Musculoskeletal Agents Flashcards
Muscle Spasms
Involuntary contractions of a muscle or muscle group. If the pattern becomes fixed may lead to decreased level of functioning.
Why muscle spasms happen?
- Excessive use/injury/pain
- Overmedication; use of psychotherapeutics
(dystonia/spasticity) - Debilitating neurological disorders
- Epilepsy
- Hypocalcemia
Non-pharm treatments for muscle spasms?
- Heat/cold
- Hydrotherapy
- Ultrasound
- Exercises
- Massage
Pharmacological agents to treat muscle spasms?
- Analgesics
- Anti-inflammatories
- Muscle Relaxants
Muscle Relaxants actions?
- Most have their site of action in the CNS
a. Inhibit motor neurons within the brain/spinal
cord
b. Exact mechanism unknown - Some act directly on skeletal muscles (direct
acting) at the neuromuscular junction
a. Interferes with the release of calcium ions in
skeletal muscle
b. Blocks release of acetylcholine from nerve
terminals
Direct and Indirect Muscle Relaxants
- Cause relaxation of skeletal muscles
- Mild weakness of skeletal muscles
- Decreased force of muscle contraction and muscle stiffness
Muscle Relaxants Indications?
- Acute skeletal muscle spasms
- Reduce rigidity
- Parkinson’s Disease
- Reduce spasticity associated with chronic disorders
- Multiple sclerosis
- Cerebral palsy
- Huntington’s chore
Muscle Relaxants Contraindications?
Allergy and severe renal (kidney) impairment
-If renal impairment, the drug may not be cleared out of the body as quickly
Muscle Relaxants Side Effects?
- Euphoria, lightheaded, dizzy, drowsy, fatigue, muscle weakness (decrease in motor neurons)
- Usually short-live; patient’s become tolerant
Muscle Relaxants interactions?
Caution with other CNS depressant drugs such as alcohol/benzos
*If on opioids, plan bed rest if used together
Examples of Centrally Acting Muscle Relaxants
- Flexeril (cyclobezaprine)
- Robaxin (methocarbamol)
- Norflex (orphenadrine) can be given IM
Examples of Direct Acting Muscle Relaxants
- Dantrium (dantrolene sodium) *chronic illness
- Botox (botulinum toxin Type A) *relaxes wrinkles
Bone and Joint Disorders
- Calcium is important for bone building; nerve transmission, blood coagulation, and muscle contraction
- Bone formation requires calcium; generally controlled by thyroid and parathyroid glands (calcitonin)
- Vitamin D: facilitates the absorption of Calcium
Calcium Related Disorders
- Hypocalcemia
- Osteomalacia
- OSTEOPOROSIS
- Paget’s Disease
When buying calcium supplements…
You should only buy calcium with vitamin D because you need the vitamin D to absorb the calcium
Osteoporosis Prevention
Supplements of calcium and vitamin D are indicated for all women at risk
At risk for Osteoporosis
- Caucasian or Asian decent
- Slender body build
- Smoking
- Alcohol consumption
- Sedentary lifestyle
- Estrogen deficiency
- Low calcium in diet
- History of osteoporosis
Biphosphonates
- Most commonly used drug for osteoporosis
- Drugs of choice
- Only drugs proven to reverse bone loss
- 1st line drug
Biphosphonates Indications
- Prevention and treatment of osteoporosis
- Paget’s disease
Biphosphonates Action
- Inhibits osteoclast activity
- Reduces rate of bone turnover, bone resorption, resulting in net gain in bone mass (bone density)
Biphosphonates Side Effects
- Nausea
- Dyspepsia (regurgitation)
- Bone pain
- Back pain
- JAW PAIN
Biphosphonates Contraindications
- Patients with dysphagia (trouble swallowing)
- Esophagitis
- Esophageal ulcer or gastric ulcer due to being very irritating
Biphosphonates Dosing
Can be daily, weekly, monthly
Biphosphonates Nursing Implications
Oral Doses
-Take first thing in morning, about 30-60 minutes
before first food
-Take with 6-8 oz of water
-Patient must be sitting upright or in a standing position for at least 30-60 minutes; do not lie down for 30-60 minutes after taking
*Very irritating to the esophagus and upper GI; needs to get to the pyloric valve
Biphosphonates Examples
- Fosamax (alendronate sodium)
- Boniva (ibandronate)
- Actonel (risedronate sodium)
Caution with Biphosphonates
Esophageal erosion can happen with this drug
Hormonal Agents
- Calcitonin
- Selective Estrogen Receptor Modulators (SERMs)
Either a replacement or an exaggeration; negative feedback loop
Calcitonin
Hormone secreted by thyroid gland
Calcitonin Action
Increases bone density and decreases risk of bone fracture
Not as effective as biphosphonates; used as second line
Calcitonin Indications
- Osteoporosis in postmenopausal women
- Paget’s disease
Calcitonin Side Effects
- Minor
- Some GI
- Nasal formulation = nasal irritation
Selective Estrogen Receptor Modulators (SERMs) Action
Decreases bone resorption and increases bone mass and density by using estrogen receptors
Selective Estrogen Receptor Modulators (SERMs) Indication
Prevention of osteoporosis
Selective Estrogen Receptor Modulators (SERMs) Side Effects
- Hot flashes
- Migraines
- Flulike symptoms
- Breast pain
- Vaginal bleeding
Selective Estrogen Receptor Modulators (SERMs) Examples
Evista (raloxifene)
Arthritis Examples
- Osteoarthritis
- Rheumatoid Arthritis
- Gout
Osteoarthritis
Most common
-Thought to be a normal aging process
Osteoarthritis is caused by?
Due to excessive wear and tear of articular cartilage of joints
Osteoarthritis can characterized by?
- Localized pain and stiffness
- Bone enlargement
- Limitations in movement
- Not usually a large degree of inflammation
Treatment of Osteoarthritis is generally?
Symptomatic
Osteoarthritis Non-Pharm Strategies
- Passive ROM exercises
- Termal therapies
- Meditation
- Massage
- Distraction
- Splinting
Osteoarthritis Pharmacological Agents
- Topical needs
- NSAIDs
- Tylenol
- Ultram (tramadol) - minor narcotic
- Intra-articular glucocorticoids (decrease
inflammation)
-Acute and temporary - Intra-articular hyaluronic acid (replaces fluid and
stimulates additional production; fluid =
lubricant)
-Hyalgan
-Synvisc
Rheumatoid Arthritis
-Occurs at an earlier age
-Autoimmune Component
*Autoantibodies cause persistent injury and the
formation of inflammatory fluid in joints
*May produce systemic manifestations:
pulmonary disease, pericarditis, fatigue,
anorexia, weakness
Rheumatoid Arthritis is characterized by?
-Crooked fingers
-Disfigurement and inflammation of multiple joints
-Joint capsules, tendons, ligaments, and skeletal
muscles may be involved
Serum
Blood test
Sedimentation Rate “SED rate”
Rate at which RBC’s fall to the bottom of the test tube
An elevated SED rate could mean?
An elevated SED rate could be increases systemic inflammation or infection
Rheumatoid Arthritis Treatment (2 Kinds)
- Symptom relief
2. Disease modifying
Rheumatoid Arthritis Treatment: Pharmacological (symptom relief)
- Topicals
- NSAIDs
- Ultram (tramadol) - mild narcotic
- Steroids for flare-ups, NOT long term (too many
side effects)
Rheumatoid Arthritis Treatment: Pharmacological (disease modifying)
- Disease modifying anti-rheumatic drugs
2. Biologicals (monoclonal antibodies)
Disease Modifying Anti-Rheumatic Drugs
-Generally works by decreasing the immune
system/inflammatory response
-Reduce mortality
-Begin within first few months of onset of
symptoms
-Many of these drugs can be toxic
-Maximum therapeutic effects may take several
months
Block steps of the inflammatory process and decrease the immune system
Disease Modifying Anti-Rheumatic Drugs Side Effects
- Gastric upset
- Headaches
Disease Modifying Anti-Rheumatic Drugs Examples
- Imuran (azathioprine) - gold salt
- Neoral (cyclosporine)
- Rheumatrex (methtrexate)
- Azulfidine (sulfasalazine)
Biologicals (monoclonal antibodies)
- Block steps in the inflammatory response
- Effective, relatively non-toxic
- Most expensive
Biologicals (monoclonal antibodies) Examples
- Enbrel (etanercept)
- Remicade (infliximab)
- Humira (adalimumab)
Primary Gout
Generally genetic; problems with uric acid metabolism
Secondary Gout
Diseases or drugs that increase metabolic turnover of nucleic acid
OR
Interferes with the excretion of uric acid
Who is Gout most common in?
90% men
Where is Gout most prevalent?
- Primarily big toes
- Heels
- Ankles
- Wrists
- Fingers
- Elbows (#2)
Gout
-Form of ACUTE arthritis
Gout is caused by?
Accumulation of uric acid crystals in joints (looks angry)
Gout is characterized by?
- Red, inflamed, swollen joints/tissues
- Worse at night; triggered by diet, stress
Uric Acid
A by-product of DNA and RNA metabolism
Can be drawn; if high, it’s probably gout
Gout: Conditions that may precipitate
- DKA
- Kidney failure
- Leukemia
- Hemolytic anemia
Gout: Drugs that may precipitate
- Thiazide diuretics
- ASA
- Cyclosporine
- Alcohol (chronic use)
Gout Treatment
- Pharmacological
- Prophylaxis
Drink more fluids!!
Gout Treatment Goal
Terminate acute episodes (maybe a narcotic)
Prevent future episodes
Gout Treatment: Pharmacological
- NSAIDs
- Uric Acid Inhibitors
- Glucocorticoids
Gout Treatment: Prophylaxis
- Dietary Management
2. Uric Acid Inhibitors
Gout Treatment: Prophylaxis Dietary Management
Avoid high purine foods: meats, alcohol, legumes
Gout Treatment: Prophylaxis Uric Acid Inhibitors
Used for clients who suffer frequent and acute attacks
Gout Treatment: Pharmacological NSAIDs
Indocin (indomathacin) for pain control
90% of the time for gout
Gout Treatment: Pharmacological Uric Acid Inhibitors
Colchicines, probenecid, allopurinol (for gout)
Side Effects: GI complaints = N/V/D, cramping
Gout Treatment: Pharmacological Glucocorticoids
Short term, sometimes intra-articular
