1. Musculoskeletal Pharmacology
Jennifer Kean MSN, RN, CCRN

2. 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

3. 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)

4. 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

5. 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

6. 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