MSK/Pain Flashcards
(100 cards)
1
Q
pharm options for MSK pain
A
NSAIDs
non-opioid analgesics
antiseizure
antidepressants
opioid analgesics
local anesthetics
2
Q
5 invasive therapies for MSK pain
A
trigger point injxns
joint injxns
regional nerve blocks
epidural injxns
surgery
3
Q
what pain med inhibits the synthesis of PG in the CNS
A
APAP
4
Q
APAP works __ to block pain impulse generation
A
peripherally
5
Q
does APAP inhibit platelets
A
not really
6
Q
is APAP antiinflammatory
A
not really
7
Q
when would you use 650 mg of APAP
A
arthritis
8
Q
available doses for asa
A
81 mg - baby
325
500 mg - extra strength
650 mg - arthritis
9
Q
what’s the max dose of APAP
A
4 g daily
10
Q
what is the actual safest dose of apap
A
3
esp in elderly
11
Q
apap is recommended for what uses
A
antipyretic
pain
-OA
-migraines
-MSK pain
-pregnant pain
12
Q
antitode for apap
A
n-acetylcystine (mucomyst)
13
Q
what pain med works by reducing PG and thromboxane A2 synthesis
A
salicylates - ASA
14
Q
does asa inhibit platelet fxn
A
yes!
irreversibly fo’ life bro –> interferes w. hemostasis and prolongs bleeding time
15
Q
use caution w. ASA in what 4 conditions
A
GI injury/upset
renal injury
viral syndromes in peds
asthma
16
Q
risk of using ASA in viral syndrome w. peds
A
reye syndrome
17
Q
how much ASA can precipitate an asthma attack in asa sensitive pt’s
A
single dose!
18
Q
asa is mc recommended for what 3 conditions
A
anticoagulation
antipyresis
pain
-OA
-migraines
-MSK
19
Q
non selective NSAIDs inhibit __ (2)
A
cox 1
cox 2
20
Q
what are the non selective NSAIDs (6)
A
ibuprofen
naproxen/naproxen sodium
indomethacin
etodolac
diclofenac
sulindac
21
Q
what is the only COX-2 inhibitor
A
celecoxib
only one!
22
Q
NSAIDs are mc used for what conditions
A
antipyresis
anti-inflammatory
pain
-dysmenorrhea
-migraine/tension ha
-MSK pain/strain/sprain
23
Q
NSAIDs are not recommended for what conditions (6)
A
fx pain
pregnancy
PUD
renal dysfxn
bleeding d.o
uncontrolled HTN
24
Q
NSAIDs should be used but w. caution in (2)
A
current n/v
GERD
25
what is the topical NSAID
diclofenac sodium (voltaren gel)
26
is voltaern gel available OTC
yes
27
benefit of voltaren gel over orals
less s.e
28
topical anesthetics (2)
lidocaine - patches, gel, cream, spray
8% capsaicin patch (qutenza)
29
what has capsaicin patch (qutenza) been approved to treat
postherpetic neuralgia
30
parenteral NSAID
ketorolac (toradol)
31
mc at home dose of ASA
325 mg
32
t/f: all NSAIDs increase CV risk
t!
33
celecoxib has less __ side effects than non selective NSAIDs
GI
34
s.e of ketorolac (toradol)
aki
severe GI toxicity (particularly in elderly)
35
why doesn't jaynstein like toradol
case reports of patients in every age group developing ARF after a single IM dose
36
per Jaynstein, max dose of toradol
30 mg
no benefit of going any higher
37
when can you give po toradol
only if it's been given IV or IM first
38
toradol is mc recommended for
op relief of pain/inflammation from:
migraine
renal colic (but contraindicated in aki!)
39
what must you check before rx'ing toradol
renal fxn
40
s.e of nsaids (4)
exacebation/development of CHF
elevated bp/HTN
renal failure
hepatotoxicity
asthma exacerbation/anaphylaxis
platelet inhibition -> GIB, ulceration, perforation. PUD, etoh, advanced age
41
pt's taking ASA for cardioprotection should not take __ bc it can interfere w. antiplatelet action
ibuprofen
42
asa __ inhibits platelets
ibuprofen __ inhibits platelets
asa: irreversibly
ibuprofen: reversibly
43
what 2 nsaids are used for chronic conditions to get pt's off more commonly used ones
meloxicam
diclofenac
44
what does recent research show regarding cv risk w. celebrex
it's prob about the same as other NSAIDs
45
antidote for nsaid toxicity
none!
46
6 strong opioids
fentanyl
hydromorphone
methadone
morphine
oxycodone
oxymorphone
47
3 weaker opioids
hydrocodone
codeine
tramadol
48
jaynsteins choices for opioids
1. vicodin (hydrocodone + apap)
2. percocet (oxycodone + apap)
49
do opioids have a ceiling for analgesic effects
no! they'll just keep feeling better until they stop breathing
unlike nsaids
50
what 3 opioids contain apap
vicodin
vicoprofen
percocet
caution w. these
51
2 names for oxycodone
percocet
oxycontin
52
oxycodone is only available __
po
53
t/f: po oxycodone is more potent than oral morphine
t!
and oral codeine
54
what is jaynstein's last line opioids choice
dilaudid
very coveted by people w. SUD
55
what increases release of fentanyl patches
heat
high fever
56
what must you do before prescribing fentanyl patch
d.c oral
and vice versa
57
fentanyl can become toxic when combined w. what drugs
CYP3A4 inhibitors -
ex ketoconazole (nizoral), clarithromycin (biaxin)
58
what 2 opioids does jaynstein hate bc some people don't metabolize them and some people are super metabolizers
codeine
tramadon't
59
vicodin, lortab, and norco are all
hydrocodone
60
why does jaynstein hate tramadol
8 black box warnings
it IS an opioid
lowers sz threshold
non metabolizers vs super metabolizers
associated w. withdrawal and overdoses
SSRI and SNRI activity --> many ddi's
61
t/f: tramdol is associated w. fewer withdrawals and overdoses than other opioids
f!
62
adverse effects of opioids (8)
constipation
sedation
n/v
pruritis
hallucinations
confusion/delirium
myoclonic jerking
respiratory dpn
63
antidote for narcotics
naloxone (narcan)
64
do not go over __ mme's when prescribing opioids
30
65
mainstay of tx for neuropathic pain syndromes
antidepressants
anticonvulsants
although most are not approved for these
66
antidepressants and anticonvulsants are commonly used to treat what 5 pain conditions
postherpetic neuralgia
diabetic neuropathy
fibromyalgia
complex regional pain syndrome
phantom limb syndrome
67
t/f: antidepressant/anticonvulsant combo increases analgesic effects
t!
68
name 3 TCAs
amitriptyline
nortriptyline
imipramine
69
TCAs are more effective than SSRIs for treating what type of pain
neuropathic
70
what SNRI has been shown to provide many analgesic benefits of older antidepressants but w. fewer side effects
duloxetine (cymbalta)
71
gabapentin is effective for what 2 types of pain
neuralgia
DM neuropathy
NO evidence for other types of pain
72
5 adverse effects of gabapentin
dizzy
somnolence
edema
wt gain
ABUSE!
73
pregabalin (lyrica) is approved for what 3 conditions
postherpetic neuralgia
DM neuropathy
fibromyalgia
74
s.e of pregabalin
same as gabapentin, but no abuse
75
what type of pain would you prescribe carbamazepine (anticonvulsant) for
trigeminal neuralgia
76
does jaynstein like lamotrigine
no!
recent studies have shown it's less effective
can cause rash and SJS
77
what type of pain might you prescribe sodium valproate and topiramate for
migraine prophylaxis
78
what may enhance the analgesic effect of apap, ASA, or ibuprofen
caffeine
79
what may enhance analgesic effect of opioids in post op and cancer pain AND reduce n/v
hydralazine
80
what is the use of corticosteroids in adjuvant pain meds
may produce analgesia in inflammatory diseases or tumor infiltration of nerves
81
what alpha 2 agonist may improve pain and hyperalgesia
clonidine
82
medical marijuana has been shown to be effective for what 2 types of pain
MS
central neuropathic pain
83
moa for muscle relaxants
block transmission thru NMJ at nicotinic receptors -> decrease skeletal muscle tone
84
indication for muscle relaxants in MSK pain
only if spasms are present
jaynstein doesn't really like
if you you have to prescribe, use short doses
85
what's the problem w. prescribing muscle relaxants w. opioids
meets criteria for conscious sedation
86
which muscle relaxant causes the most somnolence, dizziness, and cognitive slowing
cyclobenzaprine (flexeril)
doesn't really work - just causes pt's to care less
87
flexeril (cyclobenzaprine) PLUS __ is a huge no bc it lowers sz threshold
tramadol
88
jaynstein's 2 go to muscle relaxants
metaxalone (skelaxin)
baclofen
less drowsiness/cognitive effect
89
which muscle relaxant is associated w. ataxia, agitation, insomnia, tachycardia, and withdrawal symptoms
carisoprodol (soma)
90
only IV muscle relaxant
diazepam (valium)
high abuse potential
91
least sedating/cognitive effect muscle relaxer
methcarbamol (robaxin)
92
which muscle relaxants are safe for pregnant pt
none!
93
what are very efficacious drugs for chronic pain that are coming down the pipeline
methadone
suboxone
94
what 2 drugs should be first choice for all chronic pain
methadone
suboxone
95
what was our plan for 40 yo m w. chronic lb who failed supportive tx
lidocaine patches/voltaren gel
gabapentin
96
muscle relaxants should NOT be used for what type of pain
chronic
97
what was our plan for 56 yo f w. chronic pain syndrome on daily opiates and muscle relaxers
evaluate for suboxone/methadone MAT tx
98
what was our plan for the 30 yo f w. migraines w.o aura
menstrual migraines ->
nsaid dosing 2-3 days prior to menses
Mg
zomig (triptan)
99
jaynstein's go to triptan
zomig
100
what 2 meds are associated w. best evidence for prevention of menses migraines
Mg
estrogen
