Pharm7e-Ch06-Presentation

[Audio] Welcome to the Pharmacology for Technicians, Seventh Edition, Watch and Learn lessons..

[Audio] Chapter 6, The Musculoskeletal System and Drug Therapy..

[Audio] You will learn about the anatomy and physiology of the musculoskeletal system in the first two sections of this chapter. In the osteoarthritis and drug treatments section, you will learn about drug classes used to treat osteoarthritis and their usage, side effects, contraindications, and cautions or considerations. You will also discover what the antidote is for acetaminophen overdose. As you progress through that section, you will develop an awareness of the similarities and differences between traditional NSAIDs and COX-2 inhibitors. As you move through the rheumatoid arthritis and drug treatments section, you will get an overview of agents commonly used to treat rheumatoid arthritis and their usage, side effects, contraindications, and cautions or considerations..

[Audio] In the gouty arthritis and drug treatments section of this chapter, you will learn about agents used to treat gout and their usage, side effects, contraindications, and cautions or considerations. In the next section, you will learn about these same attributes for drugs used to treat osteoporosis. You will also discover the special administration instructions for bisphosphonate drugs in that section. In the muscle spasms and drug treatments section, you'll become aware of commonly used muscle relaxants. In the inflammation and swelling and drug treatments section, you'll develop an awareness of drug class options used to treat those symptoms. In the last section of this chapter, complementary and alternative therapies, you'll get an overview of therapies falling into those classes..

[Audio] Chapter 6, Section 1, Anatomy of the Musculoskeletal System.

[Audio] A joint is the place of union or junction between two or more bones. The noncontractile connective tissue that ties one bone to another is called a ligament. A muscle is an organ that produces movement by contracting. Muscles are connected to bones by tough, cordlike tissue called tendons. The illustration shows how a typical joint is made up of the bones and the joint capsule..

[Audio] Muscles are typically grouped into three types: skeletal, smooth, and cardiac. Skeletal muscle is striated, which means it appears striped. Contraction of skeletal muscle is voluntary, and it is used for locomotion and maintaining posture. In contrast to skeletal muscle, smooth muscle is nonstriated, and the contraction is involuntary. This type of muscle is found in the lining of organs such as the stomach, esophagus, uterus, and bladder. Cardiac muscle is found only in the heart. Cardiac muscle is striated, and the contraction is involuntary. Cardiac muscle pumps blood throughout the body..

[Audio] Chapter 6, Section 2, Physiology of the Musculoskeletal System.

[Audio] Skeletal muscles are controlled by impulses that start in the central nervous system. Somatic neurons conduct these impulses through the spinal cord. These neurons communicate with the muscle at the neuromuscular junction. This is the area between a neuron and muscle fiber. The somatic neurons release acetylcholine, which is a neurotransmitter. The acetylcholine then binds to receptors on muscle. The muscle releases calcium causing the muscle fibers to contract. The acetylcholine is then deactivated, and the muscle relaxes..

[Audio] Chapter 6, Section 3, Osteoarthritis and Drug Treatments.

[Audio] The word arthritis means joint inflammation. Arthritis is a disorder characterized by joint pain. Osteoarthritis is a degenerative joint disease in which cartilage in joints becomes thinner and less elastic eventually causing bone to wear and become deformed. It is a common age-related condition. The illustration on this slide compares a healthy joint to one affected by osteoarthritis. Note the exposed bone and other changes in the osteoarthritic bone..

[Audio] Osteoarthritis typically affects the sternoclavicular joint and the joints of the spine, hips, knees, fingers, and big toes. Symptoms of osteoarthritis include joint stiffness in the morning or after inactivity, progressive pain, limitation of motion, and deformed joints. The goals of drug therapy are to reduce symptoms and prevent disability. See Table 6.1 for a detailed list of agents used to treat osteoarthritis..

[Audio] An analgesic is a medication that reduces pain. Acetaminophen is both an analgesic and an antipyretic, which is a medication that reduces fever. It was once the most popular treatment for OA. However, recent studies have suggested that other options are more effective. The exact way acetaminophen works to decrease pain and fever is not fully understood. Acetaminophen may reduce pain and fever by decreasing the production of prostaglandins. It may also elevate the pain threshold. It is used for mild to moderate pain and is especially useful for patients with certain conditions. Acetaminophen is generally well tolerated and does not cause gastrointestinal irritation and bleeding-related problems like other drugs used for osteoarthritis. Its most common side effect is nausea. Acetaminophen should be used with caution in alcoholic liver disease or in patients who consume at least 3 alcoholic drinks per day. There is a risk of developing liver disease with acute overdose, daily doses in excess of 4,000 milligrams, and long-term daily use..

[Audio] Acetaminophen is a component within hundreds of medications and should be monitored to reduce chances of overdose..

[Audio] Acetylcysteine is the only antidote for an acetaminophen overdose. It works by detoxifying the active and harmful metabolite of acetaminophen. It can be administered orally or intravenously. Acetylcysteine is given over 72 hours when administered orally and 21 hours when given intravenously. Administration may vary depending upon acetaminophen levels. Acetylcysteine should be administered as soon as possible, preferably within 4 hours of ingestion of the medication, but it can be effective in patients treated up to 10 hours after ingestion..

[Audio] The generic names of several nonsteroidal anti-inflammatory drugs are listed in this table. See Table 6.1 for brand names, common dosages, and dispensing statuses. NSAIDs work by inhibiting prostaglandin synthesis in tissues. They are considered first-line therapy for inflammatory OA and are also used in noninflammatory OA in cases not responsive to acetaminophen. A variety of dosage forms are available depending on the medication. GI upset is the main side effect of NSAIDs. By inhibiting prostaglandin synthesis, NSAIDs also inhibit the protective effect of prostaglandins on the gastric mucosa. Patients should be told to report abdominal pain and dark or tarry stools to a healthcare provider immediately, as these may indicate a GI bleed. This drug class should always be taken with food, be administered at the lowest dose for the shortest period of time possible. Other side effects of NSAIDs include kidney damage, liver abnormalities, blood clotting irregularities, bone marrow depression, tinnitus, jaundice, dizziness, drowsiness, rash, and dry mouth. NSAIDs carry boxed warnings for increased risk of heart attack and stroke; and increased risk of GI inflammation, ulceration, and bleeding. A Medication Guide is required when NSAIDs are dispensed..

[Audio] Celecoxib, a type of NSAID, works slightly differently than the previously mentioned NSAIDs. Those NSAIDs inhibit both cyclooxygenase-1 and cyclooxygenase-2. COX-1 and COX-2 are enzymes that promote the production of prostaglandins and cause pain and inflammation. COX-1 also produces prostaglandins that protect the stomach lining. Celecoxib works by selectively inhibiting COX-2. This means that celecoxib decreases pain and inflammation without compromising GI protection. In other words, celecoxib has anti-inflammatory and pain-relieving properties without dramatically increasing the risk of GI side effects. Celecoxib is used for arthritis and other pain in patients with a history of ulcers or GI bleeding. It is only available as a capsule and its side effects include GI upset and fluid retention. Celecoxib carries boxed warnings for increased risk of heart attack and stroke; increased risk of GI inflammation, ulceration, and bleeding. A Medication Guide is required when celecoxib is dispensed..

[Audio] Chapter 6, Section 4, Rheumatoid Arthritis and Drug Treatments.

[Audio] Rheumatoid arthritis is an autoimmune disorder in which the immune system destroys the synovial membrane of the joint, producing inflammation. This x-ray shows wrists and hands affected by rheumatoid arthritis..

[Audio] As the process of rheumatoid arthritis begins, the synovial membrane, also called the synovium, swells and thickens. Fingerlike projections begin to grow from the synovial membrane into cartilage, bone, tendon, and joint spaces. This causes reabsorption of bone and cartilage. As the disease progresses, bone-to-bone contact occurs. This eventually causes joint fusion..

[Audio] The small joints of the hand are affected first. The joints of the feet, ankles, knees, wrists, elbows, shoulders, jaw, and vertebral column are affected later. The main symptoms of rheumatoid arthritis are morning pain and stiffness. These symptoms are usually symmetrical, last longer than an hour, and are not relieved by activity. Cold temperatures and barometric pressure can aggravate symptoms..

[Audio] The goals of therapy in rheumatoid arthritis are to maintain mobility and delay disability. Medications cannot cure this disease but are intended to improve pain symptoms, increase function, and slow disease progression. The existing treatments for rheumatoid arthritis are divided into two categories: agents that provide only symptomatic relief and agents that can potentially modify the course and progression of the disease. The former category includes NSAIDs and corticosteroids. The latter category includes a variety of agents that are collectively referred to as disease-modifying antirheumatic drugs..

[Audio] Disease-modifying antirheumatic drugs or DMARDs are agents that can potentially modify the disease progression of rheumatoid arthritis. They target the part of the immune system responsible for inflammation and joint damage. They are taken regularly to slow the progression of disease. These medications maintain disease control and symptom control and work best when started within three months of diagnosis. The chronic use of DMARDs can sometimes lead to disease remission..

[Audio] Auranofin is a unique compound in that it is formulated with gold. It is available in capsule form. Many of its side effects are gastrointestinal such as diarrhea, nausea, vomiting, and abdominal pain. It is also associated with dermatological effects such as itching, rash, hair loss, and photosensitivity. Blood disorders, kidney and liver damage, and lung problems have also been reported following the use of auranofin. This agent has boxed warnings related to gold toxicity, GI effects, hematologic effects, proteinuria, and hematuria. Azathioprine is available as a tablet. It has a wide range of side effects including malaise, nausea, vomiting, leukopenia, neoplasia, thrombocytopenia, liver toxicity, myalgia, and fever. It has a boxed warning related to malignancy. There is also a risk of severe GI toxicity with the use of azathioprine..

[Audio] Hydroxychloroquine is an antimalarial drug that is also used treat RA and lupus. It comes as a tablet. The side effects of hydroxychloroquine are corneal deposits, retinal changes, GI upset, and skin rash. It has a boxed warning advising that only an experienced prescriber should be prescribing. Leflunomide slows the progression of rheumatoid arthritis, reduces pain and joint swelling, and improves functional ability. It is available as tablet. It has numerous gastrointestinal side effects. Other side effects include headache, dizziness, weight loss, liver problems, peripheral neuropathy, hair loss, high blood pressure, anemia, blood disorders, and lung disease. Leflunomide has a boxed warning related to liver function. This drug should not be used in patients who are or are planning to become pregnant. It may increase the risk of serious infection and is considered a hazardous agent..

[Audio] Methotrexate is an antineoplastic agent used to treat cancers, arthritic conditions, and psoriasis. It comes as an injection and a tablet. It has a wide variety of side effects such as mouth sores, nausea, vomiting, abdominal distress, anemia, liver and kidney damage, Stevens-Johnson syndrome, eye irritation, and heart problems. Methotrexate has boxed warnings related to kidney damage; bone marrow suppression; dermatologic reactions; gastrointestinal toxicity; liver damage; immune suppression; pneumonitis; malignant lymphomas; tumor lysis syndrome; decreased elimination in ascites or kidney impairment; severe bone marrow suppression with concurrent NSAID use. Methotrexate may cause fetal death or congenital abnormalities and is contraindicated in pregnancy..

[Audio] Sulfasalazine is only available as a tablet. Several gastrointestinal side effects may occur with this agent including anorexia, diarrhea, and abdominal pain. Other potential side effects include blood disorders, rash, Stevens-Johnson syndrome, liver and kidney problems, hair loss, and male infertility. Special considerations with the use of sulfasalazine are its potential for cross-reactivity in sulfa allergy and its association with blood diseases and severe skin reactions..

[Audio] The use of biologic response modifiers is a newer approach in the treatment of RA. These medications target the part of the immune system responsible for inflammation and joint damage. They are all available in injection form only. The side effects of adalimumab include headache, nausea, vomiting, flu-like symptoms, rash, itching, heart problems, anemia, secondary malignancy, nephrotic syndrome, confusion, tremor, and reactivation of hepatitis B. This product's boxed warnings relate to the risk for serious infection, lymphoma in children, hepatosplenic T-cell lymphoma, and risk for TB reactivation. Anakinra has various side effects such as headache, nausea, vomiting, diarrhea, redness and pain at injection site, flu-like symptoms, and blood disorders. There is a risk of hypersensitivity with this product and it should be used cautiously in asthma because of an increased risk of infection. The needle cover of anakinra contains latex, therefore, it should be avoided in latex sensitivity..

[Audio] Etanercept's side effects include injection site reactions, headache, nausea, vomiting, hair loss, dizziness, abdominal pain, rash, and indigestion. Additional, more serious side effects include swelling, mouth sores, blood disorders, secondary lymphoma, Stevens-Johnson syndrome, seizures, heart problems, pancreatitis, and difficulty breathing. This product's boxed warnings relate to the risk for serious infection, lymphoma in children, hepatosplenic T-cell lymphoma, and possibility TB reactivation. Golimumab's side effects include upper respiratory tract infections, runny nose, fever/chills, dizziness, and redness at injection site. Like some of the other DMARDs, this product's boxed warnings relate to the risk for serious infection, lymphoma in children, hepatosplenic T-cell lymphoma, and risk for TB reactivation..

[Audio] Infliximab has several GI side effects including nausea and vomiting. Other side effects include headache, cough, fatigue, back pain, fever and chills, flushing, and dizziness. More serious side effects include chest pain, heart failure, nerve problems, seizures, and Stevens-Johnson syndrome. Its boxed warnings are like some other DMARDs: risk for serious infection, lymphoma in children, and possibility of TB reactivation. Upadacitinib is the only DMARD available in tablet form. Its side effects include upper respiratory infections, nausea, cough, and fever. It has boxed warnings related to risk of serious infection, lymphoma, and risk of blood clots..

[Audio] Chapter 6, Section 5, Gouty Arthritis and Drug Treatments..

[Audio] Gouty arthritis, or gout, is a form of arthritis resulting from the body's improper excretion of uric acid. This may manifest as either overproduction or underexcretion of uric acid. This disease usually affects single joints, causing a tophus or deposit of sodium urate that forms around joints. The symptoms of gout include painful, swollen, and red joints. The big toe is usually affected first. The x-ray shows the left foot of a person with gout. Note the characteristic swelling of the joint of the big toe..

[Audio] Treatment for gout can be used for an acute attack or for prevention purposes. Medications used for an acute attack include NSAIDs, colchicine, and corticosteroids such as triamcinolone and prednisone. Medications used for prevention of chronic gout are allopurinol, colchicine, febuxostat, and probenecid..

[Audio] Colchicine's exact mechanism of action is not completely known, but the drug is thought to work as an anti-inflammatory and may decrease uric acid accumulation. It is used in the treatment of acute gout attack and for preventive gout treatment. Colchicine is available as an oral solution, a tablet, and an injection. Side effects include diarrhea, nausea, vomiting, and neutropenia. Colchicine should be used with caution in older adults. Its clearance is reduced in patients with liver or kidney impairment..

[Audio] Allopurinol works by inhibiting the production of uric acid. It is used for preventive gout treatment. Like colchicine, it is available as a tablet and an injection. Allopurinol use has been associated with severe hypersensitivity reactions and should be discontinued if signs of allergic reaction are present. Allopurinol should be used with caution in patients with kidney impairment. Febuxostat, like allopurinol, works by inhibiting the production of uric acid. It is used for the chronic management of high uric acid levels. Febuxostat is only available as a tablet. Its side effects include diarrhea, headache, angioedema, and liver dysfunction. Febuxostat has a boxed warning for an increased risk of cardiovascular disease. Additional considerations include the potential for severe hypersensitivity reactions and liver failure. This medication should be used with caution in patients with a history of severe hypersensitivity reactions to allopurinol. A Medication Guide is required when dispensing this product..

[Audio] Probenecid prevents gout attacks by inhibiting the renal reabsorption of uric acid. In doing so, it promotes uric acid excretion. Its place in therapy is in the prevention of gout in patients with relatively low kidney uric acid excretion. It is available in only tablet form and has nausea, vomiting, and anorexia as its most common side effects. Probenecid has been associated with severe hypersensitivity reactions and should be discontinued if such reactions present..

[Audio] Chapter 6, Section 6, Osteoporosis and Drug Treatments.

[Audio] Bone is living tissue that is constantly replaced. There are two types of cells specific to bone that have opposing actions. Osteoclasts resorb or break down bone. Osteoblasts, on the other hand, form bone. The opposing activities of these cells are balanced in normal bone. Osteoporosis is the condition of reduced bone mineral density, disrupted microarchitecture of bone structure, and increased likelihood of fracture. It occurs as a result of a deficiency of estrogen, calcium, and vitamin D. Osteoporosis can cause fractures in the hips, spine, and wrists..

[Audio] Individuals at risk for developing osteoporosis typically have one or more of these characteristics: cis- or transgender woman, Caucasian or Asian descent, family history of osteoporosis, small body frame, history of smoking, heavy caffeine intake, suboptimal nutrition. A bone mineral density machine uses x-ray and ultrasound technology to measure bone density..

[Audio] A BMD screening yields a T-score which provides an estimate of risk of osteoporosis. Lifestyle changes to decrease risk include doing weight-bearing exercise, eating foods high in calcium, quitting smoking, and decreasing caffeine intake..

[Audio] The most common drugs used to treat osteoporosis are bisphosphonates. These drugs work by inhibiting osteoclasts from removing calcium from bone tissue. They are used mainly in osteoporosis but can be used in other conditions. Depending on the agent, available dosage forms include tablet, oral solution, or injection. Side effects of bisphosphonates include headache, nausea, vomiting, diarrhea, constipation, abdominal pain, indigestion, and esophagitis. Taking oral dosage forms with a full glass of water and remaining upright afterward can reduce side effects such as reflux and esophageal issues. The irritation of the upper GI system can become serious, leading to erosion or strictures of the esophagus. Other considerations include the potential for severe bone, joint, and muscle pain and the risk of jaw osteonecrosis..

[Audio] Raloxifene is a selective estrogen receptor modulator used for the treatment of osteoporosis. It works as an estrogen receptor by mimicking the beneficial effects of estrogen on bone mineral density. Raloxifene is only available as a tablet. The side effects of this product include hot flashes, headache, diarrhea, joint pain, leg cramps, flu-like symptoms, and deep-vein thrombosis. Raloxifene has a boxed warning for increased risk of blood clots and stroke. It is not to be used if prolonged immobility is anticipated. A medication guide is required with new prescriptions or refills..

[Audio] Several other medications are used for osteoporosis. They are either used for patients who have not responded to the previously mentioned therapies or for specific types of osteoporosis. They are only available as injectable dosage forms. Denosumab is used in patients who have failed other osteoporosis therapy. It inhibits osteoclast formation. Its side effects involve the skin and include dermatitis, eczema, and skin rash. One of the brand names of this medication, Prolia, has a REMS program due to its risks of hypocalcemia, osteonecrosis of the jaw, atypical femoral fractures, serious infections, and dermatologic reactions. A medication guide is required when this product is dispensed..

[Audio] Teriparatide stimulates new bone growth by regulating calcium and phosphate metabolism with bony tissue. It is used in specific types of osteoporosis such as primary or hypogonadal osteoporosis, postmenopausal osteoporosis, and in patients taking chronic glucocorticoid therapy. Its main side effects are hypercalcemia and dizziness. Teriparatide use is associated with an increased risk for dizziness or falling. It has a boxed warning for osteosarcoma..

[Audio] Romosozumab works by rapidly increasing bone mineral density. It is indicated in postmenopausal osteoporosis and in patients who have failed or are intolerant to other osteoporosis therapy. Its main side effects are arthralgia and headache. Romosozumab comes with a boxed warning for the risk of heart attack, stroke, and cardiovascular disease. Additional cautions include the risk of hypocalcemia, osteonecrosis of the jaw, bone fracture, and hypersensitivity reactions..

[Audio] Chapter 6, Section 7, Muscle Spasms and Drug Treatments.

[Audio] A muscle spasm is a sudden and involuntary contraction of one or more muscles. It is commonly called a cramp. The symptoms of muscle cramps can range from a mere annoyance to severe pain. The main sets of muscles affected are the skeletal muscles of the limbs and spine and the smooth muscles lining the internal organs. An acute muscle spasm arises from muscle injury or overuse. In contrast, a chronic muscle spasm stems from prolonged injury or underlying medical conditions..

[Audio] A muscle relaxant is a drug that reduces or prevents a skeletal muscle contraction and spasms, and provides pain relief. These drugs work by one of three mechanisms. Blocking release of acetylcholine. Preventing destruction of acetylcholine. Or preventing acetylcholine from reaching specific receptors..

[Audio] The following tables provide an overview of the skeletal muscle relaxants. Overall, the side effects of these medications include sedation, reduced mental alertness, reduced motor abilities, and gastrointestinal upset. Because of the potential for these effects, patients should be warned about the decreased ability to perform tasks that require mental alertness. They should also be advised to avoid alcohol. Many muscle relaxants are on the AGS Beers Criteria as being potentially inappropriate for use in older adults. Baclofen is available as topical, injectable, and oral dosage forms. The side effects of this medication are consistent with the overall class side effects. Severe reactions can occur when this medication is abruptly withdrawn. Carisoprodol is only available as a tablet with side effects and cautions consistent with the overall class effects. Chlorzoxazone is also only available in tablet form. In addition to drowsiness and dizziness, it can also cause liver toxicity..

[Audio] Cyclobenzaprine is available as a cream, oral suspension, and tablet. In addition to class effects such as drowsiness and dizziness, its side effects include dry mouth and acne. Dantrolene is associated with malaise, weakness, fatigue, liver toxicity, and photosensitivity. It carries a boxed warning for liver toxicity. Diazepam's side effects include drowsiness, fatigue, and loss of body control. It carries a boxed warning for profound sedation, respiratory depression, coma, and death when used with opioids..

[Audio] In addition to some of the typical class side effects, metaxalone can cause skin rash or yellowish discoloration of the skin or eyes. It should be used with caution in kidney impairment, liver impairment, or in older adults. The side effects of methocarbamol include drowsiness, vertigo, skin rash, jaundice, blurred vision, nasal congestion, and discoloration of urine. The major considerations include those typically seen with this drug class such as the impairment to perform tasks requiring mental alertness and cautious use in older adults..

[Audio] Orphenadrine's side effects include lightheadedness, dizziness, syncope, and dryness of the mouth. Its unique consideration is to use the injection cautiously patients with a history of sulfite allergy. Tizanidine has a few unique side effects including hypotension, dry mouth, and lack of energy. It carries several cautions such as hypersensitivity reactions and risk of liver toxicity. It should also be used with caution in kidney impairment. A risk of low blood pressure, visual hallucinations, and delusions may occur with this drug. There is also potential for rebound hypertension and tachycardia when this drug is abruptly withdrawn..

[Audio] Chapter 6, Section 8, Inflammation and Swelling and Drug Treatments.

[Audio] Inflammation is the body's response to tissue injury or infection. It results from the vasodilation and increased vascular permeability that occur near a site of injury or infection. Common characteristics of inflammation are heat, redness, swelling, and pain. The figure illustrates how tissue injury leads to the release of various chemical messengers and ultimately to inflammation..

[Audio] NSAIDs, discussed with osteoarthritis, are commonly used for inflammation. Salicylates are another drug class commonly used to treat inflammation. Acetaminophen, discussed with osteoarthritis, is also used for inflammation and pain. Salicylates work by inhibiting prostaglandin synthesis. They are indicated for the following symptoms and conditions. Inflammation of arthritis and rheumatism, menstrual cramps, muscular aches and pains, pain and fever for influenza and other infections, simple headache. Salicylates are available in a variety of dosage forms including capsule, chewable tablet, gum, suppository, and oral liquid. Side effects include GI upset, tinnitus, and platelet changes. Salicylates carry boxed warnings for increasing the risk of cardiovascular events and for GI inflammation, ulceration, and bleeding. They should be avoided after surgery in patients with hemophilia. In addition, they should be avoided in asthma, nasal polyps, chronic sinusitis, bleeding ulcers, and pregnancy. A medication guide is required when this class of medication is dispensed..

[Audio] Chapter 6, Section 9, Complementary and Alternative Therapies for Disorders of the Musculoskeletal System.

[Audio] Nondrug complementary and alternative therapies include acupuncture and chiropractic care. Acupuncture is a method that involves penetrating the skin with thin needles in specific areas. It is used for acute and chronic pain. Chiropractic care involves the physical manipulation of the spine based on the theory that proper alignment of the body's musculoskeletal structure will enable the body to heal. It is used to relieve pain associated with muscles, joints, bones, and connective tissue.

[Audio] Dietary supplements used as a part of complementary and alternative therapy for the treatment of musculoskeletal disorders include chondroitin, glucosamine, and willow bark. Chondroitin is used with glucosamine for hip and knee osteoarthritis. It is thought to work by inhibiting an enzyme that promotes inflammation. Studies do not clearly show that chondroitin taken with glucosamine is effective for osteoarthritis. The side effects of chondroitin include nausea, heartburn, diarrhea, and constipation. Glucosamine is used to improve pain and stiffness from OA. It is thought to slow joint degeneration. Its common side effects are identical to those of chondroitin. Willow bark is a bark that contains salicin. It's been used to treat many different kinds of pain including pain from osteoarthritis. Comparative studies with conventional agents are warranted..