Transcript Chapter 24 The Musculoskeletal System

The Pharmacy Technician
FOUNDATIONS AND PRACTICES
Chapter 24
The Musculoskeletal
System
The Pharmacy Technician: Foundations and Practices
Mike Johnston, Karen Davis, and Jeff Gricar
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Muscle
• Made of thick and thin filaments
• During contraction, thick filaments grab
•
and pull thin filaments, creating movement
Individual skeletal muscles are composed
of sarcomeres (units of organized
filaments)
The Pharmacy Technician: Foundations and Practices
Mike Johnston, Karen Davis, and Jeff Gricar
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Click the image for a larger view of bone anatomy.
Figure 24.2
The long bone.
The Pharmacy Technician: Foundations and Practices
Mike Johnston, Karen Davis, and Jeff Gricar
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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Bone
• Composed of two different kinds of bony
tissue
– Cancellous or “spongy” bone—porous, inner
bone that provides volume
– Compact bone—hard, outer covering that
provides strength and shape
• The rounded end of a bone is covered with
smooth, slippery articular cartilage
The Pharmacy Technician: Foundations and Practices
Mike Johnston, Karen Davis, and Jeff Gricar
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Bone (cont.)
• Many bones are hollow, and contain
marrow:
– Red marrow in children
– Fatty yellow marrow in adults
The Pharmacy Technician: Foundations and Practices
Mike Johnston, Karen Davis, and Jeff Gricar
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Figure 24.1
Types of muscle.
The Pharmacy Technician: Foundations and Practices
Mike Johnston, Karen Davis, and Jeff Gricar
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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Types of Muscle
• Skeletal muscles—attached to bones;
provide body movement
– Voluntary, striated in shape, contain multiple
peripheral nuclei
• Cardiac muscle—tissue that composes the
heart
– Contracts rhythmically, coordinated by
transmission of electrical impulses from nerve
to muscle fibers
The Pharmacy Technician: Foundations and Practices
Mike Johnston, Karen Davis, and Jeff Gricar
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Types of Muscle (cont.)
• Smooth or “visceral” muscle—attached to
or lines other organs such as the stomach,
intestines, lungs, and blood vessels
The Pharmacy Technician: Foundations and Practices
Mike Johnston, Karen Davis, and Jeff Gricar
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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Click the image for a larger view of the human skeleton.
Figure 24.4
The skeleton.
The Pharmacy Technician: Foundations and Practices
Mike Johnston, Karen Davis, and Jeff Gricar
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Five Categories of Bone:
• Flat bones—generally more flat than round
– Examples: cranial bones, rib bones
• Irregular bones—have no defined shape
– Examples: scapula, vertebrae
The Pharmacy Technician: Foundations and Practices
Mike Johnston, Karen Davis, and Jeff Gricar
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Five Categories of Bone: (cont.)
• Sesamoid bones—have cartilage or
fibrous tissue mixed in
– Found in the joints; help reduce friction and
enhance joint movement
– Example: patella (kneecap)
• Short bones—generally cube-shaped
– Example: carpals of the hand
The Pharmacy Technician: Foundations and Practices
Mike Johnston, Karen Davis, and Jeff Gricar
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Five Categories of Bone: (cont.)
• Long bones—the most common bone
– Divided into two areas:
• Epiphysis (the rounded end of the bone)
• Diaphysis (the main shaft or central part of
the bone)
– Example: femur of the leg
The Pharmacy Technician: Foundations and Practices
Mike Johnston, Karen Davis, and Jeff Gricar
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Osteomyelitis—Bacterial Infection
Inside the Bone
• Destroys bone tissue
• Original site of infection is frequently in
•
another part of body
Infection spreads to the bone via the blood
The Pharmacy Technician: Foundations and Practices
Mike Johnston, Karen Davis, and Jeff Gricar
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Conditions Causing Weak or Brittle
Bones
• Osteoporosis—bone brittleness due to
lack of calcium
– Prevalent in postmenopausal women
because of estrogen deficiency
• Paget’s disease—changes the normal
process of bone growth
– Causes bone to break down more quickly and
grow back softer than normal bone
The Pharmacy Technician: Foundations and Practices
Mike Johnston, Karen Davis, and Jeff Gricar
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Musculoskeletal Diseases/Disorders
• Bursitis—inflammation of the small, fluid•
•
filled pouches between bones
Tendonitis—inflammation of the cords of
connective tissue that attach muscle to
bone
Myalgia—muscle pain
The Pharmacy Technician: Foundations and Practices
Mike Johnston, Karen Davis, and Jeff Gricar
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Bone Marrow Disorders
• Anemia—failure of the bone marrow to
produce red blood cells
– Most common cause is lack of iron
– Lack of red blood cells leads to a systemic
decrease in oxygen
– Causes fatigue
The Pharmacy Technician: Foundations and Practices
Mike Johnston, Karen Davis, and Jeff Gricar
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Bone Marrow Disorders (cont.)
• Leukemia—blood-borne cancer; cancer of
the blood
– Begins when DNA of white blood cells is
damaged or mutated
– Damaged DNA is copied and passed on to
subsequent generations of cells
– Abnormal, cancerous cells do not die off like
normal cells
– Multiply unchecked within the body
The Pharmacy Technician: Foundations and Practices
Mike Johnston, Karen Davis, and Jeff Gricar
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Arthritis—Inflammation of a Joint
• Rheumatoid—an autoimmune disorder
• Osteoarthritis—caused by physical
•
degeneration of connective tissue
Gout—caused by crystals of uric acid in
blood
The Pharmacy Technician: Foundations and Practices
Mike Johnston, Karen Davis, and Jeff Gricar
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Treating Osteomyelitis
• Anti-infective agent is best treatment for
•
•
•
osteomyelitis
Pharmacokinetics plays an important role
Physician chooses drug that exhibits the
highest anti-infective activity
Determining factors: least toxicity and
lowest cost
The Pharmacy Technician: Foundations and Practices
Mike Johnston, Karen Davis, and Jeff Gricar
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Treating Osteoporosis
• Vitamin D and mineral calcium
•
replacement therapy
Hormone therapy (estrogen, calcitonin)
and bisphosphonates
– Osteoporosis: estrogen replacement therapy
(ERT), hormone replacement therapy (HRT)
– Paget’s disease and osteoporosis:
bisphosphonates and calcitonin (see Tables
24-1 and 24-2 from the textbook)
The Pharmacy Technician: Foundations and Practices
Mike Johnston, Karen Davis, and Jeff Gricar
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Treating Osteoporosis (cont.)
• SERMs for postmenopausal women
• Nonpharmacologic treatments for
osteoporosis:
– Weight-bearing exercise
– Smoking cessation
– Reduced intake of caffeinated and alcoholic
beverages
– Calcium intake of about 1,500 mg per day
(postmenopausal); 1,000 mg if on HRT
The Pharmacy Technician: Foundations and Practices
Mike Johnston, Karen Davis, and Jeff Gricar
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Treating Osteoarthritis
• Gold compounds used to treat
•
•
osteoarthritis
Exact mechanism of action is not known
Believed that gold interferes with functions
of the white blood cells responsible for
joint damage and inflammation
The Pharmacy Technician: Foundations and Practices
Mike Johnston, Karen Davis, and Jeff Gricar
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Treating Gout
• Colchicine used to alter ability of
•
•
phagocytes to attack uric acid crystals
Cycle of deposition of uric acid crystals
and acid is broken
Anti-inflammatory analgesics can be used
to reduce pain and inflammation
The Pharmacy Technician: Foundations and Practices
Mike Johnston, Karen Davis, and Jeff Gricar
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Treating Inflammation
• Salicylates relieve inflammation by
•
inhibiting the synthesis of prostaglandin
Topical corticosteroids treat most causes,
including chemical, mechanical,
microbiological, and immunological
– Corticosteroids inhibit the movement of
macrophages and white blood cells, resulting
in a decrease in swelling, redness, and
itching
The Pharmacy Technician: Foundations and Practices
Mike Johnston, Karen Davis, and Jeff Gricar
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Treating Inflammation (cont.)
• NSAIDs relieve inflammation and pain, but
not infection
The Pharmacy Technician: Foundations and Practices
Mike Johnston, Karen Davis, and Jeff Gricar
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Treating Multiple Sclerosis
• Autoimmune disease in which body’s
•
•
immune system begins to attack normal
body tissue
In MS, the immune system attacks cells
that make myelin
Treatment of MS includes steroidal antiinflammatory agents and corticosteroids
The Pharmacy Technician: Foundations and Practices
Mike Johnston, Karen Davis, and Jeff Gricar
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Treating Cerebral Palsy
• Affected person has poor control of the
•
•
brain, muscles, and joints
Caused by an injury to the brain before,
during, or shortly after birth
Pharmaceutical therapy includes drugs to
prevent seizures and spasticity
The Pharmacy Technician: Foundations and Practices
Mike Johnston, Karen Davis, and Jeff Gricar
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Musculoskeletal Pharmaceuticals
• ASA (acetylsalicylic acid)
– Relieves inflammation by inhibiting the
synthesis of prostaglandin
– Salicylates are also used as analgesics and
antipyretics
The Pharmacy Technician: Foundations and Practices
Mike Johnston, Karen Davis, and Jeff Gricar
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Musculoskeletal Pharmaceuticals
(cont.)
• NSAIDs (nonsteroidal anti-inflammatory
drugs)
– Inhibit or block the enzyme that starts the
reaction of inflammation by making
prostaglandin
The Pharmacy Technician: Foundations and Practices
Mike Johnston, Karen Davis, and Jeff Gricar
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Musculoskeletal Pharmaceuticals
(cont.)
• COX-2 inhibitors
– Block only the cyclooxygenase II that makes
PGE-2, but not C-1 (PGE-1)
– Inflammation is inhibited, but not the viscosity
of the mucosal lining
The Pharmacy Technician: Foundations and Practices
Mike Johnston, Karen Davis, and Jeff Gricar
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Musculoskeletal Pharmaceuticals
(cont.)
• Antigout agents—may be hypouricemic
agents or uricosuric agents
– Hypouricemic agents decrease production of
uric acid in the blood
– Uricosuric agents increase the excretion of
uric acid through urination
The Pharmacy Technician: Foundations and Practices
Mike Johnston, Karen Davis, and Jeff Gricar
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Musculoskeletal Pharmaceuticals
(cont.)
• Calcitonin—indicated for fragile or soft
bones
– Inhibits bone resorption
– Decreases the number of bone fractures from
low bone density
The Pharmacy Technician: Foundations and Practices
Mike Johnston, Karen Davis, and Jeff Gricar
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Musculoskeletal Pharmaceuticals
(cont.)
• Bisphosphonates—indicated for
osteoporosis
– Mimic the natural organic bisphosphonate
salts found in the body
– Inhibit bone resorption and osteoclast activity
– Restore bone mass and density
The Pharmacy Technician: Foundations and Practices
Mike Johnston, Karen Davis, and Jeff Gricar
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Musculoskeletal Pharmaceuticals
(cont.)
• SERMs (selective estrogen receptor
modulators)
– Indicated for postmenopausal women
– Protective effect on bones and heart
– Contraindications include a history of breast
cancer, liver problems, or blood clots
The Pharmacy Technician: Foundations and Practices
Mike Johnston, Karen Davis, and Jeff Gricar
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Musculoskeletal Pharmaceuticals
(cont.)
• Skeletal muscle relaxants—used to relax
specific muscles in the body
– Relieve pain, stiffness, and discomfort
– Block muscle contraction at the
neuromuscular junction
The Pharmacy Technician: Foundations and Practices
Mike Johnston, Karen Davis, and Jeff Gricar
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.