Transcript Chapter 9 lesson 1 - ROP Pharmacology for Health Care

Understanding Pharmacology
for Health Professionals
FIFTH EDITION
CHAPTER
9
Musculoskeletal Drugs
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Learning Objectives
1. Compare and contrast the therapeutic
effects of the different categories of drugs
used to treat osteoarthritis.
2. Compare and contrast the therapeutic
effects of the different categories of drugs
used to treat rheumatoid arthritis.
3. List several factors that contribute to the
development of osteoporosis.
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
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Learning Objectives
4. When given the name of a well-known
musculoskeletal generic drug, identify its
trade name.
5. When given the generic and trade names of
a musculoskeletal drug, identify what drug
category it belongs to and what disease it is
used to treat.
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
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Learning Objectives
6. When given a musculoskeletal drug
category, identify several generic and trade
name drugs in that category.
7. When given an ending common to several
generic drugs, identify the related drug
category.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Skeletal System Animation
Click on the display above to view an animation on the skeletal system.
The animation may take a moment to begin and will frequently pause.
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Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
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Introduction
• Musculoskeletal drugs are used to treat
diseases of the muscles and bones.
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

Osteoporosis
Osteoarthritis
Bursitis
Tendinitis
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
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Introduction
• Musculoskeletal drugs are used to treat
diseases of the muscles and bones.

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
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Rheumatoid arthritis
Muscle spasms
Fibromyalgia
Gout
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
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Drugs Used to Treat Osteoarthritis
• Also known as degenerative joint
disease
• Occurs when:
 Cumulative damage causes
degeneration of the cartilage pad.
 Erosion of the bone ends inside a joint.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
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Drugs Used to Treat Osteoarthritis
• First joints to exhibit signs
 Weightbearing joints
• Hips and knees
 Joints used constantly
• Fingers and toes
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
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Drugs Used to Treat Osteoarthritis
• Symptoms
 Pain
 Inflammation
 Swelling
• Synovial membrane of the joint can
also be involved.
• Damaged bone ends often form bony
spurs that irritate adjacent tissues.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
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Arthritis Video
Click on the screenshot to view a video on the topic of arthritis.
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Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
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by Pearson Education, Inc.
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Drugs Used to Treat Osteoarthritis
• Acetaminophen for osteoarthritis
 Analgesic drug
 Lacks the ability to inhibit the
production of prostaglandins
 Has no anti-inflammatory action
 Acetaminophen (Tylenol)
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
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by Pearson Education, Inc.
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Drugs Used to Treat Osteoarthritis
• Acetaminophen for osteoarthritis
 American College of Rheumatology
recommends acetaminophen use.
• Treatment of mild-to-moderate pain
associated with osteoarthritis
• Drug of choice for treating
musculoskeletal pain in older patients
• Has fewer side effects than NSAIDs
• Even though it cannot treat the
inflammation
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
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Drugs Used to Treat Osteoarthritis
• Salicylate drugs for osteoarthritis
 Acetylsalicylic acid (aspirin (ASA))
• Analgesic and anti-inflammatory effects
useful in treating:
• Pain and inflammation
• Minor conditions of the bones and muscles
- Bursitis
- Tendinitis
- Muscle sprains
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
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by Pearson Education, Inc.
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Drugs Used to Treat Osteoarthritis
• Salicylate drugs for osteoarthritis
 Aspirin (Bayer, Ecotrin)
 Magnesium salicylate (Doan's)
 Long-term therapy
• Irritating to the stomach
• Shown to cause gastric ulcers
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
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Drugs Used to Treat Osteoarthritis
• Salicylate drugs for osteoarthritis
 Ecotrin
• Manufactured as an enteric-coated tablet
• Does not dissolve in the stomach
• Dissolves only when it comes in contact
with the higher pH environment of the
duodenum
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
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Figure 9–1 Magnesium salicylate (Doan's). This salicylate drug is in the same drug
category as aspirin. It relieves musculoskeletal pain and inflammation.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
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Drugs Used to Treat Osteoarthritis
• Nonsteroidal anti-inflammatory drugs
for osteoarthritis
 Inhibit the production of prostaglandins
 Provide an analgesic and antiinflammatory effect
 Less of tendency than aspirin to cause
gastric irritation or ulcers
 Structurally similar to aspirin
• Allergy concern
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
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Drugs Used to Treat Osteoarthritis
• Nonsteroidal anti-inflammatory drugs
for osteoarthritis
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Diclofenac (Cataflam, Voltaren)
Fenoprofen (Nalfon)
Ibuprofen (Advil, Motrin)
Indomethacin (Indocin)
Ketoprofen
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
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Drugs Used to Treat Osteoarthritis
• Nonsteroidal anti-inflammatory drugs
for osteoarthritis
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


Meloxicam (Mobic)
Naproxen (Aleve, Naprosyn)
Oxaprozin (Daypro)
Piroxicam (Feldene)
Sulindac (Clinoril)
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
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Figure 9–2 Ibuprofen (Advil, Motrin). Ibuprofen is one of many nonsteroidal antiinflammatory drugs, all of which have a similar therapeutic effect to relieve pain and
inflammation.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
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Drug Alert
• The NSAID diclofenac (Voltaren) is
available as a topical gel to treat the
pain of osteoarthritis.
• It is the first prescription topical skin
gel approved by the FDA for treating
the pain of osteoarthritis.
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
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Drug Alert
• Besides its use in treating osteoporosis,
indomethacin (Indocin) has an unusual
use:
 It is given intravenously to newborn
infants to close a persistent patent
ductus arteriosus, a part of the fetal
circulation that normally closes after
birth.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
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Did You Know?
• Cats and dogs with osteoarthritis are
given the NSAID carprofen (Rimadyl).
• This drug belongs to the NSAID
category of drugs, but it has never
been approved for use in humans.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
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Drugs Used to Treat Osteoarthritis
• COX-2 inhibitor drugs for osteoarthritis
 Belong to the larger category of NSAIDs
 Selectively inhibit cyclooxygenase-2
(COX-2)
• An enzyme that decreases production of
prostaglandins that cause pain and
inflammation
 Celecoxib (Celebrex)
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
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Figure 9–3 Celecoxib (Celebrex). This is a COX-2 inhibitor drug used to treat the
pain and inflammation of osteoarthritis. Celebrex is protected by a patent until 2015.
When a drug company's patent expires, other drug companies begin to make their own
generic versions of the drug. The generic drugs are as effective, but much less
expensive.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
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Drug Alert
• COX-2 inhibitor drugs were hailed as a
new, effective way to treat
osteoarthritis when they first came on
the market in 1999.
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
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Drug Alert
• In the past, the COX-2 category of
drugs also included rofecoxib (Vioxx)
and valdecoxib (Bextra), but these
drugs were taken off the market in
2004 and 2005 because they greatly
increased the risk of heart attacks and
strokes.
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
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Drug Alert
• Celecoxib (Celebrex) is the only COX-2
inhibitor drug that remains on the
market though a study showed that
patients who use this drug have an
increased risk of heart problems.
• It is also used to treat dysmenorrhea
and colon polyps.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
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Drugs Used to Treat Osteoarthritis
• Corticosteroid drugs for osteoarthritis
 Have the same anti-inflammatory effect
 Given orally to treat acute episodes of
osteoarthritis associated with
inflammation of the synovial membrane
 Because of side effects associated with
prolonged use, only prescribed to treat
acute symptoms for a limited time.
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
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Drugs Used to Treat Osteoarthritis
• Corticosteroid drugs for osteoarthritis
 Administration
• Injected directly into a joint affected by
ostearthritis (intra-articular
administration)
• Injected into the soft tissue near the joint
to relieve bursitis and tendinitis
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
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Drugs Used to Treat Osteoarthritis
• Corticosteroid drugs for osteoarthritis
Bethamethasone (Celestone)
Dexamethasone
Hydrocortisone (Cortef, Solu-Cortef)
Methylprednisolone (Depo-Medrol,
Medrol)
 Prednisone (Deltasone, Meticorten)
 Triamcinolone (Aristospan Intraarticular, Kenalog)




Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
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Figure 9–4 Prednisone. As with all oral corticosteroid drugs, this drugcomes in a
special arrangement of tablets whose number continually decreases each day until the
treatment is finished after one week. This is because this corticosteroid drug temporarily
suppresses the production of natural cortisol from the cortex of the adrenal gland. The
large dose on day one relieves the acute symptoms of inflammation. Then the dose is
reduced each day (but never stopped abruptly) so that the adrenal gland cortex begins
to produce cortisol again.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
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Drugs Used to Treat Osteoarthritis
• Other drugs for osteoarthritis
 Hyaluronic acid
• Secreted by the synovial membrane of a
joint
• Helps maintain the lubricating quality of
the synovial fluid
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
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Drugs Used to Treat Osteoarthritis
• Other drugs for osteoarthritis
 Hyaluronic acid
• Drugs are derivatives of hyaluronic acid.
• Injected into the joint
• Improve viscosity and lubricating quality
of synovial fluid
• Hyaluronic acid (Hyalgan, Synvisc)
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
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Figure 9–5 Hyaluronic acid (Hyalgan, Synvisc). This drug is derived from the
combs of chickens! Hyaluronic acid is also used as a gel-type filler that is injected under
the skin to provide fullness and minimize wrinkle lines on the face.
Source: kyslynskyy/Fotolia
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
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Drugs Used to Treat Osteoarthritis
• Other drugs for osteoarthritis
 Flavocoxid (Limbrel)
• Prescription drug
• Medical food product
• Contains concentrated plant antioxidants
and zinc
• Inhibits enzyme lipoxygenase (LOX)
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
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Drugs Used to Treat Osteoarthritis
• Other drugs for osteoarthritis
 Osteo Bi-Flex (glucosamine,
chondroitin)
• Oral dietary supplement
• Glucosamine
• Used in the body to produce cartilage
• Chondroitin
• Helps cartilage retain its water content
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
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In Depth
• Prostaglandins, which are present
throughout the body and exert various
effects, were so named because they
were originally isolated from semen
from the prostate gland in men.
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
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In Depth
• Prostaglandins play a role in causing
the pain and inflammation of
osteoarthritis and rheumatoid arthritis.
• When body tissue is damaged, cells are
destroyed, and the cell contents spill
into the interstitial fluid.
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
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In Depth
• There, the enzyme cyclooxygenase
(COX) converts these cellular contents
into prostaglandins.
• The prostaglandins then stimulate pain
receptors in that area.
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
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In Depth
• The greater the amount of tissue
damage, the more prostaglandins are
produced and the greater the sensation
of pain.
• The joints have a large number of pain
receptors and damage to the joints can
cause chronic, severe pain.
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
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In Depth
• By inhibiting the cyclooxygenase (COX)
enzyme, fewer prostaglandins are
produced to activate pain receptors.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
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Drugs Used to Treat Osteoarthritis
• Topical drugs for osteoarthritis
 Over-the-counter drugs used to treat
the pain of osteoarthritis
 Capsaicin
• Natural substance derived from chile
peppers
• Makes the skin and joint less sensitive to
pain
• Diminishes sensory nerve signals
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
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Drugs Used to Treat Osteoarthritis
• Topical drugs for osteoarthritis
 Capsaicin
• Can also treat minor muscle injury pain
 Aspercreme (trolamine salicylate)
 Capsaicin (Capsin, Icy Hot)
 Bengay (methyl salicylate, menthol)
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
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Drugs Used to Treat Osteoarthritis
• Topical drugs for osteoarthritis
 Musterole Deep Strength Rub (methyl
salicylate, menthol)
 Therapuetic Mineral Ice (methyl
salicylate)
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
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Drugs Used to Treat Osteoarthritis
• Combination drugs for osteoarthritis
 Arthritis Pain Formula (aspirin,
aluminum, magnesium)
 Arthrotec (diclofenac, misoprostol)
 Ascriptin (aspirin, aluminum, calcium,
magnesium)
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
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Drugs Used to Treat Osteoarthritis
• Combination drugs for osteoarthritis
 Bufferin Extra Strength (aspirin,
calcium, magnesium)
 Vimovo (naproxen, esomeprazole)
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
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Drugs Used to Treat Rheumatoid
Arthritis
• Rheumatoid arthritis produces
symptoms of:





Pain
Inflammation
Swelling
Joint deformity
Loss of joint function
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
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Drugs Used to Treat Rheumatoid
Arthritis
• Rheumatoid arthritis caused by:
 An autoimmune reaction
 The body's own antibodies target and
destroy
• Cartilage
• Connective tissue
• Joints
 Thought to be trigged by a virus
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
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Drugs Used to Treat Rheumatoid
Arthritis
• Salicylate drugs, NSAIDs, COX-2
inhibitor drugs, and corticosteroid
drugs for rheumatoid arthritis
 Treated with many of same drugs used
to treat osteoarthritis
 Drugs used as a first line of treatment
• Salicylate drugs
• NSAIDs
• COX-2 inhibitors
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Drugs Used to Treat Rheumatoid
Arthritis
• Salicylate drugs, NSAIDs, COX-2
inhibitor drugs, and corticosteroid
drugs for rheumatoid arthritis
 Acetaminophen is not used because it is
not effective against inflammation.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
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Did You Know?
• Phenylbutazone (Butazolidin) is
commonly used in race horses to
reduce inflammation.
• Slang name is bute
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
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Did You Know?
• It is illegal to race a horse that is being
treated with phenylbutazone, and postrace urine tests are done to detect this
drug.
• In the past, this drug was used to treat
osteoarthritis in humans, but was
replaced by NSAIDs.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
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Drugs Used to Treat Rheumatoid
Arthritis
• Gold compound drugs for rheumatoid
arthritis
 May be added if the salicylate, NSAIDs,
or COX-2 inhibitors fail to control the
symptoms
 Contain actual gold (29%–50% of total
drug)
• Capsules
• Solution for injection
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
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Drugs Used to Treat Rheumatoid
Arthritis
• Gold compound drugs for rheumatoid
arthritis
 Used to treat active rheumatoid arthritis
 These drugs inhibit macrophages from
the immune system that attack the
joints.
 Cannot reverse joint damage that has
already occurred
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
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Drugs Used to Treat Rheumatoid
Arthritis
• Gold compound drugs for rheumatoid
arthritis
 Auranofin (Ridaura)
 Gold sodium thiomalate (Aurolate)
Understanding Pharmacology for Health Professionals, 5th Ed.
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Drugs Used to Treat Rheumatoid
Arthritis
• Monclonol antibody drugs for
rheumatoid arthritis
 Bind with tumor necrosis factor to
prevent inflammation
 Adalimumab (Humira)
 Certolizumab (Cimzia)
 Golimumab (Simponi)
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
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Drugs Used to Treat Rheumatoid
Arthritis
• Monclonol antibody drugs for
rheumatoid arthritis
 Infliximab (Remicade)
 Rituximab (Rituxan)
 Tocilizumab (Actemra)
Understanding Pharmacology for Health Professionals, 5th Ed.
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Drugs Used to Treat Rheumatoid
Arthritis
• Janus kinase inhibitor drugs for
rheumatoid arthritis
 JAK is an enzyme that triggers
cytokines.
• Substances released by white blood cells
during autoimmune response
• Produce inflammation
 Tofacitinib (Xeljanz)
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
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Drugs Used to Treat Rheumatoid
Arthritis
• Immunosuppressant drugs and other
drugs for rheumatoid arthritis
 Suppress the immune system
 Used in patients with active,
uncontrolled rheumatoid arthritis
• Azathioprine (Azasan, Imuran)
• Cyclosporine (Gengraf, Neoral,
Sandimmune)
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
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Drugs Used to Treat Rheumatoid
Arthritis
• Immunosuppressant drugs and other
drugs for rheumatoid arthritis
 Inhibits T lymphocytes that attack joint
tissues
• Abatacept (Orencia)
 Blocks interleukin-1 from binding with
receptors on cartilage cells and
destroying them
• Anakinra (Kineret)
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
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Drugs Used to Treat Rheumatoid
Arthritis
• Immunosuppressant drugs and other
drugs for rheumatoid arthritis
 Blocks tumor necrosis factor and
suppresses immune response
• Etanercept (Enbrel)
 Unknown action
• Hydroxychloroquine (Plaquenil)
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
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Drugs Used to Treat Rheumatoid
Arthritis
• Immunosuppressant drugs and other
drugs for rheumatoid arthritis
 Immunomodulator for overactive
immune response
• Leflunomide (Arava)
 Chemotherapy drug for cells dividing
uncontrollably
• Methotrexate (Rheumatrex Dose Pack)
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
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Drugs Used to Treat Rheumatoid
Arthritis
• Immunosuppressant drugs and other
drugs for rheumatoid arthritis
 Aminosalicylic acid drug with antiinflammatory effect
• Sulfasalazine (Azulfidine)
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
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Figure 9–6
Hydroxychloroquine. This is one of the older, less expensive drugs used
to treat rheumatoid arthritis. Its trade name is Plaquenil.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Did You Know?
• The immunosuppressant drugs
azathioprine are cyclosporine are
commonly given to patients following
organ transplant surgery.
• They suppress the immune system and
prevent the patient's body from
forming antibodies against the donor
organ (such as a kidney).
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
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Drug Alert
• Leflunomide (Arava) has a very long
half-life.
• Traces of the drug can still be found in
the body six months after the last dose.
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Drug Alert
• This drug is not recommended for
patients who have decreased liver
function and cannot metabolize the
drug normally, as this prolongs the
half-life even more and can result in
toxic levels of the drug.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved