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Flashcards in Drugs For Bone And Joint Deck (21):
1

Neurodegenerative Diseases

Cause degeneration and or death of neurons. Results in problems with movement and or cognitive functioning: chronic, progressive or debilitating

Ex: Parkinson's, ALzheimers, MS,

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Parkinson's Disease

Low levels or dopamine due to loss of dopamine producing neurons
ACh works in conjunction with dopamine to produce smooth muscle movement
Results in decreased ability to regulate movement and emotions
Symptoms often include tremors, muscle rigidity, bradykinesia (slow movement), impaired balance/coordination, shuffling gait, pin rolling, can have trouble starting gait.

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Pharmacotherapy for Parkinson's

Dopaminergic Medications
Dopamine Replacement therapy
Levodopa (L-dopa) is first line therapy (given in combo with carbidopa), is first line therapy and needs to be converted. Is a precourses or dopamine
Levodopa can cross blood brain barrier and converted to dopamine

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Dopaminergics

Taridopa/levodopa (sinemet)
Thera: ANtiparkinsons
Phar,: Dopamine agonist
Indications: Parkinson's
MOA; converted to dopamine in the CNS where it serves as a neurotransmitters
Adverse: Headache, anxiety, confusions, depression. N/V, orthostatic hypotension, dark urine/sweat, hepatotoxicitiy, tremors, arryhthmias
Implications: monitor liver function, rise slowly, take with high protein foods, vitamin b promotes breakdown of levodopa

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Anticholinergics for Parkinsons

Block ACh inhibiting over activity
Helps in controlling tremors
Adverse: dry mouth, b lured vision, urinary rentention, constipation, tachy
Ex: benztropine (Cogentin) - this med is also used to relieve extrapyrmidal symtomes assoc. with antipsychotics

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Alzheimer's Disease

Form of detentia due to a loss of functioning neurons. 60-80% of dementia related to Alzheimer's.

Chara by neurofibrillary tangles and beta-amyloid plaques

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Pharm for Alzheimer's

Therapy started as soon as client is diagnoses
May be discontinues in later stage due to number of damamger neurons (risk outweighs benefits)
MEdications may provide symptom relief and slow disease progression (choinesterase inhibitors, N-methyl-D-aspartame (NMDA) antagonist
Adjunct therapies for secondary symptoms such as depression, agitation, aggression

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Cholinesterase Inhibitors for Alzheimer's

ACh deficiency is thought to be responsible for cognitive decline and behavioral changes

EX: donepezil (Aricept), rivastigmine (Exelon), galantimine (Razadyne)

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donepezil (Aricept)

Thera: anti-Alzheimer's agent
Pharm: ACh-esterase inhibitor
Indications: Alzheimer's
MOA: inhibitis Achesterase making more ACh available, enhanced effects of ACh in neurons that have not yet been damaged improving meteor and cotnigniin in mild to moderate Alzheimer's
ADDD

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Muscle Spasams

Over use of muscle
Injury
Dehydration
Electrolyte imbalanced
Adverse effect of antipsychotics
Neurological disorders (stroke, cerebral palsy)

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Treatment of muscles spasams

Nonpharm:
Heat/cold therapy
Exercise
Massage
Complimentary therapy

Pharm:
Analgesics, anti-inflammatory, skeletal muscle relaxants

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Baclofen (Lioresal)

Thera: Skeletal muscle relaxant
Pharm: GABA receptor agonist
Indications: Muscle spasticity
MOA: GABA receptor agonist, general CNS depression, exact MOA unknown
Adverse: Hypotension. N/V constipation, poor muscle tone, dizziness, sedation
Implications: Avoid activities requiring mental alertness until effect are known, avoid stopping abruptly, avoid alcohol and other CNS depressants, may be administers via intrathecal pump (spinal)

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Osteoporosis

*** Asymptomatic until fracture ****
Secondary to
-lack of Vit D and calcium
- bone reabsoprtion > bone deposition
-Most common risk factor is menopause (decreased estrogen leads to increased bone demineralization (resorption)

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Pharm for Osteoprosis

Early intervention may prevent osteoprosis
Treatment of already establish osteoporosis may halt production

ADDD

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Bisphosphonates

Most common class of drugs for osteoprosis prevention and treatment
Inhibit hone resorption be suppressing osteoclasts activity (increase bone density)
Adverse Effects: Bone pain abdominal pain esophageal irritation
ImplcationsL Take on empty stomach with full glass of WATER, remain upraight for 30 minutes, long duration of action
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Selective Estrogen Receptor Modulators

Prevention and treatment of osterporosis in postmen women
Decreases bone resorption through estrogen receptors increasing bone density
ALso see for breast cancer prevention
Lower cholesterol
Black Box: increased risk for DVT, pulmonary embolism
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17

Arthritis

Arthritis: Imflammation and stiffness of joints
Osteoarthritis: Erosion of cartilage at join surface. Most often affects weight bearing joint due to wear and tear.
Rheumatoid: Auto-immune disease leads to inflammation and difigurements of multiple joints

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Pharm for Osteoarthritis

Goal to decrease pain and inflammation
Topical (capsaicin, NSAIDS)
Acetaminophen
NSAIDS
Tramadol
COrticosteroids injections into joints

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Pharm for Rheumatoid Arthritis

GOal of therapy is to decrease pain and inflammation and induce remission
DMARDS
Anagelsics
NSAIDS

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Disease Modifying ANti-Rheumatic Drugs (DMARDS)

Most important class of meds for successful treatment
CLients may be "bridged" with analgesic, anti-inflamm or corticosteroid medications until DMARDS take effects

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N-methyl-D-aspartate (NMDA) antagonist

Thought to slow intercellular calcium accumulation and thereby prevent further nerve damage

EX: memantine (Namenda)