CAMs, Marijuana, Geriatrics, Arthritis, Muscle Relaxants

Complementary and Alternative Medicine (CAMs)

natural supplements that are classified as “dietary” supplements so they are not subject to FDA testing

potential effects of CAM use with conventional medicine

additive effects, opposite effects, enzyme induction

legal classification of marijuana

schedule 1: high potential for abuse and no accepted medical use

common cannabinoids of marijuana

THC (psychoactive) and CBD (medicinal)

neuromuscular indications of marijuana

pain, MS, resistant seizures, nausea, appetite stimulant, anxiety

mechanism of marijuana

takes advantage of the endogenous cannaboid system in humans: bind to CB1 and CB2 receptors to modulate pain and provide immunosuppression and anti-inflammation and are then broken down by enzymes

systemic side effects of marijuana

increase HR/BP, airway inflammation and obstruction, higher doses cause nausea

CNS side effects of marijuana

giddiness/euphoria, confusion, paranoia, decreased cognition, decreased balance and coordination

symptoms of cannabis use disorder

tolerance and withdrawal, great deal of time spent to obtain and use, failure to fulfill obligations, social problems, used despite knowledge of problems

polypharmacy

more than 5 medications taken or at least 1 unnecessary medication taken

characteristics of polypharmacy

no reason for drug, duplicates, contraindicated drugs, interacting drugs, inappropriate dose, treating adverse reaction

pharmokinetic changes in older adults

decreased liver function slows metabolism, decreased kidney function slows excretion, decreased absorption, decreased distribution

pharmacodynamic changes in older adults

receptor binding and intracellular response changes, decline in homeostatic mechanisms (circulatory, posture, cognitive, muscles)

side effects in the elderly

2-3x more likely and more severe, more at risk because of age/fragility/organ dysfunction

why is acetaminophen the first choice in treating OA

anti-inflammatory of other NSAIDs is not needed

why are NSAIDs (specifically COX-2 inhibitors) more helpful in the later stages of OA

anti-inflammatory effect and reduce pain

mechanism of traditional DMARDs (rheumatoid arthritis medication)

non-selective inhibition of cytokine synthesis and cellular activation (auto-immune response)

mechanism of newer DMARDs (rheumatoid arthritis medication)

target specific responses like tumor necrosis factors and interleuken receptor blockers

side affects of DMARDs (rheumatoid arthritis medication)

toxicity, GI problems, hematological disorders, fevers, rashes

mechanism of centrally acting antispasm drugs

work in CNS (sedation): increase GABA-mediated inhibition which decreases excitability of alpha motor neurons, increase serotonin to inhibit outgoing information

benefits of muscle relaxants

more difficult to excite the muscle, decreases anxiety

benefits of intraethecal delivery of muscle relaxants

injected directly into the neural tissue which decreases side effects

other mechanisms of muscle relaxants

inhibition of calcium and acetylcholine release