Musculoskeletal Pharmacology Jennifer Kean MSN, RN, CCRN

Disease-modifying antirheumatic drugs (DMARDS) Treat conditions such as rheumatoid arthritis, systemic lupus erythematosus, fibromyalgia, gout Include methotrexate, hydroxychloroquine, sulfasalazine, etanercept, adalimumab, rituximab, abatacept Also used to treat: glucocorticoids- Prednisone and prednisolone And, NSAIDS: aspirin, ibuprofen, diclofenac, indomethacin, naproxen, celecoxib Act to slow joint degeneration and progression of rheumatoid arthritis, relieve inflammation, and relieve pain Used to treat joint pain & swelling, slow/delay worsening of the disease, maintain joint function

Complications Increased risk of infection, hepatic fibrosis and toxicity, bone marrow suppression, ulcers in the mouth and/or stomach. Fetal death/congenital abnormalities Also proteinuria from renal toxicity, thrombocytopenia, agranulocytosis, hepatitis, GI discomfort, retinal damage/blindness, subcutaneous sit injection reactions, IV infusion reactions, heart failure, osteoporosis, fluid retention, hyperglycemia Contraindicated in pregnancy/breastfeeding, liver or renal dysfunction, cancer/bone marrow suppression, heart failure, any type of active infection Interactions: live vaccines, PCN (toxicity), concurrent use of antiseizure meds (reduce effectiveness), insulin and oral diabetic meds (reduce effectiveness)

Pregabalin (GABA analogue) Used primarily to treat fibromyalgia, seizures, neuropathic pain Restores balance of neurotransmitters serotonin and norepinephrine Complications include drowsiness, fatigue, blurred vision, lightheadedness, increased appetite, weight gain, angioedema (indicates allergy), erectile dysfunction and anorgasmia Contraindicated in pregnancy/breastfeeding Use with caution in older adults, patients with cardiac problems, hypertension, diabetes, renal dysfunction, mental illness Interactions: benzodiazepines (increase drowsiness), alcohol (increases drowsiness and dizziness) Give with or without food, notify provider of any suicidal thoughts, taper gradually

Meds for gout (hyperuricemia) Allopurinol, probenecid, colchicine Act by inhibiting uric acid production Colchicine is only used for those who don’t respond well to allopurinol or probenecid Complications: mild GI distress, thrombocytopenia, bone marrow suppression, sudden onset of muscle pain, renal calculi, rash, hepato- and nephrotoxicity Contraindicated in pregnancy/breastfeeding, severe kidney or cardiac problems; do not give within 2 weeks of an acute gout attack Interactions: grapefruit juice can increase adverse effects, salicylates can lessen effectiveness, allopurinol slows the metabolism of warfarin, leading to toxicity

Biphosphenates Include alendronate, ibandronate, risendronate Increase the number and action of osteoclasts and inhibit bone resorption Used to treat postmenopausal osteoporosis or osteoporosis due to long-term corticosteroid use Complications include esophagitis and esophageal ulceration, GI upset, musculoskeletal pain, visual disturbances, necrosis of jaw (with IV infusion) Contraindicated in pregnancy, patients with dysphagia or known GI problems, patients who cannot sit upright or stand upright for 30 minutes after administration Absorption decreases when taken with calcium, iron, Mg supplements, antacids, orange juice and caffeine