Headache and Musculoskeletal Flashcards
(123 cards)
1
Q
estimate of 1/3 of non rx analgesic use is for
A
headaches
2
Q
primary headache
A
not associated with underlying illnesses (90% of headaches)
3
Q
examples of primary headaches
A
episodic and chronic tension-type, migraine, cluster, medication over-use headaches
4
Q
secondary headaches
A
symptom of underlying condition
5
Q
examples of secondary headaches
A
head trauma, stroke, substance abuse or withdrawal, bacterial and viral diseases, and craniofacial disorders
6
Q
tension-type headaches
A
manifests in response to stress, anxiety, depression, emotional conflicts, etc.
7
Q
episodic tension-type
A
peripheral pain source
8
Q
chronic tension-type
A
central mechanism, occurs at least 15 days/month for at least 6 months
9
Q
migraine
A
complex interaction of neuronal and vascular factors involving dysfunction of the trigeminovascular systems. stimulation of the trigeminal sensory fibers in the large cerebral and dural vessels resulting in inflammation, vasodilation, and activation of platelets and mast cells
10
Q
T/F a medical diagnosis is not needed to self treat migraines
A
false
11
Q
sinus headache
A
infection or blockage of paranasal sinuses causing inflammation of the sinus walls
12
Q
medication-overuse headache
A
results from rebound effect after withdrawal of an analgesic that has been used more than two times a week for more than three months and occurs within hours of stopping the agent
13
Q
agents associated with medication-overuse
A
APAP, NSAIDs, aspirin, caffeine, triptans, opioids, butalbital, and ergotamine
14
Q
treatment goals for headache
A
- reduce severity and alleviate acute pain
- restore normal functioning
- prevent relapse
- minimize side effects
15
Q
exclusions for self treatment of headache
A
- severe head pain
- headache longer than 10 days
- last trimester of pregnancy
- < 8 years of age
- high fever or signs of infection
- history of liver disease or consumption of three or more drinks/day
- secondary headache
- no diagnosis of migraine
16
Q
non pharm treatment
A
- relaxation exercises, physical therapy
- maintain regular schedule for sleeping, eating, and exercise
- ice packs
- diet - restrict foods that are triggers
- avoid triggers
17
Q
APAP indication
A
fever or mild to moderate pain
18
Q
MOA of APAP
A
central inhibition of prostaglandin synthesis via inhibition of COX-1 isoenzyme. Inhibits prostaglandins from sensitizing nociceptors that are initiating pain impulses
19
Q
T/F APAP has anti-inflammatory benefits
A
false
20
Q
onset of action for APAP
A
30 minutes, duration is 4 hours
21
Q
1 cause of acute liver toxicity
A
APAP
22
Q
adult dose of apap
A
325-500mg q4-6hr
23
Q
apap max dose at one time
A
1000mg
24
Q
apap max dose per day
A
4000mg/day
25
apap max dose for elderly
less than or equal to 3000mg/day
26
apap max dose and warfarin use
less than or equal to 2000mg/day
27
apap max dose with alcohol use
less than or equal to 2000mg/day
28
apap children dose
10-15mg/kg q4-6hr (max dose 5 per day)
| liquid: 160mg/5mL
29
adverse effects for apap
rash, generally well tolerated
30
precautions for apap
underlying liver dysfunction, more than 3 drinks/day
31
overdose for apap
more than 3 grams per day
32
antidote for apap overdose
N-acetylcysteine or activated charcoal
33
toxic single dose of apap
10-15g
34
fatal single dose of apap
20-25g
35
MOA of NSAIDs
reversible inhibition of COX 1 and 2 enzyme which causes central and peripheral inhibition of prostaglandin synthesis which inhibits prostaglandins sensitize nociceptors to initiate pain impulses
36
NSAIDs are used as
analgesic, antipyretic, and anti-inflammatory
37
duration of action for ibuprofen
6-8 hours
38
duration of action for naproxen
8-12 hours
39
adult dose of ibuprofen
200 to 400mg q6-8 hr
40
max OTC dose of ibuprofen
1200mg/day
41
ped dose of ibuprofen
5-10 mg/kg q6-8hr
liquid 100 mg/5mL
oral drops 40mg/1mL
42
max dose ped of ibuprofen
max 40/mg/kg/day; max 4 doses
43
naproxen adult dose
220-440mg q 8-12 hours
44
naproxen max adult dose
660mg/day
45
naproxen ped dose
not for < 12 years
46
naproxen max dose in elderly
440mg/day
47
common adverse effects of nsaids
dyspepsia, N/V, heartburn, and abdominal pain
48
nsaids cause damage to the GI mucosa in two ways
1. direct acidic damage to the GI mucosa
| 2. inhibition of GI prostaglandins synthesis that lines the smooth muscle of the GI tract
49
boxed warning for nsaids
increased risk of CV events (MI and stroke), risk increases with duration of use, higher dose, and patients with CVD risk factors
50
nsaids contraindicated in
treatment of pain in the setting of a CABG or in patient who has undergone CABG
51
#1 cause for acute renal failure
nsaids
52
GI bleeding risk factors
- older than 60
- history of peptic ulcer or GI bleed
- other medications w/ GI bleed risk
- alcohol use
- high dose of nsaids
53
pregnancy recommendations
apap recommended
54
drug interactions w nsaids
aspirin, anticoagulants, antihypertensive, nephrotoxic drugs
55
combo products w aspirin
asa with caffeine, and apap (Excedrin)
56
powder formulation of salicylates
BC powder or goody powder
57
non-acetylated salicylates
doans, nuprin, momentum
58
non-acetylated salicylates vs. aspirin
same anti-inflammatory effect but NA is less superior as analgesic/antipyretic
59
moa of aspirin
- irreversible central and peripheral inhibition of COX 1 and 2
- inhibits platelet aggregation
60
aspirin inhibits COX 1 at
low doses (81-325mg)
61
aspirin inhibits COX2 at
higher doses (anti-inflammatory drug)
62
onset of aspirin
1-2 hours
63
duration of aspirin
4-6 hours
64
aspirin metabolized by
plasma
65
adult dosing of aspirin
325-1000mg q4-6hr
| doses 0f 4-6g for anti-inflammatory
66
aspirin dosing for CV protection
81-325
67
max otc dose for aspirin
4000mg/day
68
max dose aspirin for children
not for <16 years
| fda says 19
69
adverse effects of aspirin
dyspepsia, nv, heartburn, abdominal pain
70
aspirin contraindicated in
patients with bleeding disorders and in children
71
other precautions of aspirin
h/o of gout or hyperuricemia, bleeding disorder, renal dysfunction
72
toxicity of aspirin
headache, dizziness, tinnitus, dim vision, mental confusion, drowsiness, sweating, thirst, nv, diarrhea
73
drug interactions w aspirin
warfarin, nsaids, corticosteroids, alcohol, antihypertensive
74
delayed onset muscle soreness
begins > or equal to 8 hours after repeated unaccustomed eccentric muscle contraction and is associated with delayed-onset muscle soreness which can last for days
75
myalgia
can result from systemic infections (flu, virus), chronic disorders, medications
76
strains
caused by stretching or tearing of muscle or tendon. movements that cause a strain involve twisting or pulling. can be caused by acute injury or chronic
77
strain injury of the muscle is caused by
eccentric contraction of the muscle while the muscle is lengthening
78
tendons can become strained when
their stretch capacity is exceeded
79
tendonitis
inflammation of tendon which results from acute injury or from chronic overuse of a body part (carpal tunnel), can also be caused by medications (fluoroquinolones)
80
bursitis
inflammation of the bursa (fluid filled sacs located b/t joint spaces) generally from acute injury to the joint or over-repetitive action, which can be worsened at any movement of the structure adjacent to bursa
81
sprains
caused by excessive stretching or partial/complete tearing of ligaments. typically occur during physical activity
82
low back pain
fifth most likely reason for physician visit; most patients recover within a few days or weeks; considered chronic if longer than 3 months
83
muscle spasm
involuntary muscle contractions; muscle cramps are prolonged muscle spasms that produce painful sensation
84
osteoarthritis
gradual softening and destruction of cartilage between bones; often referred to as degenerative joint disease and is considered a chronic condition
85
osteoarthritis is caused by
genetic, metabolic, and environmental factors; heavy physical activity, repetitive movement, and lifting of heavy weights can aggravate condition
86
treatment goals for muscles
1. decrease the intensity and duration of pain
2. restore function of affected area
3. prevent reinjury and disability
4. prevent acute pain from becoming chronic
87
exclusion for self treatment of musculoskeletal disorders
1. severe pain (> 6/10)
2. pain that lasts more than 10 days
3. pain that continues > 7 days after treatment with topical analgesic
4. increased intensity or change in character of pain
5. pelvic or abdominal pain
6. signs of infection
7. visually deformed joint, abnormal movement, weakness in any limb, numbness, or suspected fracture
8. pregnancy
9. < 2 years
10. back pain and loss of bowel or bladder control
88
non pharm for muscles
RICE and continue for 48-72 hours
89
R in rice
rest area for 1-2 days
90
I in rice
ice asap, should not be applied for greater than 15-20 min and applied 3-4 times daily
91
C in rice
compression with elastic support - wrap point most distal from injury and decrease tightness as your rap toward injured area
92
E in rice
elevate injured area at or above level of heart for 2-3hours a day
93
heat for muscles only in
non-inflammatory condition
| must be 48 hours after injury for 15-20 min 3 to 4 times daily
94
thermacare moa
topical heat wrap that alleviates pain by increasing blood flow, reducing muscle spasm, and improving stiffness
95
kinds of thermacare wraps
back, hip, neck, knee, wrist and hand, shoulder, and lower abdomen
96
how long to apply thermacare
up to 8 hours (remove before if pain, itching or burning)
97
transcutaneous electrical nerve stimulation (TENS)
therapy for sore, aching muscles, joint pain/ or chronic intractable pain
98
TENS moa
alteration of pain transmission and increase in production of natural endorphins
99
TENS use
15-30 min up to 3 times daily
100
avoid TENS use in
use with internal or attached medical devices
101
pharm treatment for muscles
nsaids and apap or topical analgesics
102
types of topical analgesics
local analgesic, anesthetic, antipruritic
103
topical analgesics used for
temporary relief of minor aches/pains of muscles and joints
104
apply topical analgesics
up to 3-4 times daily for up to 7 days
105
moa of counterirritants of topical analgesics
pain relief through nerve stimulation and psychological component of smell, warmth, and coolness
106
methyl salicylate products
bengay and flexall
107
rubefacient
'hot' action
108
safety considerations of methyl salicylate products
1. caution if sensitive to aspirin
2. avoid in children
3. avoid wrapping or heating area
109
methyl nicotinate products
aspercreme heat pain relieving gel, bengay ultra strength relieving patch, icy hot, mineral ice, jointflex pain relieving cream
110
if apply methyl nicotinate over large areas
can cause hypotension
111
camphor in low concentrations
(.1-3%) depress cutaneous receptors
112
examples of counterirritants of topical analgesics
methyl salicylate, methyl nicotinate, camphor, menthol, capsaicin/capsicum
113
camphor in high concentrations
(3-11%) stimulates nerve endings
114
safety considerations for camphor
keep away from children; ingestion can cause CNS toxicity, seizures, and respiratory depression; infants can have respiratory collapse if applied to nostrils
115
menthol in low concentrations
(<1%) depresses cutaneous receptor response (anesthetic)
116
menthol in high concentrations
(>1.25%) stimulates response (counterirritant)
117
safety considerations of menthol
asthma exacerbation possible; enhances permeability of other topicals
118
capsaicin products
capzasin, zostric, icy hot
119
capsaicin is extracted from
hot chili peppers (warmth)
120
moa of capsaicin
depletes substance P at the nerve ending, which is released in response to stress and injury
- elicits a feeling of warmth initially then burning and tingling sensation
121
t/f capsaicin is effective in relieving pain but not inflammation
true
122
applying capsaicin
regularly 3-4 times daily for 14 days - 6 weeks
123
topical anesthetics
lidocaine (used every 6-8 hours, max 3 applications in 24 hours)
