PTCE: The Basics of Medications - Muscular, Skeletal, and Osteoporosis Medications

Use the table below to test your knowledge of the USAN stem names for common muscular, skeletal, and osteoporosis medications.

Table: USAN Stems for Muscular, Skeletal, and Osteoporosis Medications

NOTE Medications that are used to treat pain are highly regulated. Some states may require double counting procedures, and others may have restrictions on who may count narcotics. Check your state regulations to ensure that you are meeting all requirements.
Medications in this group treat a wide range of symptoms and diseases (see table below). Medications for pain are grouped based on their ability to relieve pain, their abuse potential, and their effect (e.g., anti-inflammatory).
Opioid-based medications are scheduled under the Controlled Substances Act. Most of the controlled pain agents are C-II or C-IV and are indicated for moderate-to-severe pain. These agents exert their action by binding and interacting with mu (μ) receptors. Dosing schedules for these medications vary and depend on the indication and duration of treatment. The opioid-based agents (e.g., oxycodone, hydrocodone) can cause CNS depression and constipation. There are also agents used in the treatment of opioid use disorders. Partial agonists are agents that only have partial efficacy relative to a full agonist and are used to manage pain severe enough to require an opioid analgesic and for which alternative treatments are inadequate. Subutex is a prime example of a partial agonist. Partial agonists (e.g., buprenorphine) can also be found in combination with a mu antagonist (e.g., naloxone) to treat opioid use disorders. If taken as directed, the antagonist has negligible bioavailability via sublingual or oral routes and therefore does not accumulate to clinically significant concentrations. The antagonist effect is only exerted when the product is misused via parenteral administration. Pure opioid antagonists, such as naloxone and naltrexone, are used in the treatment of opioid toxicity. The non-opioid analgesics are indicated for mild-to-moderate pain. These agents can have anti-inflammatory effects like the NSAIDs. This is due to inhibition of the enzyme cyclooxygenase (COX) that is used to make prostaglandins. Non-selective COX inhibitors target COX-I and COX-II and include the drugs ibuprofen and naproxen. Selective COX inhibitors target COX-II and include the drug Celebrex. Adverse effects for these agents include gastrointestinal upset, cramping, ulcers, and headaches. Aspirin also inhibits cyclooxygenase and contains an irreversible antiplatelet effect. The mechanism of action of acetaminophen is unclear and is generally considered to be a weak inhibitor of the synthesis of prostaglandins. The resulting effect includes potent analgesic and antipyretic activity.

Medications for the treatment of rheumatoid arthritis can be taken daily, weekly, or monthly. They work by preventing synovial infection due to the inactivation of Tumor Necrosis Factor (TNF). A risk for serious infection is possible while taking agents with a parenteral formulation. Oral rheumatoid arthritis agents can cause gastrointestinal side effects such as nausea, cramping, and diarrhea. Muscle relaxants relieve local skeletal muscle spasms and, in return, can make the user feel drowsy, dizzy, or confused. Drugs that treat osteoporosis can cause stomach ulcers. Patients may be told to take their medication with a full glass of water and remain upright for 30 minutes to lessen the risk of developing a stomach ulcer. Bisphosphonates are first-line pharmacological agents indicated for the treatment of osteoporosis due to osteoclast-mediated bone loss. They are also prescribed for conditions such as low bone density, multiple myeloma, and Paget’s disease. These agents indirectly increase bone density by inhibiting bone resorption. Bisphosphonates should be taken in the morning, 60 minutes before eating or drinking. When taking these agents, the patient should sit in an upright position, drink a full glass of water, and remain in the upright position for 60 minutes as a precaution to avoid esophageal and gastrointestinal side effects. Bisphosphonates are available in daily, weekly, or monthly dosage regimens.

Table: Muscular, Skeletal, and Osteoporosis Medications