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MSK Flashcards

(52 cards)

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1
Q

Acute Pain

A

Temporary pain, serving as a warning that something is wrong and usually resolves as healing occurs

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2
Q

Chronic pain

A

Pain that persists for 3 or more months.

Significant emotional distress present

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3
Q

Nociceptive pain

A

Tissue damage often from injury, inflammation, or disease.
Typically acute pain.
May feel throbbing, aching, or sharp.

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4
Q

Neuropathic pain

A

Nervous system damage from peripheral or CNS dysfunction.
Often chronic pain.
Feels burning, tingling, or numb

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5
Q

Nociplastic pain

A

Neural pain despite no evidence of nervous system damage.

Presents similar as neuropathic pain

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6
Q

Cancer pain

A

Presents as both nociceptive and neuropathic

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7
Q

Hyperalgesia

A

increased sensitivity to pain

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8
Q

What is essential to success in pain therapy?

A

Nonpharmacological therapies are most effective treatment

e.g psychological, physical/rehab, device/prodecure, self management, etc.

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9
Q

Factors of pain

A

Biological, psychological, social, and cultural

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10
Q

What pain medications are safe in pregnancy and lactation?

A

P: acetaminophen, methadone, suboxone, nortripyline, (oxycodone, morphine, fent in 1st and 2nd trimesters)
L: acetaminophen, suboxone, nortripyline, morphine, fentanyl, hydromorphine, NSAIDs

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11
Q

Preferred pain agents in impaired renal function

A

Acetaminophen, hydromorphone, oxycodone, methadone, TCAs

Decrease doses of gabapentin, pregabalin, venlafaxine, tramadol

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12
Q

Preferred pain agents in hepatic dysfunction

A

NSAIDs (avoid child pugh C), acetaminophen (prolonged use reduce dose)
Caution with opioids and avoid SNRIs

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13
Q

What pain meds to avoid in geriatrics?

A

Anything that affect the CNS and increase risk of falls, i.e. TCAs, SNRIs, muscle relaxants, opioids, cannabinoids, gabapentinoids)

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14
Q

Why to avoid indomethacin in geriatrics?

A

increased risk of CNS harms

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15
Q

Treatment options for Trigeminal neuralgia

A

Anticonvulsants: CBZ (DOC), gabapentin, lamotrigine, phenytoin
Topical anesthetics: Botox (if CBZ not tolerable)
Drug causes of TN: digoxin, macrobid

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16
Q

Diabetic neuropathy treatment options

A

TCAs, SNRIs, gabapentin, pregabalin, valproate, lamotrigine, SSRIs, capsaicin

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17
Q

Treatment options for post-herpatic neuralgia

A

TCAs, SNRIs (duloxetine), gabapentin, pregablin, divalproex, opioids, capsaicin

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18
Q

Treatment options for post stroke

A

TCAs, lamotrigine

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19
Q

Treatment options for spinal cord injury

A

They all suck but Gabapentin, pregabalin, lamotrigine, strong opioids controversial, ketamine, baclofen for spasm, amitripyline if depressed, valproate not useful

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20
Q

Post mastectomy treatment options

A

Capsaicin, venlafaxine, amitripyiline

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21
Q

Phantom limb pain treatment options

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A

Gabapentin, opioids, ketamine, or CBZ or propranolol are also options

22
Q

Complex regional pain syndrome treatment options

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A

TCAs and anticonvulsants options but lack data, opioids?, NSAIDs?, bisphosphonates, prednisone, nifedipine

23
Q

Fibromyalgia treatment options

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A

Exercise, CBT, aquatic exercise, medical bathing

TCAs, cyclobenzaprine, SSRIs, SNRIs, antiepileptics

24
Q

Treatment for daily chronic headache

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A

Amitriptyline, SSRIs, divalproex, topiramate, gabapentin, botox

25
MSK Non OA pain treatment options
Non drug TX! NSAIDs useful in acute Opioids
26
Osteoarthritis treatment options
Acetaminophen, NSAIDs (more effective), duloxetine for knee, intra-articular corticosteroid injection for knee, viscosupplement, opioids
27
Concomitant psychological factors may consider using...
Depression: TCA, venlafaxine, SSRI, mirtazapine Insomnia: TCA, trazodone, mirtazapine Bipolar: CBZ, divalproex, lamotrigine Weight gain: topiramate, gabapentin, nortriptyline
28
Adequate trial for TCAs for pain
2 weeks at adequate target dose and increase dose every 1-2 weeks effective in sleep and neuropathic pain
29
Low back pain nonpharm therapy
Activity as tolerated, physiotherapy, spinal manipulation, psychosocial intervention, multidisciplinary intervention
30
Pharmacological treatment options in low back pain
NSAIDs: effective in acute LBP mod-sev, somewhat effective in chronic LBP Acetaminophen +/- codeine: option but ? benefit Opioids: not generally recommended, use for <3 days Muscle relaxants: possible short term role, <1-2 weeks, mixed evidence and studies do not support chronic use in LBP. Linked with sedation Antidepressants: Duloxetine for chronic LBP. Other antidepressants if comorbidities. TCAs possible Anticonvulsants: option if neuropathic
31
A/E of muscle relaxants
Drowsiness, impaired cognitive function, falls, dependence, hepatic toxicity with chronic use.
32
Drug interactions of muscle relaxers
1A2 inhibitors (cipro), hypotension
33
What is gout?
Uric acid crystals (needle like) deposited in joints, nephrons, and tissues Serum uric acid levels often elevated due to decrease in excretion or increased purine breakdown
34
Causes or risk factors of Gout
The 3 D's Drugs: ACE/ARBs, acetazolamide, ASA, chemo, cyclosporine, diuretics (loops and thiazides), ethambutol, lead, levodopa, niacin, ritaonvir, tacrolimus Disease: malignancies, CKD, HTN, obesity, hyperglycemia, hyperlipidemia, surgery, trauma Diet: purine rich foods (alcohol, fish, red meat)
35
Gout flare
Intense pain --> redness, heat, swelling, more often at night and in the big toe
36
Stages of Gout
1: Asymptomatic Hyperuricemia: elevated uric acid without sx (<25% develop gout and typically does not require drug tx) 2: Acute gouty arthritis: wuick onset, usually one joint, may self resolve within 14 days 3: Intercritical gout: sx free period but disease may progress 4: Chronic tophaceous period: progression to tophi, bony erosins, deformations, nephropathy, kidney stones
37
Non pharm for gout
Diet (low cal), lifestyle like weight loss, smoking cessation, exercise, etc. Rest, elevate, ice limb, (heat dissolves crystals but increases inflammation)
38
Treatment for acute attack of gout
Rapid tx is key (<24 hr) after onset to decrease inflammation and pain. Colchicine, NSAIDs, or corticosteroids all 1st line, start at high dose and taper Combo may be appropriate if severe Avoid adjusting allopurinol
39
Maintenance/prophylaxis gout therapy
Prevent flares and treat when sUA levels over 800, 2 or more flares per year. chemo, advanced damage, CKD Allopurinol 1st line and waiting 1-2 weeks post flare is reasonable as weak evidence during (start low to avoid A/E and can prophylax with colchicine or NSAID (not ASA) will titrating for 3-6 months to prevent flares
40
NSAIDs MOA for Gout
Cyclooxygenase inhibitors to decrease pain and inflammation | Indicated for acute attack or when initating allopurinol
41
Colchicine MOA for Gout
Decrease urate crystal deposition and pain/inflammation | Indicated for acute gout attacks, prophylaxsis, or when initating allopurinol
42
Corticosteroids MOA for Gout
Decrease pain and inflammatory response, effectvie for gout but not officially indicated Useful if CI to NSAIDs
43
Xanthine Oxidase Inhibitor MOA
Allopurinol, Febuxostat Decrease uric acid production Indicated for prophylaxis
44
Colchicine A/E
N/V/D (limit to <3 tabs on day 1, then 1-2 tabs/day will decrease), rash, alopecia Serious: neutropenia, myopathy, rhabdo
45
Colchicine CIs
Blood dyscrasias, solid organ transplant, ?dialysis | Caution: renal function (decrease dose)
46
Colchicine DIs
Cyclosporine (increase myopathy), P-gp, 3A4 (ketoconazole, macrolides, verapamil, etc)
47
Allopurinol A/Es
Rash, diarrhea, hypersensitivity syndrome, SJS | Precaution: renal dysfunction, acute gout, liver dysfunction
48
Allopurinol DIs
rash when used with penicillins, antacids, thiazides, ACEi | Azathioprine, cyclophosphamide, theophylline, warfarin
49
How to decrease A/E of allopurinol?
Start low and go slow with titration | Increase by 100mg Q2-4W, half that dose if elderly
50
NSAIDs A/E, CIs, DIs
A/Es: GI upset, CNS effects with indomethacin (headache, drowsy, confusion) CIs: decrease in renal, GI ulcer, HF, transplant (can use in CKD state 1 and 2) Caution: CVD (celecoxib CI) DI: lithium, ACEi/ARBs (increase K+)
51
Corticosteroids A/E, DIs
A/E: rare in short term, caution in long term. Insomnia, increase in BP/BG, GI upset, mood changes. Serious: edema/HF. Caution: infections, immunosuppression DIs: vaccines
52
Febuxostat A/Es, DIs
A/E: increase in LFTs, nausea, arthralgia, rash. Serious: HF/MI

Pharmacy CPS Flashcards (27 decks)

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