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Musculoskeletal System

EO 003.01 Part 25

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Overview of Lesson(Insert Dari)

Anti-inflammatory and anti-rheumatic products

- Non-steroidal anti-inflammatories (NSAIDS)

- Other anti-inflammatories

Topical products for joint and muscular pain

Muscle relaxants

Anti-gout preparations

Drugs for treatment of bone diseases

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What I need to know as a pharmacy technician(Insert Dari)

In this lecture we will cover the drugs listed in the ANA Formulary which are classified according to the ATC system under

(M) Musculoskeletal System

For each of these medications/classes students must obtain an understanding of:

(1) Mechanism of Action

(2) Indications (Uses)

(3) Efficacy

(4) Side Effects

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Anti-inflammatory and Anti-rheumatic Products

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Rheumatoid Arthritis

روماتو ئیدالتهابمفاصلAutoimmune disorder

Cartilage attacked

Inflammation, swelling & pain

Final step is fusion of joint

اتوایمون • تشوشقرار • حمله مورد غضروف

میگیرددرد • و اذیما التهاب،شدن • قفل یا فیوژن آخر مرحله

مفصل

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Osteoarthritisاوستیوآرتریتسالتهابمفصلیعظمی

Degenerative joint disease

aging, wear & tear

Non-inflammatory---no swelling

only cartilage is affected not synovial membrane

Deterioration of cartilage produces bone spurs

restrict movement

Pain upon awakening--disappears with movement

مفاصل • استحالوی مرضسایش- عمر،

اذیما --- • بدون التهابی غیرمیشود- متاثر غضروف تنها

ساینوویل غشای نهیا • غضروف به صدمه

باعث آن شدن مفسدهای گی برآمده یا ها سپر

عظام در مانند میخمیشود.

میسازد- محدود را حرکتبرخواستن • هنگام در درد

از -- حرکت با خواب ازمیرود بین

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Non-steroidal Anti-inflammatories (NSAIDS) (Insert Dari)

Mechanism of Action Decreases inflammation and pain by affecting the body’s immune response to injury/inflammation.

Indications• To ease pain and

inflammation (swelling). • To treat arthritis.

All NSAIDs work on the same chemical process in the body, but they do it in different ways.

Some NSAIDs need to be taken more often during the day than others to work for certain kinds of pain.

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Non-steroidal Anti-inflammatories (NSAIDS) (Insert Dari)

Specific Indications

Ibuprofen – short term treatment of minor pain and swelling. Naproxen – short term treatment of pain and swelling. Diclofenac – treatment of pain and swelling, generally for an on-going issue/injury or extended period of time. Celecoxib – to treat on going pain (decreased risk of gastric ulcer). Ketorolac – administered intravenously for severe pain. Indomethacin – used to treat pain and swelling associated with gout.

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Non-steroidal Anti-inflammatories (NSAIDS) (Insert Dari)

Side Effects• May cause stomach

irritation. • Risk for gastric ulcer. • Can increase blood

pressure. • Can rarely cause kidney

and liver problems.

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Non-steroidal Anti-inflammatories (NSAIDS) (Insert Dari)

Important Points

• Should be taken with food to decrease stomach upset/irritation. • Two different NSAIDS should not be taken together as it increases the risk for a gastric ulcer to occur. • Should be avoided in patients with a history of gastric ulcers. • Should be avoided in patients with uncontrolled hypertension (high blood pressure). • Should be avoided in pregnant women.

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Mechanism of ActionProposed to help rebuild joint cartilage.

Indication (Use) To treat osteoarthritis.

Side Effects • stomach upset• diarrhea

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Glucosamine and Chondroitin(Insert Dari)

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Side Effects • stomach upset• diarrhea

Important PointsGlucosamine and chondroitin are dietary supplements that have received a lot of attention for their potential benefit in reducing pain and in slowing the progression of arthritis.

Research shows that glucosamine and chondroitin have little no benefit in reducing pain or progression of arthritis.

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Glucosamine and Chondroitin(Insert Dari)

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Mechanism of Action Is a topically applied NSAID. Decreases inflammation and pain.

Indications To treat joint pain due to arthritis.

Side Effects May cause skin irritation at the site of application.

Important Points•Applied directly to the skin covering the joint that is affected. •Wash hands before and after application. • Tends to be less effective than oral medications.

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Topical Products for Joint and Muscular Pain: Piroxicam(Insert Dari)

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Muscle Relaxants(Insert Dari)

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Pancuronium and Suxamethonium (Succinylcholine) (Insert Dari)

Mechanism of Action Blocks neuronal transmission

Indication (Use) Calms muscles during surgery.Calm muscles while on a breathing machine.

Side EffectsPancuronium : Flushing and dizziness. Suxamethonium : increased pressure within the eye and muscle weakness.

Important PointsAdministered intravenously.

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Anti-gout Preparations(Insert Dari)

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Gouty Arthritisنقرس التهابمفاصل

Urate crystals build up in joints---pain

waste product of DNA & RNA metabolism

builds up in blood

deposited in cartilage causing inflammation & swelling

Bones fuse

Middle-aged men with abnormal gene

مفاصل • در یورات های کرستل--- درد میکند تشکل

از- ناشی فضله محصوالتRNAو DNAمیتابولیزم

میکند- تشکل خون درمیشود- جا به جا درغضروف

میشود اذیما و التهاب باعث ویکجا • یا فیوز هم با عظام

میشوندجن • با سال میانه های مرد

غیرنورمال های

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Allopurinol(Insert Dari)

Mechanism of Action Decreases uric acid formation which helps to relieve symptoms of gout.

Indications (Use) To treat gout, as well as to prevent gout flare ups from occurring.

Side Effects • Skin irritation.• Upset stomach or throwing

up

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Allopurinol(Insert Dari)

Important PointsMay take 6 weeks to see the full effect of the medication. Take after a mealBe sure to drink lots of water with this medication.

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Drugs for the treatment of Bone Diseases(Insert Dari)

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• Bone resorption is greater than bone deposit

• Spongy bone of the spine is most vulnerable

• Bones are porous and thin but bone composition is normal

• Occurs most often in postmenopausal women

• Bones become so fragile that sneezing or stepping off a curb can cause fractures

جذب • دران امراضکه گروپ یکتحویل به نسبت عظم دوباره

میگیرد پیشی عظم دهیفقرات • ستون اسفنجی عظم

است پذیر آسیب زیادولی • نازک و اند متخلخل عظام

است نورمال عظم ترکیباز • بعد های خانم در اوقات اکثر

میافتد اتفاق مینوپوزشکنندمیگردندکه • آنقدر عظام

شدن پایین یا زدن عطسه حتی ( ) باعث میتواند بلندی پلوان یک از

گردد کسر

اوستیوپوروزس

Osteoporosis

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Alendronate(Insert Dari)

Mechanism of Action• Alendronate is a bisphosphonate. • Decreases rate of bone resorption and maintenance of bone density

IndicationsTo treat osteoporosis

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Alendronate(Insert Dari)

Side Effects • Signs of low calcium levels like muscle cramps or spasms, numbness and tingling, or seizures.• This drug may cause jawbone problems.• Dizziness• Upset stomach• Diarrhea• Muscle or joint pain.

Important Points• Patients should inform other healthcare professional (i.e. dentists) if they are taking this medication. • This medication should be taken with a large glass of water 30 min before eating and patients must remain upright for 30 min after taking.

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Questions?(Insert Dari)

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In-class Assignment(Insert Dari)

This assignment will consist of 3 questions which are to be completed individually. Once complete the instructor will review the answers with the class.

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1. True or False? : All NSAIDs work on the same chemical process in the body, are taken the same way and provide

the same benefit for all types of pain.

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1. True or False? : All NSAIDs work on the same chemical process in the body, are taken the same way and provide

the same benefit for all types of pain.

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Answer: False, while all NSAIDS do work the same way, they are not taken the same way nor do they have the same

benefit for all types of pain.

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2. Match the following drugs with their indication(Insert Dari)

A) Alendronate

B) Glucosamine/chondroitin

C) Ibuprofen

D) Pancuronium

1) To keep muscles under control while performing surgery

2) To treat minor pain and inflammation

3) To treat osteoporosis

4) To prevent the progression of osteoarthritis.

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2. Answer: Match the following drugs with their indication(Insert Dari)

A) Alendronate (3) to treat osteoarthritis

B) Glucosamine/chondroitin (4) to prevent the progression of osteoarthritis

C) Ibuprofen (2) to treat minor pain and inflammation

D) Pancuronium (1) to keep muscles under control while performing surgery.

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3. Which of the following is NOT true regarding alendronate? (Insert Dari)

A) Patients should inform other health care professionals that they are taking this medication (i.e. dentists, physicians etc).

B) Patients should stay in an upright position for 30 min after taking this medication.

C) Patients should pay attention for signs of low glucose levels.

D) This medication can cause muscle of joint pain.

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3. Answer: Which of the following is NOT true regarding alendronate? (Insert Dari)

A) Patients should inform other health care professionals that they are taking this medication (i.e. dentists, physicians etc).

B) Patients should stay in an upright position for 30 min after taking this medication.

C) Patients should pay attention for signs of low glucose levels.

D) This medication can cause muscle of joint pain.

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Alendronate causes low calcium levels not glucose.

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