Musculoskeletal System - Pharmacology

Question 1

Action of DMARDs (Disease-Modifying Antirheumatic Agents)

Answer 1

• 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

Question 2

Indications for DMARDs

Answer 2

• Rheumatic disease, preferable during early treatment

Question 3

Side effects of DMARDs

Answer 3

• Nausea
• Headache
• Joint pain
• Joint swelling
• Toxicity
• GI distress
• Sore throat
• Fever
• Liver dysfunction
• Hair loss
• Potential for sepsis
• Retinal damage

Question 4

DMARDs implications for PT

Answer 4

Recognize that many agents have a high incidence of toxicity

Question 5

Examples of DMARDs

Answer 5

• Rheumatrex (methotrexate)
• Arava (leflunomide)
• Antimalarial — Aralen (chloroquine), Plaquenil (hydroxychloroquine)
  Gold compounds — Ridaura (auranofin), Solganal (aurothioglucose)
  Tumor necrosis inhibitors — Humira (adalimumab), Enbrel (etanercept)

Question 6

Action of glucocorticoid agents (corticosteroids)

Answer 6

• 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

Question 7

Indications of glucocorticoid agents (corticosteroids)

Answer 7

• Replacement therapy for endocrine dysfunction
• Anti-inflammatory effects
• Immunosuppressive effects
• Treatment of rheumatic, respiratory, and various other disorders

Question 8

Why are glucocorticoid agents (corticosteroids) indicated for MS?

Answer 8

To treat acute bouts of inflammation

Question 9

Why are glucocorticoid agents (corticosteroids) indicated for asthma?

Answer 9

• Decrease frequency of attacks
• Decrease mucous production
• Improve oxygenation

Question 10

Why are glucocorticoid agents (corticosteroids) indicated for cancer patients?

Answer 10

• 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

Question 11

For rheumatoid arthritis, glucocorticoid agents (corticosteroids) are used in conjunction with which drug and why?

Answer 11

• 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

Question 13

Glucocorticosteroid agents (corticosteroids) implications for PT

Answer 13

• 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

Question 14

Examples of glucocorticoid agents (corticosteroids)

Answer 14

• Dermacort (hydrocortisone or cortisol)
• Cordrol (prednisone)
• Medrol (methylprednisolone)
• Decadrol (dexamethasone)
• Nasonex (mometasone)

Question 15

Action of nonopioid agents

Answer 15

• Analgesia and pain relief
• Anti-inflammatory (via reduction or prostaglandin formation)
• Anti-pyretic (fever reducing)
• Decreases uterine contractions
• Minimizes impulse formation of pain fibers

Question 16

Indications for nonopioid agents

Answer 16

• Mild-moderate pain of various origins
• Fever
• Muscle ache
• Inflammation (except acetaminophen)
• Primary dysmenorrhea
• Reduction of risk of MI (aspirin only)

Question 17

Side effects of nonopioid agents

Answer 17

• Nausea
• Vomiting
• Vertigo
• Abdominal pain
• GI distress or bleeding
• Ulcer formation
• Potential for Reye syndrome in children (aspirin only)

Question 18

Nonopioid agents implications for PT

Answer 18

• 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

Question 19

Examples of nonopioids

Answer 19

• Tylenol (acetaminophen)
• Nonsteroidal anti-inflammatories (NSAIDs) — Aspirin (acetylsalicylic acid), Aleve (naproxen), Advil (ibuprofen), Celebrex (celecoxib)

Question 20

Action of opioid agents

Answer 20

• 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

Question 21

Indications for opioid agents

Answer 21

• 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)

Question 22

Side effects of opioid agents

Answer 22

• Mood swings
• Sedation
• Confusion
• Vertigo
• Orthostatic hypotension
• Constipation
• Incoordination
• Physical dependence
• Tolerance

Question 23

Opioid agents implications for PT

Answer 23

• Monitor for respiratory depression

- Painful treatment should be scheduled 2hrs after administration to maximize analgesic benefit

Question 24

Examples of opioid agents

Answer 24

Roxanol (morphine)
Demerol (meperidine)
OxyContin (oxycodone)
Sublimaze (fentanyl)
Paveral (codeine)

Question 25

Side effects of glucocorticoid agents (corticosteroids)

Answer 25

• Muscle atrophy
• GI distress
• Glaucoma
• Adrenocortical suppression
• Drug-induced Cushing syndrome
• Weakening with breakdown of supporting tissues (bone, ligament, tendon, skin)
• Mood changes
• HTN