MSK cases Flashcards by kabita Ghale

What is the goals of pain?

Decreased pain
Decreased healthcare utilization
Improved functional status
Improved quality of life

How well did you know this?

Not at all

Perfectly

T/F goal of management is no pain

false, its decrease pain

How well did you know this?

Not at all

Perfectly

What are the non-pharmacologic tx?

Heat/cold
Meditation/Relaxation
Guided imagery
Acupressure/acupuncture
TENS units
Physical Therapy
Chiropractic Care
Behavioral Therapy
Cognitive/Behavioral Therapy
Therapeutic Massage

How well did you know this?

Not at all

Perfectly

What are pharmacologic treatment?

NSAIDS
Non-opioid analgesics
Anti-seizure medications
Anti-depressants
Opioid analgesics
Local anesthetics

How well did you know this?

Not at all

Perfectly

Whats heat/cold therapy is recommended?

Ice for the 1st 24hr

How well did you know this?

Not at all

Perfectly

What are some of invasive therapies?

Trigger Point Injections
Joint Injections
Regional Nerve Blocks
Epidural Injection
Various Surgeries

How well did you know this?

Not at all

Perfectly

Whats the MOA of APAP?

Inhibit the syntheses of prostaglandins in the central nervous system

Works peripherally to block pain impulse generation

How well did you know this?

Not at all

Perfectly

Is APAP a good or poor inhibitor of platelet function?

Poor inhibitor of platelet function

How well did you know this?

Not at all

Perfectly

Does APAP a good or poor anti-inflammatory properties?

Poor/little

How well did you know this?

Not at all

Perfectly

What is the safest meds for pt who are on blood thinners?

APAP because doesn’t do anything to platelet function

How well did you know this?

Not at all

Perfectly

Whats the dosing for APAP?

325mg, 500mg (Extra Strength), and 650mg (Arthritis)

How well did you know this?

Not at all

Perfectly

What is the max dose for APAP

4 grams

How well did you know this?

Not at all

Perfectly

In elderly pt whats is the max dose for APAP?

3 gram

How well did you know this?

Not at all

Perfectly

What is APAP most commonly used for?

Anti-pyresis
Relief of pain from:
Osteoarthritis
Migraine headaches
Skeletal pain
Muscular pain
Pain in pregnant women

How well did you know this?

Not at all

Perfectly

What is the pain relief of choice in preg?

APAP

How well did you know this?

Not at all

Perfectly

What is the antidote for APAP?

N-acetylcystine (Mucomyst)

How well did you know this?

Not at all

Perfectly

What is the MOA for ASA?

Reduces prostaglandin and thromboxane A2 synthesis
Reduces platelet aggregation
Irreversibly inhibits platelet function for the life of the platelet, interfering with hemostasis and prolonging bleeding time

How well did you know this?

Not at all

Perfectly

Who should you be careful with for ASA?

Gastrointestinal tract injury/upset
Renal injury
Viral syndromes in children and teenagers -risk of Reye syndrome

How well did you know this?

Not at all

Perfectly

T/F A single dose of aspirin can precipitate asthma in aspirin-sensitive patients

True

How well did you know this?

Not at all

Perfectly

Whats the dosing for ASA?

81mg (baby), 325mg, 500mg (Extra-strength)

How well did you know this?

Not at all

Perfectly

When is ASA commonly used?

Anti-coagulation
Anti-pyresis
Relief of pain from:
Osteoarthritis
Migraine headaches
Muscular pain

How well did you know this?

Not at all

Perfectly

Which ones are Non-selective NSAIDs inhibit COX-1 and COX-2?

Ibuprofen
Naproxen
Naproxen sodium

Indomethacin
Etodolac
Diclofenac
Sulindac

How well did you know this?

Not at all

Perfectly

Which one is the only NSAID inhibit COX-2

Celecoxib

How well did you know this?

Not at all

Perfectly

T/F

Some patients may respond better to one NSAID than another

How well did you know this?

Not at all

Perfectly

When is NSAIDs commonly recommended?

Anti-pyresis Relief of pain/inflammation from: Dysmenorrhea Migraine/tension headaches Muscular/tendinous pain/strain/sprain

Which NSAID has less GI s/e?

Celecoxib

What is the choice of drug cramps etc?

NSAID but avoid in pregnancy

Can you give NSAID to Fx pt?

what is a High non-union fx?

schapoid

Can you give NSAID for pt with renal dfx?

Can you give NSAID for pt with uncontrolled HTN?

When should you be caution in with NSAIDs?

Current nausea/vomiting GERD

What are the topical NSAID?

Diclofenac sodium 1% gel (voltaren gel)

T/F Diclofenac is safer than systemic NSAID

True

What is example of one topical anesthetic?

Lidocaine (patces, gel, cream and spray)

What topical has been approved for tx of posthherpetic neuralgia?

8% capsaicin patch (Qutenza)

What is the parenteral NSAIDs?

Ketorolac - mc used injection

How long can you use ketorolac?

short-term, up to 5 days

What is s/e of ketorolac?

Severe GI toxicity can occur, particularly in the elderly

What can develop after one use of ketorolac?

acute renal failure

When is Toradol MC recommended for?

Migraine headaches Renal Colic

what are the ADEs for NSAIDs

- Exacerbation or development of CHF - Increased BP

T/F Hepatotoxicity does not occur with NSAIDs

False, it can, we use it if they do have liver failure

Can you use Aspirin and ibuprofen?

yes but not long term

Chronic switch??

Meloxicam

What can celebrex do with warfarin?

Increase INR/PT, but the effect is unlikely to be clinically significant.

Is there antidote for NSAIDs?

None

Know how to calculate MME

Which ones are the stronger opioids?

Fentanyl, Hydromorphone, Methadone, Morphine, Oxycodone, Oxymorphone

Which one is weaker opioids?

Hydrocodone, Codeine, Tramadol

T/F Unlike NSAIDs, these opioids generally does have ceiling

False, they DON"T have ceiling effect

IS Vicodin weaker?

yes

What combo with opioids should you be caution with?

opioids combined with APAP or an NSAID (Vicodin, Vicoprofen, Percocet)

What is the semi-synthetic derivative of morphine, only aval in oral formulation

Oxycodone (Percocet, OxyContin)

What is bioaval with oxycodone?

high in oral dosage, with a half-life of 2.5 to 3 hours

Which is stronger? Oxycodone or codeine?

Oxycodone

What is the formulation for hydromorphone?

parenteral (IV, IM, PO) short- and long-acting oral formulations

When is hydromorphone preferred over morphine?

In pt with renal failure

Whats another name for hydromorphone?

Dilaudid

What is the onset of action for hydromorphone?

30 min for 4 hours

What are the available formulation for fentanyl

IV, intrathecal, epidural, transdermal and oral transmucosal use

Fentanyl is approximately ____ times more potent

Whats the pro of transdermal fentanyl?

For pt with difficulty swallowing or malabsorption

What can increase the release of the fentanyl?

Exposing to heat/ high fever

what DDI can cause increase in fentanyl?

Inhibitors of CYP3A4

What are two meds that inhibit CYP3A4 and increase fentanyl?

Ketoconazole and clarithromycin

Whats fentanyl lozenge on a stick called?

Actiq

When can Actiq be used?

Cancer pt already taking strong opioids Rapid absorption from buccal mucosa and slower GI absorption

What are the formulation of fentanyl?

Buccal soluble (Onsolis) Sublingual (Abstral) Nasal Spray (Lazanda) Sublingual spray (Subsys)

Codeine is about ____ % of more potent than morphine?

50%

What is the dosage that Codeine is not tolerated?

65mg

Whats hydrocodone + APAP called?

Vicodin, lortab, norco

T/F Tramadol is NOT opiate?

False, it is!

Whats the MOA of Tramadol?

Opioid AGONIST that binds to mu receptors blocking the reuptake of norepinephrine and serotonin

How many black box warning does tramadol have?

How is tramadol metabolized?

P450

What are the S/E for tramadol?

Lowers seizure threshold Prolonged- QT Resp depression

T/F Tramadol is associated with withdrawal and overdose at comparable rates to other opiates

TRUE!

How does tramadol work with SSRI and SNRI?

Inhibits both serotonin and NE reuptake

LOOK at slide 36

Whats the antidote for narcotics?

Naloxone (Narcan)

What is the mainstay of treatment for neuropathic pain?

Antidepressant and anticonvulsants

T/F Combination use of antidepressant and anticonvulsant medication may produce synergistic increases in analgesic effect in neuropathic pain syndromes

True

What are example of TCA?

Amitriptyline (Elavil) Nortriptyline (Pamelor) Imipramine (Tofranil)

TCA are best for what types of pain?

- Neuropathic pain - Diabetic neuropathy - Postherpetic neuralgia - Polyneuropathy - Fibromyalgia - Nerve injury

Are SSRI or TCA's more effective for neuropathic pain?

TCA

When is gabapentin effective?

Postherpetic neuralgia and diabetic neuropathy

What is the S/E of gabapentin and pregabalin?

Dizziness and somnolence

What is pregabalin used for?

- Postherpetic neuralgia - diabetic peripheral neuropathy - Fibromyalgia

What are the pros of pregablin vs gabapentin?

- Titrated faster - Given wice a day vs. three times a day

When is carbamazepine used?

Trigeminal neuralgia

Whats the s/e of lamotrigine?

Rash --> SJS

What two meds is used for migraine ppx?

- Sodium valproate - Topiramate

What may enhance analgesic effects of APAP, ASA and ibuprofen?

Caffeine

What med can be added for analgesic in postop and CA pt?

Hydroxyzine

What can prodice analgesia in some pt with inflammatory dz or tumor infiltrates of nerves

Corticosteroids

Whats the name of alpha 2-adrenergic agnoist?

Clonidine

Clonidine may improve what? (2)

Pain and hyperalgesia

What has been shown to help with MS with central neuropathic pain?

Medical Marijuana

Whats the MOA of muscle relaxants

Block transmission through the neuromuscular junction (NMJ) at nicotinic receptors, thus decreasing skeletal muscle tone

What two meds will meet the criteria of conscious sedation?

Muscle relaxer and opiate

Whats the s/e of cyclobenzaprine?

somnolence, dizziness, cognitive slowing.

Which muscle relaxant lowers seizure threshold?

cyclobenzaprine

Which muscle relaxant has less drowsiness?

Metaxalone

Whats the S/e of carisoprodol?

ataxia, agitation, insomnia, tachycardia

Which one is Subject to withdrawal symptoms and strong abuse potential, particularly when combined with an opioid?

Carisoprodol

Why is Tramadol + Flexeril a NOO

Lowers seizure threshold

Which one is LEAST sedating?

Methocarbamol

When are muscle relaxant NOT SAFE?

pregnancy and lactation

How long should you have pt on muscle relaxants?

Short course only

MSK cases Flashcards

(110 cards)