MSK Pharmacology

Question 1

DMARD =

Answer 1

Disease modifying antirheumatic drugs

Question 2

What do DMARDs do?

Answer 2

stop progression of rheumatic disease

Question 3

When are DMARDs used?

Answer 3

Early in the disease process to slow progression prior to widespread damage of affected joints

Question 4

How do DMARDs induce remission?

Answer 4

Modifying pathology and inhibiting immune response responsible for dz

Question 5

Implications for PT: DMARDs

Answer 5

High incidence of toxicity

Question 6

Side effects of DMARDs

Answer 6

• nausea
• HA
• jt pain/swelling
• TOXICITY
• GI distress
• sore throat
• fever
• liver dysfunction
• hair loss
• retinal damage
• potential for SEPSIS

Question 7

How do glucocorticoids work?

Answer 7

• Hormonal, anti-inflammatory, and metabolic effects including suppression of articular and systemic diseases
• reduce inflammation in chronic conditions
• vasoconstriction

Question 8

Indications for glucocorticoids

Answer 8

• endocrine dysfunction
• anti-inflammatory
• immunosuppressant
• tx of rheumatic, respiratory, and other disorders

Question 9

Indications for PT: glucocorticoids

Answer 9

• wear mask due to weakened immune system
• toxicity: look for moonface, buffalo hump, personality changes
• at risk for OP and mm wasting

Question 10

PT indications: tx for pts with joints injected with glucocorticoids

Answer 10

Require special care due to ligament/tendon laxity/weakening

Question 11

Side effects of glucocorticoids

Answer 11

• mm atrophy
• GI distress
• glaucoma
• adrenocortical suppression
• drug-induced Cushing syndrome
• weakening/breakdown of supporting tissues (bone, ligament, tendon, skin)
• mood changes
• HTN

Question 12

How do opioids work?

Answer 12

stimulate opioid receptors in the CNS to prevent pain impulses from reaching their destinations

Question 13

Indications for opioids

Answer 13

• mod to severe pain
• induction of conscious sedation
• mgmt of opioid dependence
• relief of severe and persistent cough (codeine)

Question 14

Side effects of opioids

Answer 14

• mood swings
• sedation
• confusion
• vertigo
• dulled cognitive function
• orthostatic hypotension
• constipation
• incoordination
• physical dependence/tolerance

Question 15

Opioids: implications for PT

Answer 15

• monitor for side effects, esp respiratory depression

- painful tx should be scheduled 2 hrs after administration to maximize analgesic benefits

Question 16

What’s the class?

Rheumatrex (methotrexate)

Answer 16

DMARD

Question 17

Dermacort (hydrocortisone or cortisol)

Answer 17

Glucocorticoids

Question 18

What’s the class?

Dexamethasone

Answer 18

Glucocorticoids

Question 19

What’s the class?

Roxanne, Demerol, OxyContin, sublimaze (fentanyl), paternal (codeine)

Answer 19

Opioid agents

Question 20

What’s the class?

Antimalarial drugs (chloroquine, plaquenil)

Answer 20

DMARD

Question 21

What’s the class?

Tylenol, NSAIDs, aspirin, Aleve, Advil

Answer 21

Nonopioids agents

Question 22

How do nonopioids work?

Answer 22

Promote reduction in prostaglandin formation that decreases the inflammatory process, decreases uterine contractions, lowers fever, and minimizes impulse formation of pain fibers

Question 23

Nonopioid agents: side effects

Answer 23

• nausea
• vomiting
• vertigo
• abdominal pain/GI distress or bleeding
• ulcer formation
• potential for Reye syndrome in children (aspirin only)

Question 24

Nonopioid agents: PT implications

Answer 24

• at risk for masked pain that would allow movement beyond limitation or false understanding of level of mobility
• ℅ stomach pain should be taken seriously with referral to MD

Question 25

Which nonopioid agent is used for reduction of MI?

Answer 25

Aspirin