The musculoskeletal system Jessica Tagerman, PharmD, RPh

What is Osteoporosis?

Osteoporosis Disease characterized by a loss of bone, resulting in misshapen bone such as curvature of the backbone seen in the elderly, or in easily broken bones

Name 2 essential minerals for bone development

What is Osteoporosis? 2 essential minerals for bone formation: calcium and phosphate.

Explain how osteoporosis occurs

What is Osteoporosis? Caused by: Excessive bone loss: Too little bone formation Excessive bone loss Combination of both! Excessive bone loss: Calcium is also needed to keep the heart, brain and other organs functioning, so the body absorbs calcium that is stored in the bones to maintain blood calcium levels. If there isn’t enough calcium intake through the diet, bone production may suffer, thus causing osteoporosis Too little bone formation: More common in post-menopausal women- estrogen helps slow down bone loss, less estrogen during menopause

Osteoporosis Risk Factors Age Sex Women > Men Vitamin D Deficiency Lack of exercise Family history Smoking Alcohol use Long term steroid use https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072713/

Treatment Calcium Supplements Generic Name Brand Name Mechanism of Action Calcium Carbonate Caltrate®, Os-Cal®, Viactiv®, Tums® Supplement- ensures that the body has enough mineral to use in the bloodstream and absorb in the bone Calcium Carbonate + Vitamin D Caltrate® + D, Os-Cal® + D, Viactiv® + D Calcium Citrate Citracal® Bisphosphonates Alendronate Fosamax® Inhibit the resorption of calcium from bone, allowing the formation of new bone Alendronate/Cholecalciferol Fosamax® + D Risedronate Actonel® Ibandronate Boniva® re·sorp·tion- the absorption into the circulation of cells or tissue

Treatment Calcium supplements Bisphosphonates Vitamin D increases calcium absorption Calcium carbonate is the most common form- low cost and high calcium content Bisphosphonates Look for the *ONATE* suffix Usually taken either once a week or once a month Make sure to sit up and drink a whole glass of water to avoid esophagus damage and increase absorption

Treatment Parathyroid Hormone Analog Generic Name Brand Name Mechanism of Action Teriparatide Forteo® Stimulates bone formation and increases bone strength Misc. Agents Raloxifene Evista® Misc. mechanism of action Calcitonin Miacalcin® The agents presented on this slide are reserved for people who can’t tolerate bisphosphonate therapy because they aren’t as effective as other agents.

Knowledge Check Charles Barkley’s mother was just diagnosed with Osteoporosis. He comes into the pharmacy asking if there is anything he can take to prevent osteoporosis in the future. What is the pharmacist most likely to recommend? Calcitonin Raloxifene Alendronate Calcium Carbonate The only OTC product in this list is calcium carbonate. All other items need to be prescribed by the doctor. PREVENTION = calcium supplementation

Knowledge Check Betty White comes into your pharmacy to pick up her new prescription for Fosamax. What is the pharmacist most likely to tell her at the consultation booth? Make sure to take this medication with a full glass of water and stay upright for 30 minutes On the days that you take the tablet, make sure to use a generous amount of sunscreen. This medication may make you hypersensitive to cats and dogs. If you have a dog, give it to your sister for the duration of your therapy. Take 1 tablet by mouth every day. Make sure to take this medication with a full glass of water and stay upright for 30 minutes. This medication may cause esophageal damage.

Switching Gears

What is inflammation? What are symptoms of inflammation?

Inflammation Inflammation is the body’s response to infection or trauma. The blood vessels send fluid, dissolved substances, and cells into areas of tissue injury or death. The reaction is intended to protect and aid in the healing of the tissue. Symptoms: Redness, heat, pain, swelling, and altered function of the involved tissue

Treatment NSAIDS “Non-Steroidal Anti-Inflammatory Drugs” Generic Name Brand Name Mechanism of Action Diclofenac Voltaren® Inhibits the activity of chemicals that cause the inflammatory response (COX-1) and (COX-2) Ibuprofen Motrin® or Advil® Ketorolac Toradol® Meloxicam Mobic® Naproxen Aleve® Celecoxib Celebrex® Only inhibits COX-2- has less GI effects but may have an increased risk of cardiovascular side effects Reye's (Ryes) syndrome is a rare but serious condition that causes swelling in the liver and brain. Signs and symptoms such as confusion, seizures and loss of consciousness require emergency treatment. Early diagnosis and treatment of Reye's syndrome can save a child's life. NSAIDS “Non-Steroidal Anti-Inflammatory Drugs” Have pain relieving and fever-reducing properties Can all cause serious bleeding or stomach ulcers DO NOT GIVE ASPIRIN TO CHILDREN (REYES SYNDROME)

Knowledge Check Tommy Pickles has a high-grade fever. Which medication should NOT be given to Tommy? Aspirin Tylenol Advil Motrin Aspirin. May cause Reyes disease in children.

Switching Gears

Pain

What is pain?

What is Pain? An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage

How do you assess pain?

Pain Treatment Skeletal Muscle Relaxants All cause severe drowsiness Effectiveness unknown- do they only work because they cause drowsiness? Be cautious of interactions with other medications! Skeletal Muscle Relaxants Generic Name Brand Name Mechanism of Action Baclofen Lioresal® Decrease the neuronal response from the CNS to the tense muscles, helping to relax muscle tone. Carisoprodol Soma® Cyclobenzaprine Flexeril® Diazepam Valium® Tizanidine Zanaflex®

Pain Treatment Analgesics Many of these medications are controlled medications because of their potential for abuse Respiratory depression is a serious side effect! Analgesics Generic Name Brand Name Mechanism of Action Fentanyl Duragesic® Alters the way the brain receives and interprets the sensation of pain from the nerves Hydromorphone Dilaudid® Morphine MS Contin® Oxycodone Tramadol Ultram® All are controlled substances (2), except tramadol, which is CIV

Musculoskeletal Pain Treatment Non-Opioid analgesics Acetaminophen Relieves pain and reduces fever but has no anti-inflammatory properties Good for patients who suffer from GI damage and therefore can’t take NSAIDs Too much medication can cause liver damage

Knowledge Check Which of the following medications is a CII medication? Morphine Oxycodone Percocet Fentanyl All of the Above None of the Above All of the above!

Questions?