Drugs for Bone and Joint Disorders 33 Drugs for Bone and Joint Disorders

Directory Classroom Response System Lecture Note Presentation

Question 1 The patient taking calcitriol should be assessed for:

Question 1 Choices Dysrhythmias Hypercalcemia Fluid overload Flulike symptoms

Question 1 Answer Dysrhythmias Hypercalcemia Fluid overload Flulike symptoms

Question 2 Which of the following statements demonstrates that the patient with gout needs additional instructions?

Question 2 Choices “I will take my allopurinol as prescribed by my physician.” “I will stop having alcoholic beverages.” “I will avoid high purine foods.” “I will continue my aspirin therapy.”

Question 2 Answer “I will take my allopurinol as prescribed by my physician.” “I will stop having alcoholic beverages.” “I will avoid high purine foods.” “I will continue my aspirin therapy.”

Question 3 Because esophageal irritation can occur, this medication should not be used if the patient cannot remain in an upright position for 30 minutes after taking it.

Question 3 Choices HT with estrogen Calcitonin Alendronate (Fosamax) Raloxifene (Evista)

Question 3 Answer HT with estrogen Calcitonin Alendronate (Fosamax) Raloxifene (Evista)

Question 4 This medication, when used intranasally, may cause irritation of the nasal mucosa.

Question 4 Choices Calcitonin Vitamin D Calcium Raloxifene (Evista)

Question 4 Answer Calcitonin Vitamin D Calcium Raloxifene (Evista)

Learning Outcomes Identify the different body systems contributing to body movement. Discuss nonpharmacological therapies used to treat bone and joint disorders. Identify important symptoms or disorders associated with an imbalance of calcium, vitamin D, parathyroid hormone, and calcitonin.

Learning Outcomes Describe the pharmacological management of disorders caused by calcium and vitamin D deficiency and disorders related directly to bones and joints. Discuss drug treatments for hypocalcemia, osteomalacia, and rickets.

Learning Outcomes Identify important disorders characterized by weak, fragile bones and abnormal joints. For each of the drug classes, know representative drugs, and explain their mechanisms of action, primary actions, and important adverse effects.

Core Concept 33.1 Adequate levels of calcium, vitamin D, parathyroid hormone, and calcitonin are necessary for normal body processes.

Figure 33.1 (a) Parathyroid hormone (PTH); (b) calcitonin action

Figure 33.1 (continued) (a) Parathyroid hormone (PTH); (b) calcitonin action

Figure 33.2 Pathway for vitamin D activation

Hypocalcemia is a serious condition that requires immediate therapy. Core Concept 33.2 Hypocalcemia is a serious condition that requires immediate therapy.

Calcium Disorders Treatments Calcium supplements, vitamin D supplements, bisphosphonates, and/or several misc. Conditions of calcium and vitamin D metabolism Hypocalcemia, osteomalacia, osteoporosis, and Paget’s disease.

Calcium Disorders Causes Hyposecretion of PTH When the thyroid and parathyroid glands are surgically removed. Digestive-related malabsorption disorders Vitamin D deficiencies

Core Concept 33.3 Treatment for osteomalacia consists of calcium and vitamin D supplements.

Osteomalacia Signs and symptoms Hypocalcemia, muscle weakness, muscle spasms, and diffuse bone pain, especially in the hip area. pain in the arms, legs, and spinal column. Rickets in children include bowlegs and a pigeon breast. Children may also develop a slight fever and become restless at night.

Osteomalacia Treatment In extreme cases, surgical correction of disfigured limbs may be required. Drug therapy for children and adults consists of calcium and vitamin D supplements

Concept Review 33.1 Identify the major drug therapies used for hypocalcemia, osteomalacia, and rickets

Core Concept 33.4 Treatment for osteoporosis includes calcitonin estrogen-receptor modulator drugs, and bisphosphonates.

Risk Factors For Osteoporosis: Postmenopause High alcohol or caffeine consumption Anorexia nervosa Tobacco use Physical inactivity Testosterone deficiency, particularly in elderly men

Risk Factors For Osteoporosis Lack of adequate vitamin D or calcium in the diet Drugs such as corticosteroids, some anticonvulsants, and immunosuppressants that lower calcium levels in the bloodstream

Figure 33.3 Calcium metabolism in osteoporosis: (a) normal calcium intake; (b) low calcium intake

Drug Therapies For Osteoporosis Calcium Vitamin D Therapy Hormone Therapy with Estrogen Estrogen-receptor modulators Calcitonin Statins Slow-release sodium fluoride Bisphosphonates.

Table 33.2 (continued) Bone Resorption Inhibitors and Selected Drugs

Concept Review 33.2 What are the major drug therapies used for the treatment of osteoporosis and related bone disorders?

Treatment for Paget’s disease includes bisphosphonates and calcitonin. Core Concept 33.5 Treatment for Paget’s disease includes bisphosphonates and calcitonin.

Paget’s Disease Cause of Paget’s Blood levels of the enzyme alkaline phosphatase & calcium are elevated because of the extensive bone turnover.

Paget’s Disease Treatment Bisphosphonates Therapy is usually cyclic: bisphosphonates are administered until serum alkaline phosphatase levels return to normal; then a drug-free period of several months follows Patients should receive adequate, daily dietary intake of calcium and vitamin D. Sufficient exposure to sunlight is also important.

Concept Review 33.3 Identify two important disorders characterized by weak and fragile bones. What are the major drug therapies used in their treatments?

Core Concept 33.6 Analgesics and anti-inflammatory drugs are important components of pharmacotherapy for osteoarthritis.

Core Concept 33.7 Glucocorticoids, immunosuppressants, and disease-modifying drugs are additional therapies used to treat rheumatoid arthritis.

RA Treatments Analgesics and anti-inflammatories Glucocorticoids Disease-modifying antirheumatic drugs (DMARDs): hydroxychloroquine (Plaquenil), gold salts, sulfasalazine (Azulfidine), D-penicillamine (Cuprimine)

RA Treatments Immunosuppressants: methotrexate (Rheumatrex), leflunomide (Arava), azathioprine (Imuran), cyclosporine (Neoral), cyclophosphamide (Cytoxan) Biologic agents; tumor necrosis factor blockers and interleukin-1 blockers: etanercept (Enbrel), infliximab (Remicade), adalimumab (Humira), anakinra (Kineret)

Table 33.3 (continued) Disease-Modifying and Related Drugs for Rheumatoid Arthritis

Concept Review 33.4 Identify the major types of arthritis. What are the general differences between these disorders?

Drug therapy for gout requires agents that inhibit uric acid buildup. Core Concept 33.8 Drug therapy for gout requires agents that inhibit uric acid buildup.

Gout Accumulation of uric acid crystals that occurs when excretion of uric acid by the kidneys is reduced Primary gout: genetic errors in uric acid metabolism, is most commonly observed in Pacific Islanders.

Gout Secondary gout: diseases or drugs that increase the metabolic turnover of nucleic acids or that interfere with uric acid excretion. Thiazide diuretics, aspirin, cyclosporine, and alcohol (when ingested on a chronic basis).

Gout Secondary gout: diseases or drugs that increase the metabolic turnover of nucleic acids or that interfere with uric acid excretion. Conditions that can cause secondary gout include diabetic ketoacidosis, kidney failure, and diseases associated with a rapid cell turnover such as leukemia, hemolytic anemia, and polycythemia.

Goals of Gout Pharmacotherapy Termination of acute attacks NSAIDs are the drugs of choice for treating the pain and inflammation of acute attacks. Example: Indomethacin (Indocin) Prevention of future attacks.

Concept Review 33.5 Identify drug therapies used to treat the major arthritic and joint disorders.