Musculoskeletal System - Pharmacology Flashcards
Action of DMARDs (Disease-Modifying Antirheumatic Agents)
- Slow or halt the progression of rheumatic disease
- Used early in disease process to slow progression prior to widespread damage
- Induce remission by modifying pathology and inhibiting the immune response responsible for rheumatic disease
Indications for DMARDs
- Rheumatic disease, preferable during early treatment
Side effects of DMARDs
- Nausea
- Headache
- Joint pain
- Joint swelling
- Toxicity
- GI distress
- Sore throat
- Fever
- Liver dysfunction
- Hair loss
- Potential for sepsis
- Retinal damage
DMARDs implications for PT
Recognize that many agents have a high incidence of toxicity
Examples of DMARDs
- Rheumatrex (methotrexate)
- Arava (leflunomide)
- Antimalarial — Aralen (chloroquine), Plaquenil (hydroxychloroquine)
Gold compounds — Ridaura (auranofin), Solganal (aurothioglucose)
Tumor necrosis inhibitors — Humira (adalimumab), Enbrel (etanercept)
Action of glucocorticoid agents (corticosteroids)
- Hormonal, anti-inflammatory, and metabolic effects
- Suppression of articular and systemic disease
- Reduce inflammation in chronic conditions that can damage healthy tissues
- Vasoconstriction results from stabilizing lysosomal membranes and enhancing the effects of catecholamines
Indications of glucocorticoid agents (corticosteroids)
- Replacement therapy for endocrine dysfunction
- Anti-inflammatory effects
- Immunosuppressive effects
- Treatment of rheumatic, respiratory, and various other disorders
Why are glucocorticoid agents (corticosteroids) indicated for MS?
To treat acute bouts of inflammation
Why are glucocorticoid agents (corticosteroids) indicated for asthma?
- Decrease frequency of attacks
- Decrease mucous production
- Improve oxygenation
Why are glucocorticoid agents (corticosteroids) indicated for cancer patients?
- Support for symptoms and side effects of chemotherapy, including the following:
- Hypersensitivity reactions
- Infusion reactions
- Appetite stimulant
- Decrease inflammation and swelling
- Decrease and treat skin reactions
For rheumatoid arthritis, glucocorticoid agents (corticosteroids) are used in conjunction with which drug and why?
- DMARDs
- Used as a “bridge” for treatment of RA. DMARDs take a while to kick in (which is why they are better prescribed early on in treatment), and so corticosteroids help manage inflammation in the meantime, until the DMARDs take effect
Glucocorticosteroid agents (corticosteroids) implications for PT
- Wear a mask; they are immunocompromised
- Be aware of signs of toxicity, including moon face, buffalo hump, and personality changes
- Patients are at risk for osteoporosis and muscle wasting
Examples of glucocorticoid agents (corticosteroids)
- Dermacort (hydrocortisone or cortisol)
- Cordrol (prednisone)
- Medrol (methylprednisolone)
- Decadrol (dexamethasone)
- Nasonex (mometasone)
Action of nonopioid agents
- Analgesia and pain relief
- Anti-inflammatory (via reduction or prostaglandin formation)
- Anti-pyretic (fever reducing)
- Decreases uterine contractions
- Minimizes impulse formation of pain fibers
Indications for nonopioid agents
- Mild-moderate pain of various origins
- Fever
- Muscle ache
- Inflammation (except acetaminophen)
- Primary dysmenorrhea
- Reduction of risk of MI (aspirin only)
Side effects of nonopioid agents
- Nausea
- Vomiting
- Vertigo
- Abdominal pain
- GI distress or bleeding
- Ulcer formation
- Potential for Reye syndrome in children (aspirin only)
Nonopioid agents implications for PT
- Increased risk for masked pain that would allow for movement beyond limitation of false understanding of their level of mobility
- Take stomach pain complaints seriously with subsequent referral to physician
Examples of nonopioids
- Tylenol (acetaminophen)
- Nonsteroidal anti-inflammatories (NSAIDs) — Aspirin (acetylsalicylic acid), Aleve (naproxen), Advil (ibuprofen), Celebrex (celecoxib)
Action of opioid agents
- Analgesia for acute severe pain management
- Stimulates opioid receptors within the CNS to prevent pain impulses from reaching their destination
- Certain drugs are also used to assist with dependency and withdrawal symptoms
Indications for opioid agents
- Moderate to severe pain of various origins
- Induction of conscious sedation prior to a diagnostic procedure
- Management of opioid dependence
- Relief of severe and persistent cough (codeine)
Side effects of opioid agents
- Mood swings
- Sedation
- Confusion
- Vertigo
- Orthostatic hypotension
- Constipation
- Incoordination
- Physical dependence
- Tolerance
Opioid agents implications for PT
- Monitor for respiratory depression
- Painful treatment should be scheduled 2hrs after administration to maximize analgesic benefit
Examples of opioid agents
Roxanol (morphine) Demerol (meperidine) OxyContin (oxycodone) Sublimaze (fentanyl) Paveral (codeine)
Side effects of glucocorticoid agents (corticosteroids)
- Muscle atrophy
- GI distress
- Glaucoma
- Adrenocortical suppression
- Drug-induced Cushing syndrome
- Weakening with breakdown of supporting tissues (bone, ligament, tendon, skin)
- Mood changes
- HTN
