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 Bone and Muscles tend
to be rich in neurons that transmit pain 3
Slide 4
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 4
Slide 5
Analgesics Narcotics MOA: bind to opiate receptors in brain and
spinal cord Indications: Analgesia Main Side effects: N/V,
constipation, physical and psychological dependence. In overdose,
respiratory depression. See text for complete list. Fentanyl is
available as a IV injection, patches, oral lozenges but not as a
tablet Oxycodone is not available as an injection only orally High
potency opiates include fentanyl, remifentanil and hydromorphone
(Dilaudid). High risk of overdose Combination product: Tylenol with
Codeine denoted as follows Tylenol#2 as Codeine 15 mg/APAP 300 mg
Tylenol #3 as Codeine 30 mg/APAP 300 mg Tylenol#4 as Codeine 60
mg/APAP 300 mg
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
10
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
14
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
Drugs used for COPD 18
http://www.steroidology.com/bodybuilding-uses-for-albuterol/
http://imgbuddy.com/flovent-220.asp
/http://www.goodrx.com/proventil-hfa/latest-newshttp://www.wsj.com/articles/SB1000142405274870362820457561833
2675513808
Slide 19
Anticholinergic (Antimuscarinic) Drugs Act on muscarinic
(cholinergic) receptors as antagonists Results in bronchodilation
19 GenericBrand IpratropiumAtrovent Ipratropium +
AlbuterolCombivent TiotropiumSpiriva
Slide 20
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 20 GenericBrand Fluticasone-SalmeterolAdvair
Diskus Budesonide-FormoterolSymbicort
Slide 21
Leukotriene antagonists Drugs block the action of leukotrienes
on their receptors Leukotrienes are potent bronchoconstrictors in
COPD Contraindicated in patient with hepatic disease 21
GenericBrand MontelukastSingulair ZafirlukastAccolate ZileutonZyflo
CR
Slide 22
Steroid Products for COPD or Rhinitis GenericBrandDose Form
BeclomethasoneBeconase AQNasal Inhaler FluticasoneFlovent ,
FlonaseInhaler, Nasal Product MethylprednisoloneMedrolTablets
PrednisolonePediapred, OrapredOral liquid, tablet
TriamcinoloneNasacort AQNasal Inhaler 22
Slide 23
Mucolytic Agents Used to thin bronchial mucus and secretions
from COPD and other lung diseases 23 GenericBrandSpecial
Consideration AcetylcysteineMucomystUsed for many lung conditions;
used for acetaminophen overdose; has a horrible scent and flavor
Dornase AlfaPulmozymeUsed primarily for cystic fibrosis
Slide 24
24
Slide 25
The heart. 25
Slide 26
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 26
Slide 27
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 27
Slide 28
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 28
Slide 29
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 29
Slide 30
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 30
Slide 31
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 31
Slide 32
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) 32
Slide 33
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 33
Slide 34
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 34
Slide 35
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 35
Slide 36
Cardiovascular Drugs Beta Blockers: drugs that block the beta
receptors in the heart which blocks attachment of norepinephrine
and results in bradycardia and reduced blood pressure. ACE
inhibitors (angiotensin converting enzyme inhibitor) blocks the
enzyme (ACE) responsible to converting angiotensin I to angiotensin
II (ATII). ATII is a potent vasoconstrictor in humans This drug is
important in hypertensive patients and patients with CHF and MI.
ACEI are also important in preservation of kidney function in
diabetics
Slide 37
Antianginal agents: used to widen coronary arteries to increase
myocardial oxygen delivery and reduce chest pain. Examples:
nitroglycerin (NTG), and isosorbide (Imdur, Isordil) Calcium
channel blockers: blocks the entry of calcium ions in the heart
muscle and in the muscle that control blood vessel diameter.
Reduced heart rate and reduces blood pressure. Some are used to
control a type of cardiac arrhythmia called atrial fibrillation.
Examples: Diltiazem (Tiazac, Cardizem), amlodipine (Norvasc)
Antiarrhythmial agents: block the entry of sodium into the heart.
The drugs in this class have several mechanisms of action.
Examples: Lidocaine, amiodarone (Cordarone), Procainamide
(Procanbid)
Slide 38
Angiotensin 2 Receptor blockers (ARBs): similar to ACEI except
these drug works on a receptor for ATII Anticoagulation agents:
drugs that block the formation of blood clots. Different mechanisms
of action. Examples: warfarin (coumadin), dibigatran (Pradaxa)
Antiplatelet agents: drugs that block the action of platelets in
the formation of a blood clot. Used in the prevention of stroke or
MI. Examples: (Plavix) and Aspirin (Ecotrin) Cardiac glycosides:
drugs used to boost the strenght of the hearts contraction.
Example: Digoxin (Lanoxin)
Slide 39
Alpha Receptor blockers MOA: blocks alpha receptors on smooth
muscle in the arteries Indication: blood pressure control Side
effects: edema, dizziness Examples Prazosin (Minipress) Terazosin
(Hytrin) Doxazosin (Cardura) The following alpha blockers are used
for enlarged prostate symtom relief Tamsulosin (Flomax) Alfuzoxin
(Uroxatral) The following drugs are both alpha and beta receptor
blockers Labetolol (Trandate) Carvedilol (Coreg)
Slide 40
Anticoagulants Do not thin out the blood Prevent clots from
forming Prevent existing clots from getting bigger Cannot dissolve
existing blood clots 40
Slide 41
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 41
Slide 42
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
42
Slide 43
Low Molecular Weight Heparins Drugs that a similar to heparin
Used as IV or SubQ injections PTT test not required Protamine
sulfate is antidote 43 GenericBrand EnoxaparinLovenox
DalteparinFragmin TinzaparinInnohep
Slide 44
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 44
GenericBrandSpecial Consideration DabigatranPradaxaMust be dispense
in original container RivaroxabanXeraltoNA ApixabanEliquisNA
Slide 45
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 45 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 46
GenericBrand Simvastatin + EzetimibeVytorin Lovastatin +
NiacinAdvicor Simvastatin + NiacinSimcor 46 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 47
Non Statin Antilipidemic drugs Other drugs that target lowing
VLDL, triglycerides, and raising HDL have a beneficially affect on
coronary artery disease 47 GenericBrandIndications
GemfibrozilLopidHigh VLDL FenofibrateTricorHigh VLDL, low HDL
NiacinNiaspanHigh VLDL, low HDL Omega 3 Fatty acid LovazaHigh VLDL,
low HDL
Slide 48
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
48
Slide 49
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 49
Slide 50
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 50
Slide 51
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 51 GenericBrand
PropranololInderal MetoprololLopressor TimololBlocadren
AtenololTenormin CarvedilolCoreg
Slide 52
ACE Inhibitors Used to decrease mortality in post MI and CHF
patients Used with beta blockers and often in combination with them
52 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 53
ACE inhibitors combination products Often ACE inhibitors are
combined with diuretics to negate the potassium loss and to
synergize to lower blood pressure more 53 GenericBrand Lisinopril +
HCTZPrinzide Enalapril + HCTZVaseretic Benzapril + HCTZLotensin
HCT
Slide 54
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 54
GenericBrand Losartan Losartan + HCTZ Cozaar Hyzaar Valsartan
Valsartan + HCTZ Diovan Diovan HCT Irbasartan Irbasartan + HCTZ
Avapro Avalide
Slide 55
The renal system. 55
Slide 56
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 56
Slide 57
Diuretics Drugs that work at the kidney to help remove sodium,
water, calcium, and potassium from the body. Each class of diuretic
is named for the most part according to its mechanism of action or
the site of action in the kidney. Loop Diuretics work in a section
of the kidney called the loop of henle. This is where most of the
water and sodium and potassium is lost from the body. These drugs
are used to treat edema in CHF patients and other patient that hold
on the water. Example(s): Furosemide (Lasix), Torsemide
(Demadex)
Slide 58
Carbonic anhydrase inhibitors act on the proximal tubule of the
kidney by blocking the enzyme, carbonic anhydrase which cause
sodium retention and acid loss. Example: acetazolamide (Diamox)
Carbonic anhydrase inhibitor are pretty much weak diuretics and can
produce profound lose of potassium
Slide 59
Thiazide Diuretics Thiazide diuretics act on the distal
convoluted tubule to block the NaCL cotransporter in the kidney.
Generally good diuretics Produce a sodium rich urine Example:
Hydrochlorothiazide (HydroDiuril)
Slide 60
Potassium Sparing diuretics Most of the above diuretics cause
profound lose of potassium. To circumvent this, these diuretic are
usually taken with potassium supplements. A class of diuretic that
spares potassium in the body are know and are used for many
indications Examples are: spironolactone (aldactone), Amiloride
(Midamor), and the ACE inhibitors with ARBs. These diuretics unlike
the ones mentioned before should not be used with a potassium
supplement.
Slide 61
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 61
Slide 62
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
threatening 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 ) 62
Slide 63
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)
63