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Clinical Pod Med Exam 2 > Non-narcotic pain management > Flashcards

Non-narcotic pain management Flashcards

1
Q

Where do corticosteroids inhibit on the pain pathway?

A

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

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2
Q

where do NSAIDs and aspirin inhibit on the pain pathway?

A

inhibits formation of prostaglandins by inhibiting COX

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3
Q

what are potential complications of NSAIDs?

A
  • can exacerbate asthma symptoms
  • ulcers; perforation, dyspepsia
  • HTN, MI, stroke, CHF
  • impaired renal fxn
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4
Q

what are GI risk factors with NSAID use?

A
  • concomitant use w/ other NSAIDs, aspirin, corticosteroids, anticoagulants
  • age > 65
  • use of high dose NSAIDs
  • CV disease
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5
Q

what are the CV risks with COX-2 inhibitors?

A

vasoconstriction
platelet aggregation
thrombosis

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6
Q

what are renal effects of NSAIDs?

A

COX 1 maintains GFR

COX 2 found in kidneys

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7
Q

what MSK effects do NSAIDs have?

A
  • decrease adhesions of tendons
  • decrease osteophyte formation
  • decreased bone healing and increased non union rates
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8
Q

NSAIDs may decrease effect of which drugs?

A

beta-blockers
ACEI
diuretics

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9
Q

NSAIDs may increase levels of what drugs?

A

lithium

methotrexate

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10
Q

what AE does use of NSAID with cyclosporine cause?

A

nephrotoxicity

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11
Q

NSAID has synergistic effect with what drug?

A

warfarin- cause increased bleeding

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12
Q

describe metabolism of NSAIDs.

A

metabolized in liver

excreted in kidneys

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13
Q

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

A

aspirin

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14
Q

which drug can antagonize gout meds?

A

aspirin

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15
Q

what is the max. dosage of aspirin?

A

3g per day

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16
Q

which drug should be taken with food?

A

ibuprofen

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17
Q

what is max dose of Ibuprofen?

A

3200mg

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18
Q

which NSAID is more CV neutral than others?

A

naproxen

*but can affect BP

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19
Q

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

A

ketorolac

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20
Q

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

A

Meloxicam

21
Q

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

A

diclofenac

22
Q

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

A

diclofenac

23
Q

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

A

celecoxib

24
Q

name the injectable NSAIDs

A

diclofenac

ketorolac

25
Q

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

A

celecoxib

26
Q

side effects of corticosteroids?

A
  • weight gain
  • steroid induced DM
  • increased blood glucose
  • osteoporosis
  • immunosuppression
  • tendon rupture
  • adrenal insufficiency
27
Q

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

A

true

28
Q

which corticosteroid is administered as a dose pack?

A

methyprednisilone

29
Q

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

A
  • if on 5mg or less, no supplmentation needed
  • give patient regular dose
  • 25mg prior to start of procedure on top of regular dose
30
Q

what are steroid injection indications for intra-articular diseases?

A
  • osteoarthritis
  • traumatic arthritis
  • capsulitis
  • sinus tarsitis
31
Q

what are injection indications for non-articular diseases?

A
  • tendonitis (but do not inject around achilles)
  • plantar fasciitis
  • neuromas or nerve entrapments
  • ganglion cysts
32
Q

what are absolute contraindications for steroid injections?

A
  • joint sepsis
  • prosthesis
  • fracture
  • bacteremia
33
Q

what are relative contraindications for steroid injections?

A

-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

34
Q

what is the appearance of phosphate steroid injections?

A

water-soluble
clear
short-acting

35
Q

what is teh appearnce of acetates steroid injections?

A

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

36
Q

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

A
  • dexamethasone
  • triamcinolone
  • betamethasone
37
Q

what is max. dose of acetaminophen?

A

4g

38
Q

what drug does not have anti-inflammatory properties?

A

acetaminophen

39
Q

name some adjuvant drugs.

A

acetaminophen

muscle relaxants

40
Q

which drugs can be used to treat neuropathic pain?

A

amitriptyline
gabapentin
pregabalin
duloxetine

41
Q

what is most common side effect of gabapentin?

A

drowsiness

42
Q

which drug can cause serotonin syndrome?

A

tapentadol

43
Q

what drug is used for post-herpetic neuralgia?

A

lidoderm

44
Q

what is MOA of capsaicin?

A

depletes and inhibits substance P accumulation

45
Q

what is ionophoresis?

A

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

46
Q

what is phonophoresis?

A

noninvasive way of delivering meds using ultrasound

47
Q

what is TENS?

A

device that delivers mild, electrical current thru skin

*blocks pain thru endorphin release by blocking pain fibers

48
Q

Which drugs should you taper off when stopping meds?

A 
corticosteroids
Duloxetine 
amitryptiline
gabapentin
pregabalin

Clinical Pod Med Exam 2 (15 decks)

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