1. The musculoskeletal system
Jessica Tagerman, PharmD, RPh

2. What is Osteoporosis?

3. 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

4. Name 2 essential minerals for bone development

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

6. Explain how osteoporosis occurs

7. 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

8. Osteoporosis Risk Factors
Age
Sex
Women > Men
Vitamin D Deficiency
Lack of exercise
Family history
Smoking
Alcohol use
Long term steroid use

9. 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

10. 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

11. 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.

12. 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

13. 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.

14. Switching Gears

15. What is inflammation? What are symptoms of inflammation?

16. 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

17. 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)

18. 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.

19. Switching Gears

20. Pain

21. What is pain?

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

23. How do you assess pain?

25. 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®

26. 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

27. 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

28. 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!

29. Questions?