(Summary) Pharmacology (Musculoskeletal System Medications).

(Summary) Pharmacology (Musculoskeletal System Medications). Inflammation normal body response to tissue damage, body's attempt to remove damaging agent & repair damaged tissue (pain, edema, redness, heat, loss of function) Cyclooxygenase (COX) is the enzyme responsible for synthesis of prostanoids COX-1 good COX, present in all tissues, primarily mediates beneficial processes: protecting gastric mucosa, supporting renal function, promoting platelet aggregation Inhibition of COX-1 results largely in harmful effects: gastic erosion & ulceration, bleeding tendencies, & renal impairment. Protection against MI & stroke COX-2 bad COX, primarily mediates harmful processes COX-2 sites of tissue injury mediates inflammation & sensitizes receptors to painful stimuli COX-2 brain mediates fever & contributes to perception of pain COX-2 kidney supports renal function COX-2 blood vessels promotes vasodilation COX-2 colon contributes to colon cancer Inhibition of COX-2 beneficial effects suppression of inflammation, alleviation of pain, reduction of fever, protection against colorectal cancer Inhibition of COX-2 adverse effects renal impairment, promotion of MI & stroke NSAID inhibit COX-1 (decreased platelet aggregation & kidney damage) & inhibit COX-2 (decreased inflammation, fever, & pain NSAIDs therapeutic uses inflammation suppression, analgesia for mild to moderate pain, fever reduction, inhibition of platelet aggregation (aspirin) NSAIDs adverse effects GI discomfort, GI bleeding & perforation, renal dysfunction, increase risk of heart attack & stroke NSAIDs considerations stop taking aspirin 1 week before elective surgery, take w. food, milk, or water, notify provider if symptoms of gastric discomfort or salicylism occur Salicylates medications aspirin, magnesium salicylate, sodium salicylate, salsalate Salicylates therapeutic used pain relief & reduce fever & inflammation Salicylates adverse effects salicylsim (aspirin toxicity) & reye syndrome (rare) Aspirin toxicity therapy cooling w/ tepid water, correction of dehydration & electrolyte imbalance w/ IV fluids, reversal of acidosis & promotion of salicylate excretion w/ bicarbonate, gastric labage Salicylates considerations avoid alcohol, restrict caffeine intake, take w/ food or milk Acetaminophen (tylenol) slows the production of prostaglandin in CNS Acetaminophen therapeutic uses analgesic effect (relief of pain) & antipyretic effects (reduction of fever) Acetaminophen adverse effects acute toxicity- liver damage: diarrhea, sweating, & abdominal discomfort, progress to hepatic failure, coma, & death, do not exceed 4 grams/day, administer antidote (acetylcysteine, Mucomyst) Acetaminophen drug interactions Alcohol (increases risk of liver damage) & Warfarin (acetaminophen slow metabolism of warfarin leading to increased levels of warfarin, which places client at risk for bleeding) Anti-inflammatory drugs Glucocorticoids & Antihistamines Glucocorticoids corticosteroids (Prednisone) Antihostamines block specific histamine receptor in body, H1 antagonist help reduce itching & swelling associated w/ inflammation in certain conditions Osteoarthritis noninflammatory degenerative disorder of joints, limited to affected joints, no systemic symptoms Rheumatoid arthritis chronic, autoimmune & inflammatory disorder Rheumatoid arthritis manifestations & symptoms manifestations: symmetric joint pain, morning joint stiffness lasting longer than 1 hour symptoms: symmetric joint pain, swelling, warmth, erythema, lack of function Rheumatoid arthritis nondrug measures physical therapy, exercise, surgery, patient education & counseling Rheumatoid arthritis drug therapy NSAIDs drugs (provide rapid relief), Glucocorticoids (rapid relief, can slow disease progression), & DMARDs (reduce joint destruction & slow disease progession Prednisone suppress immune responses & provide symptomatic relief of inflammation & pain Prednisone therapeutic uses treatment of acute exacerbation of rheumatoid arthritis: reduce inflammation & pain, slow disease progression, short-term therapy until long-acting DMARD's take effect