MSK

Question 1

First line treatment for OA
Non-pharm and pharm

Answer 1

Non-Pharm: physio, assisted devices, splints, prevention of further injury, weight loss, yoga, aquatics
Pharm: topical NSAIDS, then Tylenol

Question 2

What is the preferred NSAID analgesic with high CV risk?

Answer 2

Naproxen low dose

Question 3

What is the preferred analgesic with high GI risk?

Answer 3

Low dose celecoxib + gastroprotection

Question 4

Preferred analgesic for OA (no/low CV or GI risk)?

Answer 4

Low dose NSAID

Question 5

What is preferred if high GI and CV risk for OA?

Answer 5

Duloxetine or local steroid injections

Question 6

What is the last line treatment for OA?

Answer 6

Surgery or opioids

Question 7

Max Tylenol daily dosage in elderly

Answer 7

2-3g

Question 8

When should NSAIDs be avoided?

Answer 8

Cardiac patients, Nephro kidney patients, and GI risk patients

Question 9

Which opioid has the best safety profile?

Answer 9

Tramadol

Question 10

How often can pts receive steroid injections in weight-bearing joints?

Answer 10

3-4x/yr

Question 11

What controlled substances can an NP not prescribe?

Answer 11

• opium (such as opium and belladonna suppository)
• coca leaves (such as cocaine) and
• anabolic steroids except testosterone (NPs are authorized to prescribe testosterone.)

Question 12

What is required for the prescription of an opioid?

Answer 12

A PPA - Patient and Provider Agreement, which is a pain management contract signed by pt and prescriber
- states the pt must use only 1 prescriber and 1 pharmacy, will not share meds and will comply with monitoring ie random drug urine screen

Question 13

What to prescribe for patients at risk of ulcers while receiving long term NSAIDs

Answer 13

Misoprostol is the only anti-ulcer drug proven to be well tolerated and effective

Question 14

What are some non-pharm options for acute low back pain?

Answer 14

• physical activity as tolerated
• physio
• spinal manipulative therapy
• psychological interventions
• acupuncture (weak efficacy)
• resume normal activities & work as soon as tolerated
• avoid unnecessary bedrest

Question 15

What are some non-harm for chronic low back pain?

Answer 15

• physical activity as tolerated
• physio
• yoga, tai chi, pilates, nordic walking

Question 16

First line med for acute low back pain?

Answer 16

Tylenol 500mg q4h

Question 17

T/F: Celecoxib (Celebrex) is more efficient than NSAIDs?

Answer 17

False: There is no evidence that one NSAID or COX-2 inhibitor (Celecoxib) is more efficient than another
- Celecoxib does show fewer GI side effects than traditional NSAIDs

Question 18

What is the difference between Tylenol 1, 2 & 3?

Answer 18

Tylenol 1 = acetaminophen
Tylenol 2 = 300 mg acetaminophen, 15 mg caffeine and 15 mg codeine phosphate tablets.
Tylenol 3 = 300 mg acetaminophen, 15 mg caffeine and 30 mg codeine phosphate tablets.

Question 19

How many days should you use opioids for for acute pain if indicated?

Answer 19

limit for 3-7 days, not indicated for subacute/chronic

Question 20

What is an adverse effect of muscle relaxants?

Answer 20

Some are sedating, therefore not recommended for chronic use

Question 21

When would a muscle relaxant be appropriate?

Answer 21

If a spastic component involved and is acute (<4wks) would use: baclofen, cyclobenzaprine, and tinzanidine. Generally avoid benzos

Question 22

Are cannabinoids recommended for acute pain?

Answer 22

No the evidence does not support it

Question 23

When would cannabinoids be recommended?

Answer 23

refractory neuropathic pain and refractory pain in palliative care, chemotherapy-induced nausea and vomiting, and spasticity in multiple sclerosis and spinal cord injury after reasonable trials of standard therapies have failed.
If considering medical cannabinoids and criteria are met, the guideline recommends nabilone or nabiximols be tried first.
We never recommend smoked as high bias risk in literature and long-term consequences unknown

Question 24

What is a tool that can be used when determining whether to order opioids for someone?

Answer 24

Opioid risk tool

Question 25

If on hydroxychloroquine, what needs to be monitored?

Answer 25

Eye exam dt ocular toxic risk baseline within 6m of treatment then yearly

Question 26

what is an adverse effect of biologics?

Answer 26

Infections esp resp ie TB flare, reactivation of hep B, sepsis, shingles * ensure up to date vaccinations

Question 27

What is first line treatment for RA?

Answer 27

Methotrexate with short term NSAID use

Question 28

When should RA treatment be escalated and what would be step 2?
What would be the next step?

Answer 28

After 3-6 months with failed treatment add on either sulfasalazine or hydroxychloroquine

Question 29

Whats step 3 of RA treatment?

Answer 29

Triple therapy methotrexate (MTX) + hydrochloroquine + sulfasalazine or MTX + biologic

Question 30

First line treatment for acute gout?

Answer 30

NSAID, colchicine, or oral corticosteroid. Start within first 24hrs of attack
No colchicine if presenting after 36hrs of attack
Consider steroid injection if polyarticular (affecting many joints)

Question 31

What is the treatment for hyperuricemia?

Answer 31

Allopurinol, check rate levels every 6m

Question 32

first line treatment for fibromyalgia?

Answer 32

Non pharm:
- CBT
- exercise
- Pain interventions: cold, heat, TENS
- relaxation techniques

Question 33

How to manage soft tissue injuries?

Answer 33

Rest
Ice
Compression (elastic bandages)
Elevation

Question 34

Treatment for neuropathic pain?

Answer 34

Gabapentin, SNRIs, topical capsaicin

Question 35

Recommended pain reliever in pregnancy?
What are the recommendations for NSAIDS?

Answer 35

Tylenol
No NSAIDS after 32wks, restrict in 1st and 2nd tri

Question 36

Why is ASA contradicted in children?

Answer 36

Risk of Reyes syndrome