1. Bone and Muscle 2 Disorders of the Bone Osteomyelitis Bacterial Infection Inside the Bone...
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Bone and Muscles 1
1. Bone and Muscle 2 Disorders of the Bone Osteomyelitis Bacterial Infection Inside the Bone Destroys bone tissue Original site of infection is frequently
Disorders of the Bone Osteomyelitis Bacterial Infection Inside
the Bone Destroys bone tissue Original site of infection is
frequently in another part of body Infection spreads to the bone
via the blood Osteoporosisbone brittleness due to lack of calcium
Prevalent in postmenopausal women because of estrogen deficiency
Pagets diseasechanges the normal process of bone growth Causes bone
to break down more quickly and grow back softer than normal bone
3
Slide 4
Musculoskeletal Diseases/Disorders Bursitisinflammation of the
small, fluid-filled pouches between bones Tendonitisinflammation of
the cords of connective tissue that attach muscle to bone
Myalgiamuscle pain Rheumatoid Arthritisan autoimmune disorder
Osteoarthritiscaused by physical degeneration of connective tissue
Goutcaused by crystals of uric acid in blood 4
Slide 5
Treatments Gout Colchicine used to alter ability of phagocytes
to attack uric acid crystals Anti-inflammatory analgesics can be
used to reduce pain and inflammation Inflammation Salicylates
relieve inflammation by inhibiting the synthesis of prostaglandin
Topical corticosteroids treat most causes, including chemical,
mechanical, microbiological, and immunological 5
Slide 6
Skeletal Muscle Relaxants MOA: may block action of calcium in
muscles Indications: painful muscle spasms, neurological spinal
cord injury Main Side Effects: Drowsiness, weakness GenericBrand
CyclobenzaprineFlexeril MethocarbamolRobaxin BaclofenLioresal
Slide 7
Musculoskeletal Pharmaceuticals ASA (acetylsalicylic acid)
Relieves inflammation by inhibiting the synthesis of prostaglandin
Salicylates are also used as analgesics and antipyretics NSAIDs
(nonsteroidal anti-inflammatory drugs) Inhibit or block the enzyme
that starts the reaction of inflammation by making prostaglandin
COX-2 inhibitors Block only the cyclooxygenase II that makes PGE-2,
but not C-1 (PGE-1) Inflammation is inhibited, but not the
viscosity of the mucosal linin 7
Slide 8
Non Steroidal Anti Inflammatory Drugs Called the NSAIDS
Excellent drugs for pain relief and reducing fever and inflammation
Developed as an alternative to corticosteroids MOA: blocks the COX
enzyme to block prostaglandin formation Side effects are: severe GI
bleeding (possible), GI upset and gastritis, kidney insufficiency,
edema and elevated blood pressure, hyperkalemia risk GenericBrand
IbuprofenMotrin, Advil NaproxenNaprosyn KetorolacToradol (IV
available) DiclofenacVoltaren CelecoxibCelebrex (COX2
inhibitor)
Slide 9
Musculoskeletal Pharmaceuticals Bisphosphonatesindicated for
osteoporosis Mimic the natural organic bisphosphonate salts found
in the body Inhibit bone resorption and osteoclast activity Restore
bone mass and density Risedronate (Actonel) Ibandronate (Boniva)
SERMs (selective estrogen receptor modulators) Indicated for
postmenopausal women Protective effect on bones and heart
Raloxifene (Evista) Skeletal muscle relaxantsused to relax specific
muscles in the body Relieve pain, stiffness, and discomfort Block
muscle contraction at the neuromuscular junction 9
Slide 10
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Slide 11
The Respiratory System Divided into the upper respiratory tract
and the lower respiratory tract The upper respiratory tract
consists of: Nose or nasal cavity Paranasal sinuses Pharynx and
larynx 11
Slide 12
The Respiratory System (cont.) The lower respiratory tract
consists of: Trachea Two lungs Two main bronchi 12
Slide 13
The lower respiratory tract. 13
Slide 14
Common Cold Caused by a viral infection that inflames the
membranes in nose and throat Antibiotics will not cure a cold or
any other viral infection Treatment is considered symptomatic Cough
May be a symptom of a cold, flu, respiratory problems, or
nonrespiratory diseases Most likely begins with an irritation of
nerves in the respiratory tract Nonproductive cough treated with
cough suppressant Productive cough treated with an expectorant
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Slide 15
Allergies and Asthma Allergies Caused by the immune system
reacting to a substance that does not cause disease Treatment may
be palliative, with antihistamines and antitussives Treatment may
be preventive, with mast cell stabilizers Asthma Chronic
respiratory disease Characterized by inflammation of airways,
tightening of muscles around airways Treatment is palliative with
albuterol and other bronchodilators 15
Slide 16
Nasal Congestion and Rhinitis Nasal Congestion Inflamed, stuffy
nose Treatment may be palliative, to promote easier breathing
Indications for use of decongestants are nasal and bronchial
congestion Rhinitis Inflammation of nasal membranes, and/or runny
nose Common component of colds and allergies Treatment is
considered symptomatic Drugs to treat include: 16 GenericBrand
OxymetazolineAfrin Nasal Spray PhenylephrineNeoSynephrine Nasal
Spray FluticasoneFlonase (Nasal Steroid preparation)
MometasoneNasonex (Nasal Steroid preparation) Oxymetazoline and
Phenylephrine are sympathomimetic and can raise blood pressure.
They also should be used with caution in gluacoma patients
Slide 17
Chronic Obstructive Pulmonary Disease (COPD) Umbrella term for
emphysema and chronic bronchitis, and asthma Characterized by
partially blocked bronchi and bronchioles, mucus plugging and
bronchoconstriction Causes shortness of breath Treatment may be
palliative, with bronchodilators Beta Agonist Drugs 17 GenericBrand
AlbuterolProventil PirbuterolMaxair SalmeterolSerevent
FormoterolForadil LevalbuterolXopenex Albuterol and Pirbuterol and
Beta 2 agonist but can cause tachycardia in some people. All of the
above drugs are available as MDI Formoterol is beta agonist
available as a capsule
Slide 18
Anticholinergic (Antimuscarinic) Drugs Act on muscarinic
(cholinergic) receptors as antagonists Results in bronchodilation
18 GenericBrand IpratropiumAtrovent Ipratropium +
AlbuterolCombivent TiotropiumSpiriva
Slide 19
Steroid / Beta Agonist Combination products These products are
not meant as rescue agents but for chronic long term use in
prevention of COPD Available as MDI and for Advair as dry powdered
inhaler as well Patients should rinse after use to prevent oral
fungal infections 19 GenericBrand Fluticasone-SalmeterolAdvair
Diskus Budesonide-FormoterolSymbicort
Slide 20
Leukotriene antagonists Drugs block the action of leukotrienes
on their receptors Leukotrienes are potent bronchoconstrictors in
COPD Contraindicated in patient with hepatic disease 20
GenericBrand MontelukastSingulair ZafirlukastAccolate ZileutonZyflo
CR
Slide 21
Steroid Products for COPD or Rhinitis GenericBrandDose Form
BeclomethasoneBeconase AQNasal Inhaler FluticasoneFlovent ,
FlonaseInhaler, Nasal Product MethylprednisoloneMedrolTablets
PrednisolonePediapred, OrapredOral liquid, tablet
TriamcinoloneNasacort AQNasal Inhaler 21
Slide 22
Mucolytic Agents Used to thin bronchial mucus and secretions
from COPD and other lung diseases 22 GenericBrandSpecial
Consideration AcetylcysteineMucomystUsed for many lung conditions;
used for acetaminophen overdose; has a horrible scent and flavor
Dornase AlfaPulmozymeUsed primarily for cystic fibrosis
Slide 23
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Slide 24
The heart. 24
Slide 25
Anatomy of the Heart Composed of four chambers: two upper and
two lower Atriatop two chambers Ventriclesbottom two chambers
Septumdivides heart into right and left sides 25
Slide 26
Valves of the Heart Tricuspid valvelocated between the right
atrium and the right ventricle Pulmonary valvelocated between the
right ventricle and the pulmonary artery Mitral or bicuspid
valvelocated between the left atrium and the left ventricle Aortic
valvelocated between the left ventricle and the aorta 26
Slide 27
Layers of the Heart Pericardiumfluid-filled sac that surrounds
and protects the heart Permits free movement of the heart during
contraction Endocardiuminnermost wall layer; covers the inside
surface of the heart Myocardiumsurrounds heart and causes chamber
contractions 27
Slide 28
Function of the Heart Provides oxygenated blood throughout the
body by a pumping mechanism Oxygenated blood deposits materials
necessary for growth and nourishment Receives from tissues the
waste products resulting from metabolism 28
Slide 29
Hypertension Sustained elevation of systemic arterial blood
pressure Symptoms include: Severe headache Chest pain Irregular
heartbeat Fatigue Pharmaceutical treatment includes diuretics,
vasodilators, ACE inhibitors, beta blockers, and calcium channel
blockers 29
Slide 30
Congestive Heart Failure Heart pumps out less blood than it
receives Results in weakened and enlarged heart Symptoms of CHF
include: Upright posture or leaning forward Anxiety and
restlessness Cyanotic and clammy skin Persistent cough Rapid
breathing Fast heart rate Edema of the lower limbs Pharmaceutical
treatment includes cardiac glycosides, diuretics, vasodilators, ACE
inhibitors, beta-adrenergic blockers, and phosphodiesterase
inhibitors 30
Slide 31
Coronary Artery Disease Occurs when there is insufficient blood
flow to the heart Can lead to: Angina Heart attack Arrythmias
Stroke Pulmonary embolism Heart failure Early CAD is closely
monitored and symptomatic relief is given by the use of
nitroglycerin and other nitrate drugs. NTG ISDN (isosorbide
dinitrate) Once CAD has progressed to the point where a patient has
angina at rest. Two procedures can be taken PCI with stents CABG
(Coronary artery bypass graft) 31
Slide 32
Cardiovascular Pharmaceuticals Antiarrhythmic drugsrestore
normal rhythm patterns but do not cure the cause of the irregular
heartbeat Cardiac glycosidesused to increase the force of
myocardial contraction, without causing an increase in the
consumption of oxygen Diureticsused to eliminate excess sodium and
water via the urinary tract Vasodilatorsallow more blood to exit
the heart, preventing or mitigating congestion; lower blood
pressure 32
Slide 33
Cardiovascular Pharmaceuticals (cont.) Angiotensin-converting
enzyme inhibitors (ACE inhibitors)lower high blood pressure;
thought to reshape the heart; prevent the body from producing
natural vasodilators Angiotensin II receptor blockerssimilar to ACE
inhibitors; block the bodys natural vasodilators Beta-adrenergic
blockersused to block cells from receiving natural vasoconstrictors
Platelet aggregation inhibitorsreduce the ability of the blood to
coagulate 33
Slide 34
Cardiovascular Pharmaceuticals (cont.) Anticoagulantsprevent
clots from forming or existing clots from getting bigger Tissue
plasminogen activatorsbreak down blood clots by reversing the
clotting order and interfering with the synthesis of various
clotting factors Thrombin inhibitorsinactivate bound thrombin by
binding to the enzyme and blocking its interaction with its
substrates of fibrin Antihyperlipidemicshelp prevent the
progression of coronary artery disease by lowering plasma lipid
levels 34
Slide 35
Anticoagulants Do not thin out the blood Prevent clots from
forming Prevent existing clots from getting bigger Cannot dissolve
existing blood clots 35
Slide 36
Warfarin Oral drug of choice Works by preventing the synthesis
of clotting factors II, VII, IX, and X Used in the long-term
prevention or management of venous thromboembolic disorders,
including: Deep vein thrombosis Pulmonary embolism Clotting
associated with atrial fibrillation and prosthetic heart valves
Vitamin K may be used as an antidote when too much warfarin has
been given For immediate correction of bleeding: fresh frozen
plasma is required Testing of bleeding is required for therapy test
is called INR For most conditions INR should be between 2-3, INR in
the range of 5 or more requires vitamin K 36
Slide 37
Heparin Parenterally administered drug of choice Works by
inactivating clotting factors IX, X, XI, and XII Used
prophylactically to: Prevent and treat deep vein thrombosis Prevent
and treat pulmonary embolism Treat thrombophlebitis Prevent
clotting during cardiac and vascular surgery The only antidote for
heparin overdose is protamine sulfate PTT testing is required
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Slide 38
Low Molecular Weight Heparins Drugs that a similar to heparin
Used as IV or SubQ injections PTT test not required Protamine
sulfate is antidote 38 GenericBrand EnoxaparinLovenox
DalteparinFragmin TinzaparinInnohep
Slide 39
Newer anticoagulants Used primarily for anticoagulation for
atrial fibrillation Does not required INR testing like warfarin
Less drug interactions Cant be reversed by vitamin K 39
GenericBrandSpecial Consideration DabigatranPradaxaMust be dispense
in original container RivaroxabanXeraltoNA ApixabanEliquisNA
Slide 40
Cholesterol and Triglycerides HDLhigh-density lipoproteins or
good cholesterol LDLlow-density lipoproteins or bad cholesterol
Triglyceridesa form of energy stored in adipose and muscle tissues
Often measured to depict fat ingestion and metabolism Can be used
to assess CAD risk factors Statins- drugs used to lower LDL
cholesterol 40 GenericBrand AtorvastatinLipitor SimvastatinZocor
FluvastatinLescol RosuvastatinCrestor Major: Side effects are
nausea, GI and a reaction called Rhabdomyolysis and myopathy where
patient experiences muscle pain and at the extreme renal failure
and hospitalization Statins are drug interactions with medications
that block the livers CYP450 systems: Diltiazem, amiodarone, HIV
protease inhibitors, Ketoconazole
Slide 41
GenericBrand Simvastatin + EzetimibeVytorin Lovastatin +
NiacinAdvicor Simvastatin + NiacinSimcor 41 Above medications are
combination products that contain a statin + one other drug.
Exetimibe is a drug that block enteral absorption of cholesterol.
Niacin is a B vitamin used to high doses to alter metabolism of
triglycerides and raise HDL One unique combination product is
Caduet, which is a combination of Atorvastatin and Amlodipine
(calcium channel blocker ). This product is used to treat metabolic
syndrome
Slide 42
Non Statin Antilipidemic drugs Other drugs that target lowing
VLDL, triglycerides, and raising HDL have a beneficially affect on
coronary artery disease 42 GenericBrandIndications
GemfibrozilLopidHigh VLDL FenofibrateTricorHigh VLDL, low HDL
NiacinNiaspanHigh VLDL, low HDL Omega 3 Fatty acid LovazaHigh VLDL,
low HDL
Slide 43
Drugs used in the Treatment of MI MI is a myocardial
Infarction. Heart attacks occurs because a arterial plaque raptures
and triggers the coagulation cascade completely occudding a
coronary artery. This cause necrosis of the heart muscle. If not
treated MI result in death from cardiogenic shock Even if treat
mortality is high from secondary ventricular fibrillation Even if
treated, patient will suffer irrevocable heart damage resulting in
CHF and/or damage to cardiac conduction system leading to pacemaker
or ICD placement The main goal is to relieve the blood vessel of
the clot and reestablish coronary blood flow Can use clot busters
drugs or have percutaneous coronary intervention (PCI) which the
femoral artery undergo catherization and a probe is guide to the
site of occlusion and a ballon is inflated to push aside the clot
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Slide 44
GenericBrandUse AspirinEcotrinTo stop platelet action at the
clot ClopidogrelPlavixTo stop platelet action at the clot
TicagrelorBrilintaTo stop platelet action at the clot
NitroglycerinVariousTo vasodilate coronary artery to relieve pain
Tissue plasminogen activator TPA Alteplase (Activase) Reteplase
(Retavase) Tenecteplase (Tnkase) Activate plasmin, a blood protein
that opens blood clots HeparinN/AA potent blood anticoagulant that
stop further coagulation MetoprololLopressorA beta blocker that
slows heart rate and slows spread of infarction 44
Slide 45
Drug used in the treatment of Atrial Fibrillation Atrial
Fibrillation is a heart rate disturbance in which the atrium/ atria
are beating extremely rapidly Can lead to cardiogenic shock if the
rate reaches the ventricles Therapy is aimed blocking this rate
disturbance from reaching the ventricles (called rate control),
preventing blood clots in the heart muscle wall from forming
embolus (anticoagulation), and eventual cardioversion Rate control
Diltiazem Verapamil Beta blockers Amiodarone Anticoagulation
Warfarin Apixaban (Eliquis) Cardioversion Ibutilide (Tikosyn) High
dose Amiodarone 45
Slide 46
Ventricular Fibrillation Ventricular Fibrillation, VF, is a
cardiac arrythmia where the ventricles beat extremely rapidly to
the point where no coordinated contraction occurs Medical emergency
VF lasting more than the 90 seconds leads to asystole, sudden
cardiac death and cardiogenic shock. Brain death from cerebral
hypoxia Therapy Direct DC shock with ACD: delivery of DC shock with
about 360 Joules of electricity to bring about normal sinus rhythm.
Best chance at survival but not always successful Drug treatment
used in conjunction with ACD if shock initially unsuccessful
Amiodarone: 300 mg IV push with 150 mg IV supplemental doses
Lidocaine: 100 mg IV push Epinephrine or Atropine can be tried
after failed attempts at shock Other drugs include calcium chloride
10%, magnesium sulfate and vasopressin 46
Slide 47
Beta Blockers Very useful in extending the life expectancy of
patients post MI and in CHF patients Due to evidence from clinical
trials like the Scandinavian Timolol study and the BHAT (beta block
heart attack trial with propranolol) beta blocker are now an
important drug in the therapy of post MI patients 47 GenericBrand
PropranololInderal MetoprololLopressor TimololBlocadren
AtenololTenormin CarvedilolCoreg
Slide 48
ACE Inhibitors Used to decrease mortality in post MI and CHF
patients Used with beta blockers and often in combination with them
48 GenericBrand CaptoprilCapoten EnalaprilVasotec
LisinoprilZestril, Prinivil BenazaprilLotensin RamiprilAltace
Potassium levels should be monitored ACE inhibitors are pregnancy
category X May cause relentless coughing in some patient requiring
discontinuation due to potent edema and closure of the airway
Slide 49
ACE inhibitors combination products Often ACE inhibitors are
combined with diuretics to negate the potassium loss and to
synergize to lower blood pressure more 49 GenericBrand Lisinopril +
HCTZZestoretic, Prinzide Enalapril + HCTZVaseretic Benzapril +
HCTZLotensin HCT
Slide 50
Angiotensin Receptor Blockers Similar to ACEI but works at a
receptor for angiotensin 2 If patient has angioedema to ACEI; ARBs
can be tried Used in MI and renal disease, HTN and CHF 50
GenericBrand Losartan Losartan + HCTZ Cozaar Hyzaar Valsartan
Valsartan + HCTZ Diovan Diovan HCT Irbasartan Irbasartan + HCTZ
Avapro Avalide
Slide 51
The renal system. 51
Slide 52
The Renal System Composed of two kidneys, two ureters, one
bladder, and the urethra Filtering system of the kidneys is
composed of millions of nephrons Waste from food and drug
metabolization is filtered through the nephrons Wastes exit the
kidneys as urine via the ureters Ureters lead to the bladder, where
urine is stored until released The kidneys are located in the
posterior abdomen just above the waist 52
Slide 53
Nephron Smallest, most basic part of the kidney Filters the
blood that passes through the kidneys Produces urine through the
processes of filtration, reabsorption, and secretion Enables blood
to reabsorb water, electrolytes, and nutrients 53
Slide 54
Kidney and Bladder Kidney Built almost entirely of nephrons
Organ that filters blood and produces urine Urine produced by the
kidneys is conducted to the bladder Bladder Organ used for waste
storage Can collect approximately 350 mL to 500mL of urine Allows
for discretionary voiding 54
Slide 55
Drugs for Kidney Disorders Failing kidneys cause disorders
relating to retention of toxins in the blood, acidity and
electrolytes abnormalities Kidney disorders effects blood
potassium, calcium, phosphate levels, and levels of various
hormones in the body. Patients have high PTH levels Low vitamin D
levels Low erythropoetin levels Patients have high levels of urea
and other nitrogenous toxin that causes damage to the CNS 55
Slide 56
Drugs to lower patients potassium levels K binding resins
Kayexalate is sodium polystrene sulfonate resin and bind K in the
GI prevent absorption In emergency situation, where life threating
hyperkalemia exists the following is given (in a hospital ICU)
Insulin 10 units IVP Calcium choride 10% 300 mg -1 gram IVP
Albuterol USP solution Kayexalate 30 g orally Drug that lower
phosphate levels Sevelamer (Renagel, Renvela Lanthanum Carbonate
Calcium Acetate (Phoslo ) 56
Slide 57
Drugs used to correct PTH levels (secondary
hyperparathyroidism) Calcitriol (Calcijex, Rocaltrol) IV form is
given with dialysis Oral capsule (Rocaltrol ) is given as
maintanence tx outpatient Paricalitol Zemplar (IV form given with
dialysis) Drugs used to correct renal induced red blood cell anemia
Epogen (Erythropoetin) Procit (erythropoetin) Aranesp (darbepoetin)
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Slide 58
ESRD, end stage renal disease is where there is no kidney
function left Renal transplantation is only cure Periodically
patients require Dialysis Hemodialysis Modality where a machine
acts as an artificial kidney Removal excessive potassium,
phosphates Added sodium, magnesium and calcium (MD must order)
Removal of excessive water from body (hemofiltration) Number one
cause of ESRD in the US is diabetes 58