Exam 16 - Drugs for Msk

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

• Mechanism of Action: NSAIDs slow prostaglandin, kinins, histamine, tumor necrosis factor, and other inflammatory mediator production from arachidonic acid. This leads to analgesic, anti-inflammatory, and antipyretic effects, preventing tissue and blood vessel response to injury. NSAIDs are categorized as selective or nonselective.
• Types:
  • Nonselective NSAIDs: Block both COX-1 and COX-2 enzymes, leading to more side effects. COX-1 produces protective prostaglandins, while COX-2 is associated with inflammation. Examples include aspirin, ibuprofen, naproxen, nabumetone, and indomethacin.
  • Selective NSAIDs: Primarily block COX-2 enzymes. Examples include celecoxib, meloxicam, and diclofenac.
  • Inhibit platelet aggregation.
• Uses: Myalgia, neuralgia, arthralgia, headache, dysmenorrhea, arthritis (rheumatoid, osteoarthritis, ankylosing spondylitis, gout), pain from procedures/injuries (dislocations, herniation of intervertebral disk), and clot prevention.
• Side Effects: GI irritation (heartburn, nausea, vomiting), dizziness, headache, increased risk of bleeding, fluid retention, edema, increased blood pressure, reduced effectiveness of antihypertensive drugs, and increased risk of hypoglycemia in patients taking oral antidiabetic drugs.
• Adverse Reactions/Contraindications: Allergic reactions, renal failure, GI bleeding/ulceration/perforation, blood disorders, increased risk of cardiovascular events (stroke, myocardial infarction), Reye syndrome (in children), and toxicity (tinnitus, hyperventilation, diaphoresis, thirst, headache, drowsiness, skin eruptions, electrolyte imbalances, CNS depression, stupor, convulsions, coma, tachycardia, respiratory insufficiency).

Corticosteroids

• Types: Examples include prednisone, methylprednisolone, dexamethasone, and hydrocortisone.
• Mechanism of Action: Decrease production of inflammatory cytokines (including COX-1 and COX-2) and white blood cells. Mimic natural cortisol hormones.
• Uses: Reducing inflammatory, allergic, or immunologic responses in acute adrenal emergencies, allergic states, acute brain injury, severe asthma, herniation of intervertebral disk, carpal tunnel syndrome, arthritis (rheumatoid, osteoarthritis, ankylosing spondylitis, gout), inflammatory bowel diseases, systemic lupus erythematosus, fat embolism, and local injections for joint, soft tissue, bursae, or skin issues. Topical use for integumentary, rectal, ophthalmic, or otic problems is possible, inhaled corticosteroids are also common in asthma.
• Side Effects (Short-term): Sodium and fluid retention, potassium depletion, increased blood pressure, acne, insomnia, nervousness, mood changes, and hyperglycemia.
• Side Effects (Long-Term/Cushing Syndrome): Weight gain, fat redistribution (moon face, buffalo hump), loss of muscle mass/strength, thinning hair, hirsutism, stretch marks, immunosuppression, increased risk of bleeding, and GI ulcers/bleeding.
• Adverse Reactions/Contraindications: Adrenal gland suppression (symptoms include anorexia, nausea, vomiting, lethargy, headache, fever, joint pain, skin peeling, myalgia, weight loss, hypotension), Immunosuppression (decreased WBCs, reduced infection signs), osteoporosis, cataracts, corneal fungal infections (blurred vision, discoloration, tearing), hypertension, and ocular hemorrhage.
• Other Considerations: Corticosteroids should be tapered off rather than stopped abruptly. Monitor for infection signs (fever, cough, pain, drainage) and adrenal insufficiency (malaise, weakness, hypotension, anorexia, nausea, vomiting, aching, headache, elevated temperature) which can be fatal when abrupt tapering occurs.

Disease-Modifying Antirheumatic Drugs (DMARDs)

• Types: Examples include etanercept, adalimumab, infliximab, and rituximab.
• Mechanism of Action: DMARDs prevent chronic inflammatory diseases by inhibiting tumor necrosis factor (TNF), preventing TNF from binding to inflammatory cells; thereby reducing pain, improving physical function, and reducing tissue damage.
• Uses: Chronic inflammatory disorders with severe tissue destruction caused by excessive TNF, including rheumatoid arthritis, ankylosing spondylitis, psoriasis, psoriatic arthritis, Crohn's disease, and ulcerative colitis.
• Side Effects: Injection site reactions (pain, swelling, itching, redness), headache, nausea, and bone marrow suppression (anemia, increased risk of bleeding).
• Adverse Reactions/Contraindications: Immunosuppression (increased risk of infection), heart failure, and anaphylaxis.

Other Musculoskeletal Medications

• Further specifics regarding various classes including: antimalarials (Hydroxychloroquine, visual examination is needed), gold salts (renal/hepatic damage, corneal deposits, dermatitis, stomatitis, hematologic changes), antineoplastics (methotrexate, GI irritation), immunosuppressants (azathioprine, cyclophosphamide, GI irritation, rash), topical analgesics (capsaicin, rash, burning), nonopioid centrally acting analgesics (tramadol, sedation, dizziness, dry mouth, constipation, seizures), acetaminophen (mild to moderate pain, fever, potential hepatotoxicity at high doses), skeletal muscle relaxants (cyclobenzaprine, tizanidine, dizziness, headache, dry mouth, blurred vision, urinary retention, cardiac dysrhythmias), antidepressants (amitriptyline, duloxetine, chronic/cancer pain, neuropathic pain), anticonvulsants (pregabalin, fibromyalgia, neuropathic pain), other unspecified analgesics (for fractures, hip/knee replacements, compartment syndrome, strains, whiplash), colchicine (acute gout attacks), uricosurics (probenecid, gout, avoid aspirin), uric acid synthesis inhibitors (allopurinol, febuxostat, prevent/shorten gout), Bisphosphonates, estrogen receptor modulators, parathyroid hormone, calcitonin-salmon, calcium and Vitamin D supplements, indirect thrombin inhibitors (heparin and LMWH), vitamin K antagonists (warfarin).

• Additional crucial information concerning all drugs: Careful assessment for contraindications, administration guidelines, monitoring for side effects, and patient education about adverse reactions (including specific guidelines concerning food, interactions, patient follow up, etc) are crucial aspects of drug use.