MSK Pharmacologic

Question 1

Disease Modifying Antirheumatic Drugs (DMARD) Action

Answer 1

• slow or halt the progression of rheumatic disease
• used early during the disease process to slow progression prior to widespread damage of the affected joints
• induce remission by modifying the pathology and inhibiting the immune response responsible for rheumatic disease

Question 2

DMARD indications

Answer 2

• rheumatic disease, preferably during early treatment

Question 3

DMARD side effects

Answer 3

nausea
headache
joint pain and swelling
toxicity
GI distress
sore throat
fever
liver dysfunction
hair loss
potential for sepsis
retinal damage

Question 4

DMARD Implications for PT

Answer 4

therapists should recognize that many of the agents have high incidence of toxicity

Question 5

Glucocorticoid agents (corticosteroids) action

Answer 5

• provide hormonal, anti-inflammatory and metabolic effects including suppression of articular and systemic diseases
• reduce inflammation in chronic conditions that can damage healthy tissue
• vasoconstriction results from stabilizing lysosomal membranes and enhancing the effects of catecholamines

Question 6

Corticosteroids indications

Answer 6

• replacement therapy for endocrine dysfunction, anti-inflammatory and immunosuppressive effects; treatment of rheumatic, respiratory, and other disorders

Question 7

Corticosteroids side effects

Answer 7

muscle atrophy
GI distress
glaucoma
adrenocortical suppression
drug-induced Cushing's syndrome
weakening with breakdown of supporting tissues
mood changes
hypertension

Question 8

corticosteroids implications for PT

Answer 8

• must wear mask when working with patients on glucocorticoid therapy since their immune system is weakened
• must be aware of signs of toxicity such as moon face, buffalo hump. and personality changes
• patients are at risk for osteoporosis and muscle wasting
• joint that has been injected will need extra care due to laxity or weakening

Question 9

Nonopiod agents actions

Answer 9

• provide analgesia and pain relief, produce anti-inflammatory effects, and initiate anti-pyretic (reduces fever)
• promote reduction of prostaglandin formation that decreases the inflammatory process, decreases uterine contractions, lowers fever, and minimizes impulse formation of pain fibers

Question 10

nonopiod indications

Answer 10

• mild to mod pain, fever, muscle ache, inflammation. primary dysmenorrhea, reduction of risk of myocardial infarction

Question 11

nonopiod side effects

Answer 11

nausea
vomiting
vertigo
abdominal pain
GI distress or bleeding
ulcer formation
potential for Reye syndrome in children

Question 12

nonopiod implications for PT

Answer 12

• patients are at increased risk for masked pain that would allow for movement beyond limitation or false understanding of their level of mobility
• complaints of stomach pain should be taken seriously

Question 13

opiods (narcotics)

Answer 13

• provide analgesia for acute severe pain

- stimulates opiod receptors within the CNS to prevent pain impulses from reaching their destination

Question 14

Narcotics indications

Answer 14

• mod to severe pain of various origins
• induction of conscious sedation to a diagnostic procedure
• management of opiod dependence
• relief of severe and persistent cough

Question 15

narcotics side effects

Answer 15

mood swings
sedation
confusion
vertigo
dulled cognitive function
orthostatic hypotension
constipation
incoordination
physical dependence
tolerance

Question 16

narcotics implications for PT

Answer 16

• must monitor for potential side effects, especially respiratory depression
• treatment that is painful should be scheduled 2 hours after administration for max analgesic benefit
• patient may not accurately report painful treatments