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Musculoskeletal Drugs Flashcards

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1
Q

Bisphosphonates MOA

A

inhibit osteoclast activity, promote osteoclast apoptosis

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2
Q

Bisphosphonates Examples

A
  1. Alendronate (Fosamax)
  2. Risedronate (Actonel)
  3. Ibandronate (Boniva)
  4. Zolendronate (Reclast/Zometa)
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3
Q

Considerations when taking Bisphosphonates

A

take on empty stomach, separate from other medications, don’t lie down for 30 minutes to 1 hour after taking

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4
Q

Bisphosphonates Route of Administration

A
  1. Alendronate: oral daily, or oral weekly in high dose
  2. Risendronate: weekly
  3. Ibandronate: monthly
  4. Zolendronate - IV yearly
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5
Q

Bisphosphonates Indications

A
  1. treatment and prevention of osteoporosis

2. Paget’s disease

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6
Q

Bisphosphonates Contraindications

A
  1. Hypocalcemia
  2. Poor renal function
  3. Significant GI disease (ie esophagitis)
  4. Invasive dental procedures (can cause osteonecrosis of the jaw)
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7
Q

Bisphosphonates Side Effects

A
  1. GI - nausea, dyspepsia, reflux, cramps
  2. esophagitis or esophageal erosion
  3. osteonecrosis of the jaw
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8
Q

Lab Work with Bisphosphonates

A
  1. Ca and BMP (kidney function) prior to starting

2. Monitor serum calcium, phosphorous, alkaline phosphatase

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9
Q

Recommended daily intake of Vit D3

A
  1. 600 IU/day

2. 800 IU/day for females over age 71

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10
Q

Effect of Vit D

A

increase serum calcium concentrations (increase calcium absorption from intestine and distal renal tubules, regulate bone resorption and formation)

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11
Q

Vit D effect on PTH

A

inhibits PTH

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12
Q

What kind of vitamin is vitamin D?

A

lipophilic

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13
Q

Indications for Vit D

A
  1. osteoporosis
  2. hyperparathyroidism
  3. osteomalacia
  4. Rickets
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14
Q

Contraindications for Vit D

A

hypercalcemia

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15
Q

Vit D drug interactions

A
  1. Vit D analogues - calcitrol, paricaltrol, and doxercalciferol –> hypercalcemia –> headache, nausea, dizziness, vomiting, and loss of appetite
  2. Hydrocholorthiazide –> hypercalcemia
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16
Q

Side effects of Vit D

A
  1. Vit D toxicity –> GI pain, renal stones, psychiatric disturbance
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17
Q

How are sunlight and Vit D related?

A

UV -B rays convert 7-dehydrocholesterol to pre-vitamin D3 which then becomes Vit D3

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18
Q

sunlight recommendations

A

5-30 minutes of sun exposure between 10 am and 3 pm twice a week, to face, arms, legs, or back

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19
Q

Types of NSAIDs

A
  1. Nonselective

2. COX-2 selective

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20
Q

Nonselective NSAID examples

A
  1. ibuprofen (Motrin/Advil)
  2. naproxen (Aleve/Anaprox)
  3. ketorolac (Toradol)
  4. indomethacin (Indocin)
  5. etodolac
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21
Q

COX-2 selective NSAID example

A

Celecoxib/Celebrex

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22
Q

NSAID MOA

A

acts on arachidonic acid pathway and blocks COX-1 and COX-2 and causes decrease in prostaglandin formation which results in decreased inflammation, pain, and fever

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23
Q

Function of COX-1 pathway

A

production of protective lining in stomach

platelet aggregation

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24
Q

Function of COX-2 pathway

A

inflammatory response

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25
Pharmacokinetics of NSAIDs
1. well absorbed 2. hepatic metabolism (most) 3. short to intermediate half-lives (2-12 hr)
26
Indications for NSAIDs
pain, inflammation, fever
27
Contraindications for nonselective NSAIDs
history of peptic ulcers, GI bleeding, chronic inflammation of GI tract, history of sensitivity
28
Contraindications for COX-2 selective NSAIDs
history of sensitivity | history of sensitivity to sulfonamides
29
Side Effects of nonselective NSAIDs
GI, edema, dizziness, acute renal failure
30
Side Effects of COX-2 selective NSAIDs
cardiovascular, dizziness, edema
31
which NSAID is the strongest
Indomethacin
32
Aspirin - MOA and function
1. irreversibly inhibits COX-1 and COX-2 | 2. prolonged platelet activity (prevents clotting)
33
Contraindications for aspirin
``` same as other NSAIDs anti-coagulation 3rd trimester pregnancy children!!! pre-surgery ```
34
Aspirin side effects
1. Reyes syndrome 2. asthma 3. ototoxicity 4. bledding
35
what medication class should you NOT use NSAIDs with
glucocorticosteroids --> increased risk of GI bleed
36
What is gout?
Dysfunction in uric acid metabolism --> high levels of circulating uric acid in blood --> uric acid crystals deposited in cartilage (big toe, ankle, knee, elbow) --> crystals grow and causes inflammation/pain
37
Gout medication examples
1. Colchicine 2. Probenecid 3. Allopurinol
38
Colchicine MOA
suppresses immune function (affects PMNs ability to attract other immune modulators)
39
Colchicine route of administration
oral
40
Colchicine route of excretion
89-90% fecal | 10-20% renal
41
Colchicine Indications
1. acute gout attacks 2. long term prevention of recurrent gout attacks in combo with uric acid lowering therapy 3. 2nd line therapy
42
Colchicine Contraindications
1. renal failure 2. hepatic disease 3. cardiac disease
43
Side effects of Colchicine
1. DIARRHEA, GI UPSET 2. bone marrow suppression 3. myopathy 4. neuropathy
44
Probenecid MOA
increase uric acid excretion
45
Indication for Probenecid
1. prevention of gout | 2. improve effectiveness of penicillin
46
Contraindications of Probenecid
1. renal insufficiency 2. urolithiasis 3. peptic ulcer disease
47
Side effects of Probenecid
1. generally well tolerated 2. GI irritation (N/V/D) 3. allergic reaction
48
Important Patient Education with Probenecid
1. Adequate hydration to prevent kidney stones | 2. may have precipitating acute gout attack when starting Probenecid (can take indomethacin)
49
Allopurinol MOA
decreases uric acid synthesis
50
Indications for Allopurinol
1. prevention of gout 2. prevention of uric acid renal stones 3. complicated hyperuricemia
51
Allopurinol contraindications
previous hypersensitivity
52
Side effects of Allopurinol
1. skin reactions (Steven-Johnsons Syndrome) 2. liver reactions 3. renal insufficiency
53
Considerations for taking Allopurinol AND Probenecid
1. Need higher dose of allopurinol | 2. makes probenecid more effective
54
What do you need to monitor in patients taking daily medication for gout prevention
1. CMP (renal and liver function) | 2. CBC (anemia or bleeding issues)
55
Why should you be cautious when giving colchicine?
it has a narrow therapeutic index, overdose if fatal --> not used for chronic control
56
what is allopurinol often taken in conjunction with ?
colchicine for acute treatment and prevention
57
NSAIDs and surgery?
all NSAIDs must be stopped 7-10 days prior to surgery
58
dose of naproxen
500 mg BID (according to pharm tutor)
59
useful info about Ketorolac/Toradol
can give IV, stronger than ibuprofen
60
What is an indication for indomethacin?
gout if lots of inflammation but more GI S/E
61
When would you suggest Celebrex?
if patient has lots of abdominal pain when taking nonselective NSAIDs
62
aspirin indications
1. clot prevention 2. coronary artery dx, hx of MI (baby aspirin 81 mg) 3. acute MI (4 baby aspirin or 1 adult aspirin 325 mg) 4. fever and pain
63
Reyes syndrome
altered mental status, jaundice due to liver damage, encephalopathy
64
benefits of aspirin
doesn't irritate GI lining, don't have to worry about overdose like tylenol
65
name of vitamin D2
ergocalciferol (plant source?)
66
name of vitamin D3
cholecalciferol (animal source?)
67
aspirin's effect on uric acid levels
causes net retention of uric acid
68
first line treatment for Gout
NSAIDs - indomethacin, naproxen, sulindac

Pharmacology (27 decks)

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