Pharmacotherapy of Musculoskeletal Alterations

Question 1

NSAIDs - Selective Cox-2 inhibitors: celecoxib

Answer 1

Indications for use
* mild to moderate pain and inflammation assoc. with rheumatoid arthritis, OA, dysmenorrhea, dental procedures, headache
* prophylaxis of adenomas or colorectal polyps
* limited due to an increased risk of MI and stroke
Mechanisms of action
* blocks COX-2 without inhibiting COX-1 -> analgesic, anti-
inflammatory, and antipyretic effects
* but prostacyclin may also be suppressed allowing platelet aggregation and blood vessels to constrict
Desired effects
* reduction of pain, fever and
inflammation
Adverse effects
* may increase risk of serious and potentially fatal cardiovascular
thrombotic events, MI, and stroke
* GI adverse effects including bleeding, ulcer, and stomach or
intestine perforation
* chronic kidney disease (CKD) and
hepatic impairment

Question 2

Non-opioid analgesics: acetaminophen

Answer 2

Indications
* mild to moderate pain
* osteoarthritis of hip or knee
* fever
Mechanisms of Action
* inhibits COX activity and
inhibits synthesis of prostaglandins in CNS
* antipyretic action may be due
to action at hypothalamus
Desired effects
* reduces pain
* reduces fever
Adverse effects (at recommended doses, adverse effects are uncommon)
* hepatotoxicity, acute liver failure
* renal failure

Question 3

NSAID (non-selective
inhibitor): Ibuprofen

Answer 3

Indications for use
* relieve mild to moderate pain, fever, inflammation
* management of pain in inflammatory conditions i.e. OA
Mechanisms of action
* block action of COX-1 and COX-2
* reduces prostaglandin production
Desired effects
* reduction of pain, fever, inflammation
Adverse effects
* nausea, heartburn, GI irritation & ulceration
* can decrease platelet function
* bleeding
* Acute Kidney Injury (AKI)
* azotemia, increased BUN and creatinine

Question 4

Proton Pump Inhibitors (PPIs): Pantoprazole

Answer 4

Indications
* treatment & prevention of
NSAID-induced ulcers
Mechanism of action
* inhibits action of H+/K+ pump on parietal cells
* reduces acid secretion
* take about 30 minutes before meals
* increases effectiveness
Desired effects
* achlorhydric: >90% gastric acid secretion is temporarily blocked
Adverse effects
* well tolerated with some exceptions
* action limited to effects on gastric acid secretion

Question 5

Biphosphonates: alendronate

Answer 5

Indications
* tx and prevent osteoporosis in
postmenopausal females
* tx osteoporosis in men
* tx corticosteroid- induced osteoporosis in postmenopausal females not receiving estrogen, or in men who are continuing corticosteroid tx with low bone mass
Mechanisms of action
* inhibits osteoclast activity
* shifts balance toward bone deposition
Desired effects
* decreases rate of bone resorption
* strengthens bones by slowing bone resorption
Adverse effects
* N/V, diarrhea, esophageal ulceration, acid reflux, esophageal perforation, esophageal cancer
* osteonecrosis of jaw
* risk of atypical femoral fractures