Pharmacology session 11:

Cancer, Musculoskeletal, and poison:

Cancer

  • unregulated cell proliferation
  • activation of oncogenes, and inactivation of tumor suppressor genes
  • these are genetic changes

Chemotherapy

  • disseminated cells
  • interrupts mitosis during cell division
    Hair, GI tract, skin all divide fast too so most of the symptoms come from this.
  • solid tumors
    • use radiation and surgery
  • killing all of the malignant cells is almost impossible
  • dose limiting effect is when a specific amount of dose causes adverse effects that will outweigh the benefit of the drug.
  • toxicities of chemo
    • cisplatin – tubular necrosis in the kidney
    • Vincristine – Neurotoxicity – in the periphery
    • Daunorubicin – cardiac toxic HF
    • The classes are by what they kill
    • Must be certified to administer cancer drugs
    • INFILTRATION is very important!!! chunks of tissue will fall off!!!
  • Megace (progestin)
    • increases appetite
    • used in aids and anorexia
    • s/e alopecia

Hormone/ Hormone antagonists

  • anti-estrogen
    • Tamoxifen, raloxifene
  • Estrogen
    • DES
      • causes vaginal cancer decades later in the mother, daughter, granddaughter, (testicular cancer in the sons)

Musculoskeletal Drugs

muscle spasms

  • Caused by hypoCa, injury, back pain,

treatment

    • non medication first ie. ice and PT
    • Anti-inflammatories
    • CNS acting MM relaxers
      • Methocarbamol – (robaxin)
        • decreases activity and tone of muscle
        • tid-Qid
        • color of urine changes
  • MM relaxers should be short term use only
  • Drugs for spasticity
    • Baclofen (Lioresal)
    • similar to GABA
    • Causes diplopia and weakness
    • do not come off drug fast, must be tapered
      • if taken off too fast causes fever, tetanus, hallucinations
    • NO Antidote
  • NM blockers
    • block ACH from the nicotinic receptors
      • causes MM relaxation
    • Non-depol NM blocker
      • tubocurarine (curare)
        • old, used in arrows!
        • flaccid paralysis
        • not CNS action
        • works in tissues only
  • NM blocker II
    • Flaccid paralysis
    • – curinum
  • Depol neuro MM blocker
    • Succinylcholine
      • very short acting paralysis
        • for intubation
      • S/E: Malignant hyperthermia, sever MM contractions and cannot get out of the contraction, arrhythmias, Potassium release from MM
      • Can’t move but can hear and feel
      • can’t breath
      • Face recovers first, but there may be a lot of the drug still in the system

Calcium

  • normal value 8.5-10.5 mg/dl
  • absorption increased by vit D and PTH
  • hypoCa: increase twitching chvostek’s sign, rickets, convolution

osteoporosis

  • increased fragility of bone and low bone bone mass
  • can run in the family
  • prevention through Ca supplementation, weight bearing exercise, and not smoking
  • Drugs that stop resorption of bone
    • – dronates
  • drug that help build bone
    • teraperitda
  • Calcium supplements should be separated throughout the day

Paget’s disease

  • bone overgrowth, but very fragile

bisphosphonates

  • Alendronate (fosamax) -Dronate
    • inhibitor of osteoclast from breaking down bone
    • the amount of time between doses can range from weeks to a year
    • S/E: GI esophageal irritation(take an hour before other drugs and stay upright for 30 min after taking it), osteonecrosis of the jaw(loose teeth), atypical femur fracture(mid thigh)
    • only take with water
    • renal Fxn needs to be high
    • foods high in metals can slow absorption
  • Denosumab
    • reduces bioresorption
    • for pt that has osteoporosis but cannot be on bisphosphonate
  • Teriparatide (Forteo)
    • Stimulates bone formation (unique!!)

Selective estrogen receptor modulator or SERM

  • raloxifene (evista)
    • less bone loss
    • do not give if any coagulopathies are present

Pramipexol (Mirapex)

  • not miralax
  • for RLS
    • and used in parkinson’s
  • narcoleptic effects, and drowsiness

Rheumatoid arthritis   

  • autoimmune, symmetrical stiffness
  • systemic S/S: thinning and nodules under skin,
  • wake up with pain in joints, and with more movement it improves
  • DMARD – disease modifying antiRA drugs
    • stops inflammation and autoimmune function to delay function
  • treat s/s then try to get function back and treat pain.
  • Plaquenil
    • non-biologic DMARD
  • Etanercept (enbrel)
  • biologic are most expensive

gout

  • cannot process uric acid
  • chronic inflammatory disorder
    • uric acid crystals form in the night when the blood flow is low
      • this causes toe pain
  • treat with NSAID for pain and inflammation
    • watch for GI upset and do not take with ETOH
  • Uloric allopurinol
    • preventative for chronic gout

Posins

prevention is best

identify the problem

irrigate the poison on the skin

  • the solution to pollution is dilution

removal

  • lavage through large bore tube
  • activated charcoal
    • powder, mixed in water and
  • ipecac to throw up
    • mallory weiss tear from violent puking
    • vomiting like the exorcist
  • sodium bicarb to raise ph of blood
    • also increase renal excretion
  • mental health drugs do not commonly dialize

antidotes

  • metal:
    • chelation
  • anticholinergic
    • physostigmine
  • non depol NM blocker
    • neostigmine
  • ACHase inhibitors
    • atropine
  • opiates
    • narcan
  • Benzos
  • acetaminophen
    • mucomyst, protects the kidney
  • Radiation
    • iodine to protects the thyroid from problems in the future.
  • Nerve Gas
    • Atropine, and 2-PAM chloride (hold the auto injector to the leg for 5-10 seconds)
      • you can die from too much of this antidote.

herbs

  • echinacea
    • for cold, not for prevention. doesn’t work well, does not work in kids
  • zink
    • same as echinacea
  • glucosamine
    • turns into chondroitin in the body
    • shoulders are weird, some people have reduced pain in the shoulder with this
    • sulfa allergy
  • CQ10
    • when taking lipid drugs
    • to replenish the body’s own CQ10
    • might as well take it
  • omega 3
    • lowers triglycerides.
  • niacin
    • increases chances for hemorrhagic stroke.
  • vit E
    • antioxidant
    • toxic in over 1500 IU/ day
    • makes cancer grow faster
  • st.john’s wort
    • SSRI drug
    • for mild depression
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