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Muscle Pain Pharm Flashcards

(44 cards)

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1
Q

What are the most common analgesics for muscle pain?

A

NSAIDs & Paracetamol

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2
Q

What are 5 contraindications of NSAIDs?

A

1) Kidney impairment
2) Heart failure
3) GI ulcer/bleeding
4) Bleeding disorders
5) Systemic corticosteroids/ antiplatelet/ anticoagulations
6) 3rd trimester

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3
Q

How should NSAID choice be altered for a px at risk of renal toxicity?

A

AVOID all NSAIDs
- just maintain hydration and avoid hypovolemia

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4
Q

How should NSAID choice be altered for a px at risk of CVS toxicity?

A

Only celecoxib or ibuprofen
- limited to <6days
- if cannot NSAID → paracetamol alone

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5
Q

How should NSAID choice be altered for a px at risk of GI toxicity?

A

Avoid non-selective NSAIDs
- use COX2 selective w caution (eg. celecoxib)
- co-pharmacy with GI protectant (eg. PPI)

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6
Q

How should NSAID choice be altered for a px at risk of NSAID-related bronchospasm/pseudoallergic rxn?

A

Avoid non-selective NSAIDs
- use COX2 selective w caution (eg. celecoxib)

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7
Q

What is the triple whammy in NSAID pharmacology?

A

NSAID + Diuretics + ACEi → ↑↑↑AKI

NSAID inhibit COX → ↓prostaglandins → Afferent arteriole constriction → ↓renal blood flow

Diuretics → ↓blood volume

ACEi → prevent efferent arteriole contriction → cannot maintain glomerular BP

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8
Q

When should paracetamol be used in caution?

A

1) Hepatic dysfunction/alcohol abuse
2) Underweight/cachectic/frail

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9
Q

What is the main risk in paracetamol overdose?

A

Hepatotoxicity

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10
Q

Alternating paracetamol and ibuprofen improves _________ while combining them improves _____________.

A

Alternating → prolong antipyretic

Combined → ↑analgesia

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11
Q

True or false:
Paracetamol is commonly used to relief muscle pain via its anti-inflammatory effects.

A

False.
For anti-pyretic and analgesic
- NOT anti-inflammatory at clinical doses

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12
Q

What is the moa of tramadol?

A

1) Weak opioid
2) Serotonin-norepinephrine reuptake inhibitor (SNRI)

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13
Q

When is tramadol prescribed for muscle pain?

A

Moderate to severe pain in combination w NSAID or paracetamol

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14
Q

What are 2 AEs of tramadol?

A

1) Constipation, nausea, vomiting
2) Respiratory depression
3) Dependence

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15
Q

What is the most important principle when prescribing opioid analgesics to prevent dependency?

A

Use lowest effective dose of weakest effective opioid for shortest duration
- ensure px is well-educated on use, storage and risk of AEs

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16
Q

True or false:
Opioid combinations are often more effective than NSAIDs for pain associated with acute inflammation?

A

False.
NSAIDs are often more effective than Opioid combinations for pain associated with acute inflammation?

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17
Q

What are 4 AEs of opioid analgesics?

A

1) GI effects
2) Hormonal effects
3) Depression
4) Respiratory effects
5) OD and death
6) Falls and fractures
7) Sedation/drowsiness → accidents
8) Tolerance/dependency
9) Hyperalgesia

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18
Q

What are 4 risk factors for opioid analgesics?

Study These Flashcards
A

1) CNS depressants (eg. alcohol, benzodiazepines, anti-depressants)
2) Comorbidities (eg. mental health conditions)
3) Renal insufficiency
4) Hepatic insufficiency
5) >65 y/o
6) Prenancy
7) FHx of substance use disorder
8) Other opioids

19
Q

Of the muscle relaxants,
__________ is used for acute muscle pain while ______________ are reserved for subacute/chronic/refractory muscle and neuropathic pain.

Study These Flashcards
A

Acute muscle pain → Orphenadrine

Subacute/chronic/refractory muscle and neuropathic pain → Benzodiazepines/GABA analogues

20
Q

What is the moa of orphenadrine?

Study These Flashcards
A

Central muscle relaxant:
1) Muscarinic receptor antagonist
- tertiary amine → crosses BBB well → muscarinic receptors in basal ganglia

2) H1 antihistamine
3) NMDA receptor antagonism
4) NE and Dopamine reuptake inhibitor
5) Na-channel blocker

21
Q

What are 4 AEs of orphenadrine?

Study These Flashcards
A

Common:
1) Nausea and vomiting
2) Flushing
3) Dilated pupils
4) Xerostomia

Higher doses:
5) Tachycardia
6) Ataxia
7) Nystagmus
8) Drowsiness
9) Delirium
10) Agitations
11) Visual hallucinations

22
Q

When should orphenadrine be used with caution?

Study These Flashcards
A

1) Other CNS sedatives
2) 1st gen antihistamines
3) Anticholinergics
4) Antiparkinsonian drugs

23
Q

What is the moa of benzodiazepines (eg. diazepam)?

Study These Flashcards
A

1) Allosteric modulators or GABAA receptors→ ↑freq. of Cl channel opening ↑potency of GABAnergic neurotransmission

2) Suppress brain reticular activating system

3) ↑inhibitory neurotransmission

24
Q

What are 3 indications for benzodiazepines?

Study These Flashcards
A

1) Muscle relaxant
2) Sedative/hypnotic
3) Anxiolytic
4) Anti-epileptic for status epilepticus
5) Induction of anaesthesia

25
What are 2 AEs of benzodiazepines?
1) Drowsiness/impaired judgement/↓motor skills 2) Tolerance and high potential for dependance 3) PD DDI with other CNS depressants
26
What is the moa of Baclofen?
CNS GABAB receptor specific GABA analogue → ↓tonic neural stimulation to muscles
27
What are 2 indications of baclofen?
1) Skeletal muscle spasms and/or pain - usually in combination with NSAID or paracetamol - should be used temporarily 2) Spasmolytic in px with MS or spinal cord lesions
28
What are 2 AEs of Baclofen?
1) Sedation, weakness, CNS effects 2) Withdrawal syndrome (with abrupt cessation) - hyperthermia, pruritus, ↑spasticity
29
What is the moa of Gabapentinoids (eg. Gabapentin, pregabalin)?
GABA analogues but act at voltage-gated Ca channels → ↓tonic neural stimulation to muscles
30
What are 3 indication for Gabapentinoids (eg. Gabapentin, pregabalin)?
1) Neuropathic pain 2) Chronic pain refractory to other treatments 3) Anti-epileptic for partial seizures
31
What are 2 AEs of Gabapentinoids (eg. Gabapentin, pregabalin)?
1) Somnolence, dizziness, ataxia 2) Renal elimination w/o metabolites → heavily dependent on renal f(x)
32
What is the main indication for adjucts for muscle pain?
In combination with analgesic for subacute/chronic/refractory muscle and neuropathic pain
33
What is the moa of topiramate?
Reduces tonic neural stimulation to muscles by: 1) Inhibits excitatory neurotransmission - block AMPA subtype glutamate receptors - block voltage-sensitive Na channels 2) potentiate inhibitory GABAnergic neurotransmissioon
34
What are 2 indications for Topiramate?
1) Chronic neuropathic pain 2) Anti-epileptic for partial seizures and adjuvant for generalised tonic-clonic seizures
35
What are 2 AEs of Topiramate?
1) Dizziness, fatigue 2) Ataxia 3) Confusion
36
What is the moa of Duloxetine?
5-HT and NE reuptake inhibitor (SNRI) antidepressant
37
What are 2 indications of Duloxetine?
1) Chronic/neuropathic pain - low back/non-radicular neck pain 2) Clinical depression
38
What are 3 AEs of Duloxetine?
Common: 1) Xerostomia 2) Abdo pain 3) Drowsiness 4) Fatigue 5) Headache 6) Weight loss Severe: 7) Mania 8) Hypomania 9) Bleeding risk 10) Fragility fractures 11) Hepatoxicity 12) Hyponatremia 13) Ocular effects 14) Serotonin syndrome 15) Sexual dysfunction 16) Suicidal ideation
39
What is the moa of amitriptyline?
TCA antidepressant inhibits reuptake of NE and serotonin (5-HT)
40
What are 2 indications of amitriptyline?
1) Chronic/neuropathic pain 2) Clinical depression
41
What are 3 AEs of amitriptyline?
Antihistamine: 1) Sedation 2) Weight gain Anticholinergic: 3) Blurred vision 4) Xerostomia 5) Urinary retention 6) Constipation 7) Agitation 8) Tachycardia 9) Sweating α1 blockade: 10) postural hypotension 11) tachycardia
42
What are 3 analgesics used for myalgia?
1) Opioids (eg. tramadol) 2) Paracetamol 3) NSAIDs (eg. celecoxib)
43
What are 3 muscle relaxants used for myalgia?
1) Orphenadrine 2) Benzodiazepines (eg. diazepam) 3) GABA derivatives (eg. baclofen, gabapentin)
44
What are 3 adjuvants used for myalgia?
1) Anticonvulsants (eg. gabapentin, topiramate) 2) Antidepressants (eg. Duloxetine, amytriptiline)

Musculoskeletal System (22 decks)

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