Pharm - Musculoskeletal, Pain & Inflammation

Objectives

• Explain the expected therapeutic effects of Musculoskeletal System and Pain & Inflammation Medications.

• Summarize the pharmacological action of Musculoskeletal System and Pain & Inflammation Medications.

• Monitor for common adverse effects of Musculoskeletal System and Pain & Inflammation Medications.

• Apply the concept of safe medication administration and dosage calculation when administering Musculoskeletal System and Pain & Inflammation Medications.

• Reinforce client education regarding Musculoskeletal System and Pain & Inflammation Medications.

• Determine if the Musculoskeletal System and Pain & Inflammation Medications are appropriate for the client.

• Monitor for potential interactions that can cause adverse or life-threatening effects when administering Musculoskeletal System and Pain & Inflammation Medications.

• Rheumatoid Arthritis - autoimmune

• Osteoarthritis - age, injury, heredity

• Osteoporosis - age, lifestyle, heredity

DMARDs

• Slows RA progression & joint degeneration

• Immunosuppress

• Methotrexate

  • Increase risk of infection, bone marrow suppression

  • Avoid NSAIDs, but take folic acid

  • Can take 3-6 weeks for therapeutic effect

  • Hydration

​Resorption vs Reabsorption

SERMs

• Prevent and treat postmenopausal osteoporosis

• Raloxifene

  • Activates and blocks estrogen receptors

  • Increases hot flashes and risk for stroke or DVT

  • Take extra calcium and Vitamin D

  • Monitor bone density, for blood clots, and cholesterol

Bisphonates

• Prevent and treat postmenopausal osteoporosis

• Alendronate

  • Decreases bone resorption

  • Esophagitis, vision changes, osteonecrosis of jaw

  • Take with water, sit/stand for 30m, analgesic for mild pain

  • Avoid if difficulty swallowing, unable to sit/stand, renal insufficiency, upper GI disorder

Calcitonin

• Treats postmenopausal osteoporosis and hypercalcemia

• Calcitonin-Salmon

  • Decreases bone resorption; inhibits osteoclasts and increases calcium excretion

  • Hypersensitivity; hypocalcemia; epistaxis; site irritation

  • Allergy test before admin; rotate inj sites and nares

  • Diet high in calcium and Vitamin D

Calcium Supplements

• Calcium deficiency

• Calcium Citrate

  • Dietary supplement

  • Take with Vitamin D to increase absorption

  • Hypercalcemia -> kidney stones

  • Monitor urine output, flank pain, hematuria, decreased GI motility

• Chronic pain

• Gout

• Migraines

Adjuvant meds are used with a primary pain medication to increase pain relief.
Reduces the amount of opioids necessary to achieve pain relief, thereby reducing adverse effects (respiratory depression, sedation, constipation).

• NSAIDs - reduces inflammation and pain

  • Ibuprofen

  • Aspirin

  • Celecoxib

• Acetaminophen - relieves pain & fever

• Tramadol - analgesic for mild-to-moderate pain

• Morphine - mod - severe pain

• Naloxone - antagonist

• ​Stops the production of uric acid, reducing future attacks

• Allopurinol

  • Hypersensitivity, GI upset, thrombocytopenia

  • Monitor uric acid, liver & kidney function

  • Drink water!

  • Increases anticoag effects

• ​Delay RA progression; anti-inflammatory effects

• Prednisone

  • Hyperglycemia; immunosuppression; bone loss; cataracts

  • Monitor BS, vitals, K and Na

  • Weight-bearing exercises

  • Report s/s of infection, weight gain & edema

  • Take with food, taper dose slowly

• ​Prevent inflammation & dilation of intracranial blood vessels

• Sumatriptan

  • Stops migraine or prodromal s/s

  • Chest pressure, dizziness, vertigo

  • Not for those with liver failure, heart disease

  • Not used more than 2x week

  • Dark, quiet room; avoid triggers