Musculoskeletal Disease Drugs

Question 1

describe MUSCLE RELAXANTS

Answer 1

• relieves pain asso. with SM spasms
• most are CENTRALLY ACTING; CNS site of action (similar to CNS depressants)
• can be DIRECT ACTING; skeletal muscle site of action (similar to GABA)

Question 2

indications for muscle relaxants

Answer 2

• muscle spasms
• severe chronic disorders (MS, cerebral palsy)
• *IV dantrolene - malignant hyperthermia
• works best with PT!

Question 3

adverse effects for muscle relaxants

Answer 3

• euphoria
• lighheadedness
• dizziness
• drowsiness
• fatigue
• muscle weakness

Question 4

musc relaxants interactions

Answer 4

• benzos
• alcohol
• other cns depressants

Question 5

toxicity/management of musc relaxant OD

Answer 5

• no antidote or reversal
• want to ensure proper airywa, EKG, IV fluids to avoid crystalluria

Question 6

baclofen (lioreseal)

Answer 6

• oral and injectable
• treats chronic spastic muscular conditions
• use of implantable pump **need a test dose first to confirm positive response

Question 7

cyclobenzaprine (flexeril)

Answer 7

• oral & extended release (amrix)
• CNS muscle relaxer; the most common
• causes sedation

Question 8

allopurinol (zyloprim)

Answer 8

• prevents URIC ACID production
• prevents ACUTE TUMOR LYSIS SYNDROME
• can cause exofoliative dermatitis, SJ syndrome, or toxic epidermal necrolysis

Question 9

probenecid (benemid)

Answer 9

• inhibits the REABSORPTION of URIC ACID in kidneys
• increases EXCRETION of URIC ACID
• type of URIOSURIC
• need good RENAL FXN

Question 10

febuxostat (uloric)

Answer 10

• type of NONPURINE SELECTIVE INHIBITOR of xanthine oxidase
• more selective
• greater risk of cardiac death/cardio events vs. allopurinol

Question 11

colchicine

Answer 11

• reduces the INFLAM response of the urate crystals in joints
• only used SHORT TERM; can cause SHORT-TERM LEUKOPENIA or BLEEDING in GI or URINARY TRACT

Question 12

lesinurad (zurampic)

Answer 12

• type of URIC ACID TRANSPORTER INHIBITOR - inhibitor of transporter proteins for uric acid reabsorption > lowers levels
• given in COMBO with xanthine oxidase inhibitor
• at least 2 liters of fluid a day

Question 13

drug therapy for OSTEOPOROSIS

Answer 13

• increase of CALCIUM and vitamin D supplements
• recommendation: women 60+ consider taking supp.

Question 14

what are our BISPHOSPHONATES?

Answer 14

• alendronate (fosamax)
• ibandronate (boniva)
• risedronate (actonel)
• zoledronic acid (reclast)
  *all end in nate

Question 15

how do biphosphonates work?

Answer 15

• inhibits OSTEOCLAST-MEDIATED BONE RESORPTION > enhances density of bone
• reverse lost bone mass, reduces fracture risk
• prevents and treats OP

Question 16

contraindications for bisphosphonates

Answer 16

• DA
• HYPOcalcemia
• esophageal dysfxn.
• inability to sit/stand upright for at least 30 min after taking med

Question 17

adverse effects bisphosphonates

Answer 17

• headaches
• GI upset
• joint pain
• take with FULL glass of water/stay upright for at least 30 min after

Question 18

interactions bisphosphonates

Answer 18

• CALCIUM supplements & antacids (issues with absorption) *spaced out to avoid
• NSAIDS; can cause more GI irritation

Question 19

alendronate (fosamax)

Answer 19

• oral bisphos
• the FIRST NON-ESTROGEN NON-HORMONAL OPTION for prevention of bone loss
• indicated for; osteoporosis, gluco-induced osteoporosis, paget disease

Question 20

selective estrogen receptor modifiers (SERMS) MOA & indication

Answer 20

• prevents postmenopausal OP
• stimulates more estrogen receptors on bone/increases bone density
  *raloxifene (evista)
  *tamoxifen (nolvadex)

Question 21

contraindications SERMS

Answer 21

• women with DA
• pregnant women
• venous thromboembolic disorder / DVT/PE
• retinal vein thrombosis

Question 22

adverse effects SERMS

Answer 22

• hot flashes & leg cramps
• increases risk for venous thromboembolism
• leukopenia
• tetatogen

Question 23

interactions SERMS

Answer 23

• cholestyramine (decreases absorption of raloxifene)
• warfarin (decreased effects)

Question 24

raloxifene (evista)

Answer 24

• adverse effects - hot flashes
• stimulates estrogen receptors of bone and increases bone density
• prevents postmenopausal osteoporosis

Question 25

calcitonin (calcimar)

Answer 25

- inhibits osteoclastic bone resorption - treats OP - contra; DA/DA to salmon - can interact with CAL supplements > can cause hypercalcemia

Question 26

teriparatide (forteo)

Answer 26

- only drug that stimulates bone formation - deriative of PTH; similar to natural PTH - used for OP patients who are at highest risk of fracture - contra; DA

Question 27

denosumab (prolia)

Answer 27

- type of MONOCLONAL ANTIBODY > blocks osteoclast activation/prevention of bone resorption - SUBQ injection every 6 months given with CALCIUM and VITAMIN D (daily) - contraindications: HYPOcalemia/renal impairment, pregnancy or infection

Question 28

romoszumab (evenity)

Answer 28

- new - sclerostin inhibitor monoclonal antibody