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Pharmacology > Musculoskeletal Drugs > Flashcards

Musculoskeletal Drugs Flashcards

1
Q

Bisphosphonates MOA

A

inhibit osteoclast activity, promote osteoclast apoptosis

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2
Q

Bisphosphonates Examples

A
  1. Alendronate (Fosamax)
  2. Risedronate (Actonel)
  3. Ibandronate (Boniva)
  4. Zolendronate (Reclast/Zometa)
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3
Q

Considerations when taking Bisphosphonates

A

take on empty stomach, separate from other medications, don’t lie down for 30 minutes to 1 hour after taking

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4
Q

Bisphosphonates Route of Administration

A
  1. Alendronate: oral daily, or oral weekly in high dose
  2. Risendronate: weekly
  3. Ibandronate: monthly
  4. Zolendronate - IV yearly
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5
Q

Bisphosphonates Indications

A
  1. treatment and prevention of osteoporosis

2. Paget’s disease

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6
Q

Bisphosphonates Contraindications

A
  1. Hypocalcemia
  2. Poor renal function
  3. Significant GI disease (ie esophagitis)
  4. Invasive dental procedures (can cause osteonecrosis of the jaw)
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7
Q

Bisphosphonates Side Effects

A
  1. GI - nausea, dyspepsia, reflux, cramps
  2. esophagitis or esophageal erosion
  3. osteonecrosis of the jaw
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8
Q

Lab Work with Bisphosphonates

A
  1. Ca and BMP (kidney function) prior to starting

2. Monitor serum calcium, phosphorous, alkaline phosphatase

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9
Q

Recommended daily intake of Vit D3

A
  1. 600 IU/day

2. 800 IU/day for females over age 71

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10
Q

Effect of Vit D

A

increase serum calcium concentrations (increase calcium absorption from intestine and distal renal tubules, regulate bone resorption and formation)

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11
Q

Vit D effect on PTH

A

inhibits PTH

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12
Q

What kind of vitamin is vitamin D?

A

lipophilic

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13
Q

Indications for Vit D

A
  1. osteoporosis
  2. hyperparathyroidism
  3. osteomalacia
  4. Rickets
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14
Q

Contraindications for Vit D

A

hypercalcemia

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15
Q

Vit D drug interactions

A
  1. Vit D analogues - calcitrol, paricaltrol, and doxercalciferol –> hypercalcemia –> headache, nausea, dizziness, vomiting, and loss of appetite
  2. Hydrocholorthiazide –> hypercalcemia
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16
Q

Side effects of Vit D

A
  1. Vit D toxicity –> GI pain, renal stones, psychiatric disturbance
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17
Q

How are sunlight and Vit D related?

A

UV -B rays convert 7-dehydrocholesterol to pre-vitamin D3 which then becomes Vit D3

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18
Q

sunlight recommendations

A

5-30 minutes of sun exposure between 10 am and 3 pm twice a week, to face, arms, legs, or back

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19
Q

Types of NSAIDs

A
  1. Nonselective

2. COX-2 selective

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20
Q

Nonselective NSAID examples

A
  1. ibuprofen (Motrin/Advil)
  2. naproxen (Aleve/Anaprox)
  3. ketorolac (Toradol)
  4. indomethacin (Indocin)
  5. etodolac
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21
Q

COX-2 selective NSAID example

A

Celecoxib/Celebrex

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22
Q

NSAID MOA

A

acts on arachidonic acid pathway and blocks COX-1 and COX-2 and causes decrease in prostaglandin formation which results in decreased inflammation, pain, and fever

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23
Q

Function of COX-1 pathway

A

production of protective lining in stomach

platelet aggregation

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24
Q

Function of COX-2 pathway

A

inflammatory response

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25
Q

Pharmacokinetics of NSAIDs

A
  1. well absorbed
  2. hepatic metabolism (most)
  3. short to intermediate half-lives (2-12 hr)
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26
Q

Indications for NSAIDs

A

pain, inflammation, fever

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27
Q

Contraindications for nonselective NSAIDs

A

history of peptic ulcers, GI bleeding, chronic inflammation of GI tract, history of sensitivity

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28
Q

Contraindications for COX-2 selective NSAIDs

A

history of sensitivity

history of sensitivity to sulfonamides

29
Q

Side Effects of nonselective NSAIDs

A

GI, edema, dizziness, acute renal failure

30
Q

Side Effects of COX-2 selective NSAIDs

A

cardiovascular, dizziness, edema

31
Q

which NSAID is the strongest

A

Indomethacin

32
Q

Aspirin - MOA and function

A
  1. irreversibly inhibits COX-1 and COX-2

2. prolonged platelet activity (prevents clotting)

33
Q

Contraindications for aspirin

A 
same as other NSAIDs
anti-coagulation
3rd trimester pregnancy
children!!!
pre-surgery
34
Q

Aspirin side effects

A
  1. Reyes syndrome
  2. asthma
  3. ototoxicity
  4. bledding
35
Q

what medication class should you NOT use NSAIDs with

A

glucocorticosteroids –> increased risk of GI bleed

36
Q

What is gout?

A

Dysfunction in uric acid metabolism –> high levels of circulating uric acid in blood –> uric acid crystals deposited in cartilage (big toe, ankle, knee, elbow) –> crystals grow and causes inflammation/pain

37
Q

Gout medication examples

A
  1. Colchicine
  2. Probenecid
  3. Allopurinol
38
Q

Colchicine MOA

A

suppresses immune function (affects PMNs ability to attract other immune modulators)

39
Q

Colchicine route of administration

A

oral

40
Q

Colchicine route of excretion

A

89-90% fecal

10-20% renal

41
Q

Colchicine Indications

A
  1. acute gout attacks
  2. long term prevention of recurrent gout attacks in combo with uric acid lowering therapy
  3. 2nd line therapy
42
Q

Colchicine Contraindications

A
  1. renal failure
  2. hepatic disease
  3. cardiac disease
43
Q

Side effects of Colchicine

A
  1. DIARRHEA, GI UPSET
  2. bone marrow suppression
  3. myopathy
  4. neuropathy
44
Q

Probenecid MOA

A

increase uric acid excretion

45
Q

Indication for Probenecid

A
  1. prevention of gout

2. improve effectiveness of penicillin

46
Q

Contraindications of Probenecid

A
  1. renal insufficiency
  2. urolithiasis
  3. peptic ulcer disease
47
Q

Side effects of Probenecid

A
  1. generally well tolerated
  2. GI irritation (N/V/D)
  3. allergic reaction
48
Q

Important Patient Education with Probenecid

A
  1. Adequate hydration to prevent kidney stones

2. may have precipitating acute gout attack when starting Probenecid (can take indomethacin)

49
Q

Allopurinol MOA

A

decreases uric acid synthesis

50
Q

Indications for Allopurinol

A
  1. prevention of gout
  2. prevention of uric acid renal stones
  3. complicated hyperuricemia
51
Q

Allopurinol contraindications

A

previous hypersensitivity

52
Q

Side effects of Allopurinol

A
  1. skin reactions (Steven-Johnsons Syndrome)
  2. liver reactions
  3. renal insufficiency
53
Q

Considerations for taking Allopurinol AND Probenecid

A
  1. Need higher dose of allopurinol

2. makes probenecid more effective

54
Q

What do you need to monitor in patients taking daily medication for gout prevention

A
  1. CMP (renal and liver function)

2. CBC (anemia or bleeding issues)

55
Q

Why should you be cautious when giving colchicine?

A

it has a narrow therapeutic index, overdose if fatal –> not used for chronic control

56
Q

what is allopurinol often taken in conjunction with ?

A

colchicine for acute treatment and prevention

57
Q

NSAIDs and surgery?

A

all NSAIDs must be stopped 7-10 days prior to surgery

58
Q

dose of naproxen

A

500 mg BID (according to pharm tutor)

59
Q

useful info about Ketorolac/Toradol

A

can give IV, stronger than ibuprofen

60
Q

What is an indication for indomethacin?

A

gout if lots of inflammation but more GI S/E

61
Q

When would you suggest Celebrex?

A

if patient has lots of abdominal pain when taking nonselective NSAIDs

62
Q

aspirin indications

A
  1. clot prevention
  2. coronary artery dx, hx of MI (baby aspirin 81 mg)
  3. acute MI (4 baby aspirin or 1 adult aspirin 325 mg)
  4. fever and pain
63
Q

Reyes syndrome

A

altered mental status, jaundice due to liver damage, encephalopathy

64
Q

benefits of aspirin

A

doesn’t irritate GI lining, don’t have to worry about overdose like tylenol

65
Q

name of vitamin D2

A

ergocalciferol (plant source?)

66
Q

name of vitamin D3

A

cholecalciferol (animal source?)

67
Q

aspirin’s effect on uric acid levels

A

causes net retention of uric acid

68
Q

first line treatment for Gout

A

NSAIDs - indomethacin, naproxen, sulindac

Pharmacology (27 decks)

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