Transcript Chapter 9 lesson 2 - 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. Describe the therapeutic effects of the
different categories of drugs used to treat
osteoporosis.
2. Describe the therapeutic effects of skeletal
muscle relaxant drugs and of drugs used to
treat fibromyalgia.
3. When given the name of a well-known
musculoskeletal generic drug, identify its
trade name.
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
Learning Objectives
4. 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.
5. When given a musculoskeletal drug
category, identify several generic and trade
name drugs in that category.
6. 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
Drugs Used to Treat Osteoporosis
• Mature bone is hard, but is a living
tissue.
• 10% of the entire bony skeleton is
rebuilt.
 Osteoblasts deposit new bone.
 Osteoclasts break down and remove
areas of old or damaged bone.
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 Osteoporosis
• Normal bone maintains a healthy
balance (homeostasis) between:
 New bone deposition
 Bone breakdown
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 Osteoporosis
• Normal bone balance is maintained by:
 Hormones that control the amount of
calcium
• Parathyroid hormone (parathyroid gland)
• Calcitonin (thyroid gland)
 Hormones in women
 Diet
 Exercise
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 Osteoporosis
• Thinning of bone at the cellular level
• Risk factors include:


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Caucasian or Asian race
Slender build
Smoking
Alcohol use
Lack of exercise
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 Osteoporosis
• More common in post-menopausal
women
 Decreasing levels of progesterone no
longer stimulate new bone formation
 Decreasing levels of estradiol allows
osteoclasts to increase the breakdown
of bone
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 Osteoporosis
• Prevented or treated with:
 Drugs that decrease the rate of bone
resorption
 Supplemental estradiol and
progesterone
 Supplemental calcium and vitamin D
 Increasing exercise
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Figure 9–7 Bone deposition and resorption. (a) In normal bone, deposition of new
bone by osteoblasts is balanced by bone resorption (breakdown) by osteoclasts. A
balance (homeostasis) is maintained through the actions of parathyroid hormone,
calcitonin, dietary calcium, exercise, and (in women) by the hormones estradiol and
progesterone. (b) Osteoporosis. In both older men and women, but particularly in
postmenopausal women whose estradiol level has decreased, the rate of bone resorption
(breakdown) exceeds that of bone deposition, and this leads to osteoporosis.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
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Focus on Health Care
• Osteoporosis is a major public health
problem.
• An estimated 44 million Americans
have osteoporosis or are at risk for
developing it.
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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Focus on Health Care
• One in every two women and one in
every four men over age 50 will have a
fracture due to osteoporosis at some
time in their lives.
• Healthcare costs for osteoporosisrelated fractures went from $7 billion in
1995 to $14 billion in 2012.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Osteoporosis Video
Click on the screenshot to view a video on the topic of osteoporosis.
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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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Drugs Used to Treat Osteoporosis
• Bone resorption inhibitor drugs for
osteoporosis
 Inhibit osteoclasts that decrease the
rate at which bone is resorbed (broken
down)
•
•
•
•
Alendronate (Fosamax)
Ibandronate (Boniva)
Risedronate (Actonel)
Zoledronic acid (Reclast, Zometa)
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
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Figure 9–8 Alendronate (Fosamax). This drug was the first bone resorption inhibitor
drug approved for the treatment of osteoporosis. It is taken orally each week. It has a
unique bone-shaped indentation on the tablet to remind patients that it is used to
improve bone density.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Drug Controversy
• Actress Sally Field had an active
lifestyle and was involved in many
sports when, just prior to her 60th
birthday, she discovered she had
osteoporosis.
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 Controversy
• Advertisements for the bone resorption
inhibitor drug ibandronate (Boniva)
claim that the drug reversed bone loss
for 9 out of 10 women.
 FDA said this claim was misleading in
2012.
• Information has been revised to
mention what are being called "lowimpact fractures."
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
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Focus on Health Care
• Although all bone resorption inhibitor
drugs are used to treat osteoporosis,
their frequency of doses and their
routes of administration are very
different.
• Alendronate and risedronate tablets are
taken orally every morning, 30 minutes
before eating.
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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Focus on Health Care
• Ibandronate is advertised as the
osteoporosis drug that is the easiest to
remember to take.
• It can be taken daily (the 2.5-mg
tablet), but its selling point is that it
can also be taken just once a month
(the 150-mg tablet).
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
Focus on Health Care
• Zoledronic acid is now approved to
treat osteoporosis in postmenopausal
women with a single dose just once a
year, but that dose can only be given
intravenously, which necessitates a
visit to the doctor's office or clinic.
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 Osteoporosis
• Selective estrogen receptor modulator
drugs for osteoporosis
 Used to prevent and treat
 Bind to estradiol receptors on cells
 Stimulate the receptors in the same way
that estradiol does
• Raloxifene (Evista)
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Historical Notes
• In the past, a selective estrogen
receptor modulator (SERM) drug—
tamoxifen—was being used to treat
breast cancer.
• It was discovered that, in patients who
took tamoxifen for breast cancer, there
was a positive effect on the bones.
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
Historical Notes
• Researchers then created another
SERM drug that did not have the severe
side effects of tamoxifen and was
suitable for treating patients with
osteoporosis; that drug was Evista.
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 Osteoporosis
• Estrogen drugs for osteoporosis
 Estradiol
• Female hormone secreted by the ovaries
• Inhibits the action of osteoclasts that
break down bone
• When levels naturally decline during
menopause, the rate of bone resorption
(breakdown) accelerates.
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 Osteoporosis
• Estrogen drugs for osteoporosis
 Hormone replacement drugs
• Used to treat the symptoms of
menopause
• Some are also indicated for the
prevention of osteoporosis in
postmenopausal women.
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 Osteoporosis
• Estrogen drugs for osteoporosis
 Conjugated estrogens (Premarin)
 Estradiol (Estrace, Estraderm, Vivelle)
 Estropipate (Orgen, Ortho-Est)
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Drug Alert
• In the past, hormone replacement
therapy was commonly used for
extended periods of time to treat the
symptoms of menopause (hot flashes,
vaginal dryness) in postmenopausal
women, with a secondary effect of
preventing osteoporosis.
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
• Now, however, it is known that this can
increase the risk of endometrial cancer,
breast cancer, stroke, and myocardial
infarction; this has limited the use of
these drugs for the long-term
treatment of osteoporosis in
postmenopausal women.
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
• Naturopathic physicians recommend
the use of over-the-counter
progesterone cream to treat the
symptoms of menopause, prevent
osteoporosis, and avoid the adverse
effects of hormone replacement
therapy with estrogen.
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 Osteoporosis
• Other drugs for osteoporosis
 Calcitonin-salmon (Miacalcin)
• Form of the hormone calcitonin
• Takes excess calcium in the blood and
deposits it in the bones
 Denosumab (Prolia)
• Monoclonal antibody drug that inhibits
osteoclasts from breaking down bone
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 Osteoporosis
• Other drugs for osteoporosis
 Teriparatide (Forteo)
• Parathyroid hormone
• Created by recombinant DNA technology
• Used to stimulate new bone formation in
patients who are at high risk for fractures
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Did You Know?
• Calcitonin-salmon (Miacalcin) is actually
derived from salmon fish.
• It can be injected or given as a nasal
spray.
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 Osteoporosis
• Calcium supplements for osteoporosis




Over-the-counter
Calcium with added vitamin D
Milk with added calcium
Soy and rice milk also have added
calcium.
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 Osteoporosis
• Calcium supplements for osteoporosis
 Antacid Tums
• Uses calcium to neutralize stomach acid
• Advertised as a secondary therapeutic
effect of calcium supplement for women




Caltrate
Chooz
Os-Cal
Tums Calcium for Life Bone Health
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 Osteoporosis
• Combination drugs for osteoporosis
 Hormone drugs containing an estrogen
and a progestin or androgen
• Activella
• Estradiol, norethindrone
• ClimaPro
• Estradiol, levonorgestrel
• Femhrt
• Ethinyl estradiol, norethindrone
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 Osteoporosis
• Combination drugs for osteoporosis
 Hormone drugs containing an estrogen
and a progestin or androgen
• Premphase
• Conjugated estrogens,
medroxyprogesterone
• Prempro
• Conjugated estrogens,
medroxyprogesterone
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 Osteoporosis
• Combination drugs for osteoporosis
 Containing bone resoprtion inhibitor
drug and calcium or vitamin D
• Actonel with Calcium (risedronate,
calcium)
• Fosamax Plus D (alendronate, vitamin D)
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Skeletal Muscle Relaxant Drugs
• Acute muscular conditions
 Strains
 Sprains
 "Pulled muscles"
• Treated with:
 Analgesic drugs
 NSAIDs
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Skeletal Muscle Relaxant Drugs
• May also be used with:
 Rest
 Physical therapy
• Drugs specifically relieve:
 Muscle spasms
 Stiffness
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Skeletal Muscle Relaxant Drugs
• Carisoprodol (Soma)
• Chlorzoxazone (Paraflex, Parafon Forte
DSC)
• Cyclobenzaprine (Flexeril)
• Diazepam (Valium)
• Metaxolone (Skelaxin)
• Methocarbamol (Robaxin)
• Orphenadrine (Norflex)
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Figure 9–9 Methocarbamol. This skeletal muscle relaxant drug, available as the trade
name drug Robaxin, has been on the market for many years. It relaxes sore, bruised, or
strained muscles without causing drowsiness.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Cyclobenzaprine Animation
Click on the screenshot to view an animation showing Cyclobenzaprine.
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Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Skeletal Muscle Relaxant Drugs
• Drugs used to treat severe muscle
spasticity in patients with multiple
sclerosis, cerebral palsy, stroke, spinal
cord injury




Baclofen (Lioresal)
Dantrolene (Dantrium)
Diazepam (Valium)
Tizanidine (Zanaflex)
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Drug Alert
• Diazepam (Valium) belongs to the
benzodiazepine class of antianxiety
drugs, a different class of drugs from
the other muscle relaxant drugs.
• Diazepam is best known for its use in
treating anxiety and neurosis.
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 Fibromyalgia
• Specific, small trigger points along the
neck, back, and hips are firm and very
tender to the touch.
• Cause is unknown.
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 Fibromyalgia
• Topical anesthetic sprays
 Aerofreeze
 Ethyl chloride
• Local anesthetic injected into the
trigger points
 Lidocaine (Xylocaine)
 Procaine (Novacain)
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 Fibromyalgia
• An oral muscle relaxant
 Cyclobenzaprine (Flexeril)
• Oral antidepressant drugs
 Amitriptyline
 Duloxetine (Cymbalta)
 Milnacipran (Savella)
• An oral anticonvulsant drug
 Pregabalin (Lyrica)
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved