Lecture Musculoskeletal Flashcards
Muscle spasm
involuntary contraction of a muscle or muscle group
Causes
i) Epilepsy
ii) Hypocalcemia
iii) Pain syndromes: Adult and chronic
iv) Trauma: Localized skeletal muscle injury
Treatment - Drug Therapy
(1) Analgesic Anti-inflammatory (i.e. ASA, ibuprofen, naproxen)
(2) Centrally Acting Muscle Relaxants - diazepam and tizanidine
Centrally Acting Muscle Relaxants - diazepam and tizanidine
Uses Relief of localized spasm caused by muscle injury Can decrease local pain and tenderness Can increase range of motion Sedation
AEs CNS depression (Avoid alcohol) Hepatic toxicity - Esp tizanidine: watch LFTs Physical dependence Anticholinergic effects
Includes:
i) baclofen [Lioresal, Gablofen]
ii) carisoprodol [Soma]
iii) chlorzoxazone [Lorzone, Parafon Forte DSC]
iv) cyclobenzaprine [Flexeril, Fexmid, Amrix]
v) diazepam [Valium]
vi) metaxalone [Skelaxin]
vii) methocarbamol [Robaxin]
viii) orphenadrine [Norflex]
ix) tizanidine [Zanaflex]
Spacity
Movement disorders of CNS origin
Multiple sclerosis, cerebral palsy, spinal cord injury, stroke
Increased muscle tone, spasm, loss of dexterity
Treatment
(1) baclofen [Lioresal]
(2) diazepam [Valium]
(3) dantrolene [Dantrium]
Notes:
(a) Baclofen and diazepam affect the CNS (Centrally Acting Muscle Relaxants)
(b) Dantrolene works on the smooth muscles -> so don’t use for someone that needs muscle strength
baclofen
Indications: Multiple Sclerosis, Spinal Cord Injury, Cerebral Palsy
Doesn’t work on muscle, so use w/those of low muscle
NOT used with stroke
AEs (1) CNS depression (2) GI upset, urinary retention (3) Abrupt withdrawal PO - hallucinations, paranoia, seizures Intrathecal (spinal) - high fever, alt mental status, rebound spasticity/rigidity -> Rhabdomyolosis, organ system failure, death
dantrolene
Acts directly on skeletal muscle
Uses
Multiple Sclerosis, Cerebral Palsy, Spinal Cord Injury, malignant hyperthermia
AEs
(1) Hepatic toxicity
(2) Muscle weakness
(3) Drowsiness
(4) Diarrhea
(5) Acne-like rash, anorexia, N//V
Hypercalcemia
S/S:
Constipation and abdominal (belly) pain.
Tiredness, weakness, or muscle pain.
Confusion, disorientation, and difficulty thinking.
Causes: Cancer Hyperparathyroidism Vitamin D intoxication Sarcoidosis (inflammatory disease) Use of thiazide diuretics
Hypocalcemia
Increases neuromuscular excitability
Clinical presentation - Tetany, convulsions, and spasm of the pharynx
Causes
Deficiency of PTH, Vit D, or calcium
Chronic renal failure
Long-term use of certain medications - Magnesium-based laxatives and drugs used to manage osteoporosis
Rickets / Osteomalacia
Vit D deficiency
Softening of bone
Called rickets in children
Highest risk in older adults, premature infants, and strict vegetarians
Global resurgence may be from promotion of breast-feeding over vitamin D–fortified formulas.
osteoporosis
Most common disorder of calcium metabolism
Bone demineralization - Decreased bone density
Women four times more likely than men to develop
“Gold standard” for diagnosis is dual-energy x-ray absorptiometry (DEXA).
Paget’s disease
Chronic, progressive condition of accelerated remodeling of the bone leading to enlarged and softened bones
Cause unknown
Pharmacotherapy with biphosphonates and calcitonin
biphosphonates: alendronate [Fosamax]
Indications include treatment of osteoporosis, Paget disease, hypercalcemia of malignancy
Major Adverse effect - GI symptoms (N/V, abdominal pain, esophageal irritation)
-
Nursing 101 – for ALL biphosphonates
(1) Take with full glass of water and remain in upright position for 30 min to 1hr after taking
(2) Take upon arising for the day
(3) Take 30 minutes before first food, beverage or medication
SERM: raloxifene [Evista]
Bind to estrogen receptors
Increase bone density
Prevent fractures in postmenopausal women
Uses
Osteoporosis
Breast cancer
Contraindication
(1) Lactation
(2) Pregnancy
(3) *History of venous thromboembolism
(4) Should be discontinued 72 hours before prolonged immobilization
Nursing 101
(1) Obtain baseline serum lipid and calcium levels, bone density, and height and weight
(2) Discontinue at least 72 hours before prolonged immobilization
(3) Monitor for signs of thromboembolic events
Other SERMs
i) Calcitonin – lowers serum calcium
ii) Cinacelcet – lowers calcium (mimics calcium)
iii) Teriparatide – only drug that increases bone formation
osteoarthritis
Progressive degenerative joint disease
Wake up -> OK!
As day goes -> gets WORSE!
Nonpharmacologic therapy
(1) Walking
(2) Nonimpact aerobics
(3) Passive ROM exercises
Pharmacotherapy
(1) Acetaminophen
(2) NSAIDs
(3) Corticosteroid injections
(4) Hyaluronate sodium
(5) Topical salicylates, capsaicin, and Bengay
rheumatoid arthritis
Chronic, progressive autoimmune disease
Wake up -> STIFF & SORE!
As day goes -> gets BETTER!
Nonpharmacologic therapy
(1) ROM exercises
(2) Joint and muscle strengthening exercises
(3) Psychological counseling
Pharmacotherapy
(1) NSAIDs
(2) Acetaminophen (has no antiinflammation)
(3) Corticosteroids
(4) DMARDs (disease modifying anti-rheumatic drugs)
DMARD methotrexate
fastest DMARD
3-6 weeks
once weekly po/IM
AEs
Hepatic fibrosis, bone marrow suppression, GI ulcers, pneumonitis, Preg Cat X
non-biologic DMARD (along with Sulfasalazine)
