12. musculosceletal,joint and bone kki

8/8/2019 12. musculosceletal,joint and bone KKI

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Pharmacotherapy of

musculo-skeletal, joints andbone problems

Purwantyastuti


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ANALGESIC: opioid & non-opioid

ANTI_INFLAMMATION

DISEASEMODIFYINGANTI-RHEUMATIC

DRUGS (DMARD)

MUSCLE RELAXANTS

IMMUNOSUPPRESSANT Bone problem: osteoporosis


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Analgesics Opioid : morphine, pethidine, fentanyl,

codein (and combined with simple

analgesic paracetamol) --> central action inthe brain (opioid receptorQ)

--> for constant acute moderate & severe

pain: fracture (injectables);--> for chronic moderate to severe pain:

cancer (oral)


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Analgesics

NSAID= non-steroid anti-inflamatory drugs -->suppress the formation of prostaglandin byinhibiting enzyme cyclooxygenase (COX)=COXinhibitor --> analgesic-antipyretic effects

Analgesic non-narcotic: paracetamol,phenacetin --> antipyretic effects

Local anaesthetics: inhibits sensation locally byinterfering peripheral nerve sensory transmissionof pain >< induce warm sensation in the painfularea


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Drugs as examples Salicylic acid: aspirin,diflunisal

Fenilasetic acid: diclofenac

Indolasetic acid: indometacin,sulindac

Propionic acid: ibuprofen, ketoprofen,naproxen

Fenemic acid: mefenamic acid,meclofenamate Pirazolon: phenylbutazone,oxiphenbutazone

Oxicam: piroxicam, tenoxicam


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Anti-inflammation NSAID: similar mechanism with its analgesics

effect --> prevent the formation of

prostaglandin; all NSAIDs are analgesics and

anti-inflammation (and antipyretics)

Corticosteroids : all are anti-inflammation

because they suppress antigen-antibodyreactions as well as anti-inflammation


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Drugs for Gout

Indomethasin / otherNSAID except aspirin, salicylate,

tolmetin: inhibit urate crystal phagocytosis +

antiinflamation.

Aspirin is contra-indicated, competes for secretion Uricosuric (eg.probenecid): act at anionic transport

site of renal tubules, not for those w/ high uric acid

secretion via urine --> stone form.

Allopurinol: inhibits formation of uric acids by inhibiting

xanthine oxidase

Colchicine doesnot inhibit formation nor altering

metabolism of uric acid --> antiinfl for gout


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Disease modifying anti-rheumatic

drugs (eg. methotrexate, chloroquine,gold salt,cyclophosphamide,cyclosporin,Azathioprine,TNF

alpha blockers:Adalimumab,Infliximab etc) Indications : rheumatoid arthritis,

caused by autoimmune reactions

Mechanism of actions: prevent/slow

progression of bone & cartilage

destruction (effects seen after 6 weeks-6 months) eg via suppression ofT cells

& B cells functions -->induce remission


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Immunosupressants Corticosteroids: suppressing immune

response by inhibition of arachidonic

acid synthesis. Affecting many other

systems --> side effects

DMARD


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Muscle relaxants

Pain maybe caused by skeletal muscle continuouscontractions (spasm), e.g. in dislocations, musclesprains and strains, inflamation

Trauma --> muscle spasms--> less blood are able to

enter the area due to blood vessels squeezed by thecontracted muscles --> pain --> more contractions

Sometimes anti-anxiety effect is needed because painis actual pain + pain perception

Act at the CNS or muscle cells, rather than atneuromuscular junction, because muscle strengthshould be retain:Carisoprodol, diazepam (a

muscle relaxants+anti-anxiety), baclofen, dantrolene


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Osteoporosis Calcium & vit D

calcitonin

biphosphonate Physical activity/ sports

HRT= hormone replacement therapy:estrogens

Selective estrogen receptor modulators(SERM)

teriparatide


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Route of administrations Injectables

Oral drugs

Locally applied: cream,ointment, lotion,

spray


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Have a nice day !

12. musculosceletal,joint and bone kki

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