Non-narcotic pain management

Question 1

Where do corticosteroids inhibit on the pain pathway?

Answer 1

inhibits release of arachidonic acid from the cell mb by inhibiting phospholipase

Question 2

where do NSAIDs and aspirin inhibit on the pain pathway?

Answer 2

inhibits formation of prostaglandins by inhibiting COX

Question 3

what are potential complications of NSAIDs?

Answer 3

• can exacerbate asthma symptoms
• ulcers; perforation, dyspepsia
• HTN, MI, stroke, CHF
• impaired renal fxn

Question 4

what are GI risk factors with NSAID use?

Answer 4

• concomitant use w/ other NSAIDs, aspirin, corticosteroids, anticoagulants
• age > 65
• use of high dose NSAIDs
• CV disease

Question 5

what are the CV risks with COX-2 inhibitors?

Answer 5

vasoconstriction
platelet aggregation
thrombosis

Question 6

what are renal effects of NSAIDs?

Answer 6

COX 1 maintains GFR

COX 2 found in kidneys

Question 7

what MSK effects do NSAIDs have?

Answer 7

• decrease adhesions of tendons
• decrease osteophyte formation
• decreased bone healing and increased non union rates

Question 8

NSAIDs may decrease effect of which drugs?

Answer 8

beta-blockers
ACEI
diuretics

Question 9

NSAIDs may increase levels of what drugs?

Answer 9

lithium

methotrexate

Question 10

what AE does use of NSAID with cyclosporine cause?

Answer 10

nephrotoxicity

Question 11

NSAID has synergistic effect with what drug?

Answer 11

warfarin- cause increased bleeding

Question 12

describe metabolism of NSAIDs.

Answer 12

metabolized in liver

excreted in kidneys

Question 13

which drug should you not give to children due to potential cause of Reye’s syndrome?

Answer 13

aspirin

Question 14

which drug can antagonize gout meds?

Answer 14

aspirin

Question 15

what is the max. dosage of aspirin?

Answer 15

3g per day

Question 16

which drug should be taken with food?

Answer 16

ibuprofen

Question 17

what is max dose of Ibuprofen?

Answer 17

3200mg

Question 18

which NSAID is more CV neutral than others?

Answer 18

naproxen

*but can affect BP

Question 19

which drug is quite potent and treatment should not exceed 5 days?

Answer 19

ketorolac

Question 20

which drug is more COX-2 selective and thought to have less GI side effects?

Answer 20

Meloxicam

Question 21

which NSAID are you supposed to check for elevated liver enzymes?

Answer 21

diclofenac

Question 22

which drug is available in many forms- patch, gel, injection?

Answer 22

diclofenac

Question 23

which NSAID is our only true COX-2 selective inhibitor?

Answer 23

celecoxib

Question 24

name the injectable NSAIDs

Answer 24

diclofenac

ketorolac

Question 25

which drug must be used with caution due to sulfa allergy?

Answer 25

celecoxib

Question 26

side effects of corticosteroids?

Answer 26

- weight gain - steroid induced DM - increased blood glucose - osteoporosis - immunosuppression - tendon rupture - adrenal insufficiency

Question 27

due to adrenal insufficiency with long term use of steroids, be sure to taper patients off corticosteroids slowly.

Answer 27

true

Question 28

which corticosteroid is administered as a dose pack?

Answer 28

methyprednisilone

Question 29

for most podiatric sx, what are the guidelines for corticosteroid supplementation?

Answer 29

- if on 5mg or less, no supplmentation needed - give patient regular dose - 25mg prior to start of procedure on top of regular dose

Question 30

what are steroid injection indications for intra-articular diseases?

Answer 30

- osteoarthritis - traumatic arthritis - capsulitis - sinus tarsitis

Question 31

what are injection indications for non-articular diseases?

Answer 31

- tendonitis (but do not inject around achilles) - plantar fasciitis - neuromas or nerve entrapments - ganglion cysts

Question 32

what are absolute contraindications for steroid injections?

Answer 32

- joint sepsis - prosthesis - fracture - bacteremia

Question 33

what are relative contraindications for steroid injections?

Answer 33

-joint instability -coagulopathy -cellulitis -poor response to injections at that site >3-4 injections at a particular joint or soft tissue area in past year

Question 34

what is the appearance of phosphate steroid injections?

Answer 34

water-soluble clear short-acting

Question 35

what is teh appearnce of acetates steroid injections?

Answer 35

water-insoluble cloudy longer acting can crystallize (so should not use in joint injections)

Question 36

what are teh 3 most common steroid injections used in podiatry?

Answer 36

- dexamethasone - triamcinolone - betamethasone

Question 37

what is max. dose of acetaminophen?

Answer 37

4g

Question 38

what drug does not have anti-inflammatory properties?

Answer 38

acetaminophen

Question 39

name some adjuvant drugs.

Answer 39

acetaminophen | muscle relaxants

Question 40

which drugs can be used to treat neuropathic pain?

Answer 40

amitriptyline gabapentin pregabalin duloxetine

Question 41

what is most common side effect of gabapentin?

Answer 41

drowsiness

Question 42

which drug can cause serotonin syndrome?

Answer 42

tapentadol

Question 43

what drug is used for post-herpetic neuralgia?

Answer 43

lidoderm

Question 44

what is MOA of capsaicin?

Answer 44

depletes and inhibits substance P accumulation

Question 45

what is ionophoresis?

Answer 45

noninvasive way to deliver meds of like charge thru skin using direct current

Question 46

what is phonophoresis?

Answer 46

noninvasive way of delivering meds using ultrasound

Question 47

what is TENS?

Answer 47

device that delivers mild, electrical current thru skin | *blocks pain thru endorphin release by blocking pain fibers

Question 48

Which drugs should you taper off when stopping meds?

Answer 48

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