw (ONJ), hypocalcemia, hypophosphatemia, dyspepsia, arthralgia, myalgia, headache- Pathologic fractures may occur if the drug is taken longer than 3 months.
    • Interactions: Calcium, iron, antacids can interfere with absorption.
  8. raloxifene (Evista)
    Class:*Selective estrogen receptor modulators (SERM)
    • Therapeutic class: Drug for osteoporosis prevention.
    • MOA: decreases bone resorption and increases bone mass/density by acting through estrogen receptors. Can also lower TCL/LDL without lowering HDL.
    • Preg. Cat: X
    • Indications: Prevention of Osteoporosis-Give with food.
    • Contraindications: Lactating patients, prego, history of DVT, hypersensitivity to drug.
    • Alerts: Can increase risk of Venous thromboembolism.
    • Adverse effects: hot flashes, Peri-menopausal symptoms. 
    • Interactions: Concurrent use with warfarin may decrease prothrombin time. Patients should not take this medication with cholesterol lowering drugs or ERT-Estrogen Hormone Therapy.
  9. Calcitonin-will effect the body in the same way as natural Calcitonin.
    • MOA: increases bone density- reduces risks of pathologic fractures. pulls calcium from the blood and into the bone.
    • Indications: osteoporosis, Hypercalcemia
  10. Hormone Replacement Therapy (HRT)
  11. Slow release sodium flouride
  12. PTH analog
  13. Tramadol (Ultram)
  14. hydroxychloroquine sulfate (Plaquenil)
    Class:*DMRAD-Disease modifying rheumatoid arthritis drugs
    • Therapeutic class: antirheumatic drug; antimalarial.
    • MOA: relieves severe inflammation of arthritis and lupus, exact mechanism of action not known.
    • Preg. Cat: C
    • Indications: rheumatoid arthritis and lupus erythematous patient who have not responded well to other anti-inflammatory drugs, as well as malaria prevention
    • Contraindications: Hypersensitivity, retinal or visual field changes associated with med use.
    • Adverse effects: can be Hepatotoxic, GI upset, anorexia, alopecia, headache, *blood dyscrasia.
    • Interactions: antacids may prevent absorption, liver toxicity increases if patient drinks alcohol.
  15. Biologics Tumor necrosis factor (TNF) blockers
    Humira, Enbrel examples
    • MOA: Genetically engineered proteins derived from human genes, designed to either inhibit specific components of the immune system or suppressing inflammation
    • Adverse effects: Rare but serious – reactivation of TB, infections, neurological disorders such as MS, lymphoma, lupus like syndromes. Fewer side effects then DMRADS -GI upset, anorexia, alopecia, headache, ocular effects, blood dyscrasias
  16. Corticoids and Glucocorticoids
    Prednisone example
    Used to treat a wide variety of inflammatory disorders. Can be injected which is more effective. Many adverse effects-hyperglycemia, muscle weakness, bone thinning,gastric ulcers.
  17. allopurinol (Zyloprim)
    Pharm class: Xathine Oxidase Inhibitor
    • Therapeutic class: Drug for Gout-Anti-hyperuricemia
    • MOA: Take 1-3 weeks to take effect
    • Indications: Inhibit the formation of uric acid preventing gout. prophylactically taken to reduce the severity of hyperuricemia associated with antineoplastics and radiation.
    • Contraindications: hypersensitivity to drug, idiopathic hemochromatosis-, caution in patients with impaired hepatic or renal function, bone marrow depression and pregnancy.
    • Adverse effects: rash, bone marrow depression, hepatotoxicity, renal failure
    • Interactions: ototoxic when taken with thiazides, ACE inhibitors, antacids may inhibit absorption. potentiates anticoagulants. 
  18. Non-pharmacological remedies for muscle spasms
    • Herbal remedies
    • Kava – antianxiety
    • Black cohosh – topically
    • Castor oil – topically
    • Capsaicin - topically

    • Application of heat/cold
    • Hydrotherapy
    • Therapeutic ultrasound
    • Assisted exercise
    • Massage
    • Traction
    • Manipulation
    • acupuncture
  19. NSAIDS
  20. Cyclobenzaprine (Amrix, Flexeril)
    • Therapeutic Class: Skeletal Muscle Relaxant
    • Pharmaologic class: Centrally acting norepinephrine-releasing agent.
    • MOA: Thought to work on CNS (centrally) increases norepinephrine activity by inhibiting reuptake to produce anticholinergic effect.
    • Indications: Short term therapy for acute musculoskeletal conditions-unrelated to CNS, Fibromyalgia 
    • Contraindications: Hypersensitivity to Tricylic antidepressents (TCA), QT-interval prolongation- don't give to pt. recovering from MI.
  21. Paget's Disease
    • Idiopathic disease of the bone, theories suggest it is due to genetic factors or a viral infection early in life-possibly autoimmune?
    • *affected bone may be in only one or two areas of the skeleton or widespread. The bone/s abnormally break down and reform.
  22. Bone Resorption
    Demineralization that breaks down bone into it's mineral components- Calcium becomes available for other areas in the body.
  23. Bone Deposition
    Bone building, accomplished by Osteoblasts-removes calcium from the blood to be placed in bone-Stimulated by hormone calcitonin
  24. Hypercalcemia
    • Sodium permeability decreases across cell membranes. 
    • Causes: Hyperparathyroidism, Calcium supplements, Vitamin D supplements (calcitriol)

    • Side effects:
    • Shortening of QT interval on EKG
    • Dysrhythmias
    • palpitations
    • Muscle twitches/weakness
    • fatigue
    • headache, dry mouth, thirst, increased urination and nausea vomiting.
  25. Cholecalciferol- Conversion and reason
    Inactive form of vitamin D-synthesized from skin from cholesterol. Skin-Sunlight-ultraviolet light=increases levels of cholecalciferol in blood. Also obtained in Diet( Fish oil/ fatty fish, Egg yolk)

    • Gets converted into Calcifediol where enzymes in the kidneys metabolize it into Calcitriol an active form of vitamin D. 
    • PTH: responsible for this conversion to increase the absorption of calcium through the GI tract.