1. Dr. Steven I. Dworkin Drugs That Affect the Musculoskeletal System

2. Dr. Steven I. Dworkin

3. Musculoskeletal Disorders Variety of drug are used to in the treatment of bone and muscle disorders Drug selected on basis of –Disorder –Severity –Patients response to past therapy

4. Dr. Steven I. Dworkin Rheumatoid Arthritis Chronic disease characterized by inflammatory changes within the body’s connective tissue. –Early cases respond to the salicylates –Advanced disease may require gold compounds

5. Dr. Steven I. Dworkin Gold Compounds Suppress or prevents arthritis and synovitis –Therapeutic effects occur over 6 weeks to 6 months. –Early improvement in morning stiffness, Actions –Unknown Use –Treat active juvenile and adult rheumatoid arthritis when cartilage and bone damage has already occurred but in early stage. Cannot reverse structural damage. Adverse Reactions –Dermatitis, stomatitis, pruritus

6. Dr. Steven I. Dworkin Treatment of Gout Actions of Drugs Used –Allopurinol reduces production of uric acid, decreasing serum uric acid crystals in joints –Sulfinpyrazone increases excretion of uric acid by kidneys –Colchicine unknown –Probenecid increases excretion of uric acid Also prolongs the plasma levels of penicillins and chphalosporins.

7. Dr. Steven I. Dworkin

11. Skeletal Muscle Relaxants Actions –Not clearly understood independent of sedative effects. –Cyclobenzaprine appears to effect muscle tone. Use –Various acute, painful conditions such as muscle strains and back pain. Adverse reactions –Drowsiness, sedation

12. Dr. Steven I. Dworkin Corticosteroids Actions –Hormones useful in treatment of many types of musculoskeletal disorders. Use –Treatment of rheumatic disorders. –Provide relief for inflamed areas of the body. – They lessen swelling, redness, itching, and allergic reactions. – They are often used as part of the treatment for a number of different diseases, such as severe allergies or skin problems, asthma, or arthritis.

13. Dr. Steven I. Dworkin Adverse Reactions When this medicine is used for short periods of time, side effects usually are rare –Less common Decreased or blurred vision; frequent urination; increased thirst –Rare Blindness (sudden, when injected in the head or neck area); burning, numbness, pain, or tingling at or near place of injection ; confusion; excitement ; false sense of well- being; hallucinations (seeing, hearing, or feeling things that are not there); mental depression; mistaken feelings of self- importance or being mistreated; mood swings (sudden and wide); redness, swelling, or other sign of allergy or infection at place of injection; restlessness ; skin rash or hives.

14. Dr. Steven I. Dworkin Adverse Reactions (continued) Long term use –Abdominal or stomach pain or burning (continuing); acne; bloody or black, tarry stools ; changes in vision; eye pain; filling or rounding out of the face; headache; irregular heartbeat; menstrual problems; muscle cramps or pain; muscle weakness; nausea; pain in arms, back, hips, legs, ribs, or shoulders; pitting, scarring, or depression of skin at place of injection; reddish purple lines on arms, face, groin, legs, or trunk; redness of eyes; sensitivity of eyes to light; stunting of growth (in children); swelling of feet or lower legs; tearing of eyes; thin, shiny skin; trouble in sleeping; unusual bruising; unusual increase in hair growth; unusual tiredness or weakness; vomiting; weight gain (rapid); wounds that will not heal.

15. Dr. Steven I. Dworkin Adverse Reactions (continued) Other Effects not needing medical attention –More common Increased appetite; indigestion; loss of appetite (for triamcinolone only); nervousness or restlessness –Less common or rare Darkening or lightening of skin color; dizziness or lightheadedness; flushing of face or cheeks; hiccups; increased joint pain (after injection into a joint); increased sweating; nosebleeds (after injection into the nose) ; sensation of spinning Following long term treatment –Abdominal, stomach, or back pain; dizziness ; fainting; fever; loss of appetite (continuing); muscle or joint pain; nausea; reappearance of disease symptoms; shortness of breath ; unexplained headaches (frequent or continuing) ; unusual tiredness or weakness; vomiting; weight loss.