Pain part 2

Question 1

what are skeletal muscle relaxants and examples

Answer 1

act predominantly within the CNS to relieve pain associated with skeletal muscle spasms
methacarbamol
chlorzoxazone
orphenadrine

Question 2

methocarbamol MOA

Answer 2

unknown
causes skeletal muscle relaxation
doesnt work directly on muscle

Question 3

indication for methocarbamol

Answer 3

treat acute, painful, musculoskeletal muscle spasms

Question 4

methocarbamol onset and use

Answer 4

12-24 hours

use limited due to side effects

Question 5

orphenadrine indication

Answer 5

treat painful muscle spasms due to acute musculoskeletal conditions

Question 6

orphenadrine onset of action and use

Answer 6

more than 24 hours

use limited due to side effects

Question 7

hwo does chlorzoxazon work

Answer 7

central acting properties doesnt act on the muscles

decreases muscle spasm to decrease pain and increase mobility in musculoskeletal conditions

Question 8

onset and use of chlorzoxazone

Answer 8

12-24 hours

nto used to side effect of hepatotoxicity

Question 9

common side effects of skeletal muscle relaxants

Answer 9

drowsiness
dizzines
headache
light headed

Question 10

common contraindications of skeletal muscle relaxants

Answer 10

pregnancy

anticholinergic activity therefore gluacoma, porstate hypertrophy, arrhythmias etc

Question 11

side effect of methocarbamol and chlorzoxazone

Answer 11

urine discoloration
metho - black, blue, green
chlor - orange, purple, red

Question 12

skeletal muscle relaxant drug interactions

Answer 12

other Ach agents
CNS depressants 
MAO inhibitors 
alcohol 
all CMS depressants

Question 13

difference between anesthetic and analgesic

Answer 13

analgesic raises pain threshold at terminal nerve endings

anesthetic blocks pain receptors to numb the area

Question 14

whats the counterirritant effect of topical

Answer 14

stimulates cutaneous sensory receptors causes you to feel that sensation instead of the more intense pain
known as paradoxical pain
adjuvant therapy
placebo effect from the odor or cooling/warming effect

Question 15

analgesic with cooling effect

Answer 15

methyl salicylate
capcaicin
trolamine salicylate

Question 16

analgesic wiht cooling effect

Answer 16

menthol

camphor

Question 17

which product has no odor

Answer 17

trolamine salicylate

Question 18

advice for external analgesic use

Answer 18

dont apply to wounds or damaged skin 
dont bandage 
avoid contact with eyes
not for children under 2
dont use more than 4 times a day 
dont apply heat with it

Question 19

avoid use of methyl salicylates and trolamine salicylate in

Answer 19

people taking anticoagulants
allergic to salicylates
caution for salycylate sensitive asthmatics

Question 20

are external analgesics any good

Answer 20

lack scientific evidence
more just a placebo due to the subjective nature of pain
doesnt alter underlying process more symptomatic relief or a distraction

Question 21

what is tachyphylaxis and what does it occur in

Answer 21

effect diminishes with repeated applications

capsaicin

Question 22

capsaicin MOA

Answer 22

depletion of substance P which normally allows the transmission of pain impulses in sensory neurons
reduces the pain not the inflammation

Question 23

onset of capsaicin

Answer 23

pain relief in 14 days but can be delayed by 4-6 weeks

Question 24

indication for capsaicin

Answer 24

osteoarthritis pain
postherapeutic neuralgia
low back pain

Question 25

specific instructions for capsaicin

Answer 25

application less than 3 times a day may not provide relief and may cause the initial burning sensation to persist continued application for 3-4 weeks need for optimal response, burning sensation will diminish discontinue if doesnt improve in 28 days

Question 26

CI for topical NSAIDs

Answer 26

same as oral

Question 27

OTC topical NSAID use and effectiveness

Answer 27

short term 7 days | similar pain relief to oral but less GI effects

Question 28

application of diclofenac diethylamine gel

Answer 28

3-4 times a day | extra strength every 12 hours

Question 29

characterization of back pain (3)

Answer 29

``` acute = <4 weeks subacute = 4-12 weeks chronic = >12 weeks ```

Question 30

what is the cause of acute low back pain

Answer 30

mechanical | results from a sprain or strain of muscles or ligaments that support the lumbar spine

Question 31

causes of acute low back pain

Answer 31

``` repetitive or awkward use of lumbar muscles improper lifting strenuous work improper posture excessive tension from stress improper shoes ```

Question 32

less common causes of low back pain

Answer 32

``` inflammatory or traumatic injuries to joints and ligaments disc injury neurological involvement arthritis malignancy and infection ```

Question 33

what age is low back pain the most common

Answer 33

45-64 years old

Question 34

symptoms of low back pain.. duh

Answer 34

muscle ache to spasem | low back, buttocks, posterior thigh

Question 35

risk factors associated with lower back pain

Answer 35

age - not common in children occupation posture - lying

Question 36

red flags for abck pain

Answer 36

``` pain middle-upper part of the back present for more than 5 days bladder/sexual dysfunction fever/chills vertebral tenderness >50 or <20 years old - if cant be explained constant pain, no relief with postural change loss of movement/motion unexplained weight loss chronic liver disease inflammatory arthritis fibromyalgia gout tingling/numb legs long term steroid use history of malignant disease (cancer) high risk for fractures no response after 1 month treatment herniation cauda equina syndrome compression fracture sciatica visceral pain ```

Question 37

treatment goals for lower back pain

Answer 37

``` symptom relief improve functional ability decrease long term disability prevent recurrence prevent work absence promote healthy behavior ```

Question 38

what is better for back pain then just bed rest and pain meds

Answer 38

returning to activity asap

Question 39

non pharms for backpain

Answer 39

``` cryotherapy(ice) first 24-48 hours thermotherapy (heat) exercise rest only if essential control anxiety or depression ```

Question 40

role of skeletal muscle relaxants in lower back pain

Answer 40

not first line maybe sedative agent short term use only, 2-3 days effects last no longer than 4-7 days otherwise may develop dependence

Question 41

recommended pharmacological approach for acute back pain

Answer 41

oral analgesics | NSAIDS for inflammation but in no inflammation the acetaminophen preferred because safer

Question 42

how should oral analgesics be dosed in back pain

Answer 42

scheduled | not as needed

Question 43

prevention of back pain

Answer 43

program for flexibility aerobic conditioning proper posture weight loss

Question 44

monitoring for back pain

Answer 44

improve in 7-10 days should be able to continue ordinary activities recover in a month

Question 45

define a strain

Answer 45

muscle fibres are pulled apart causing pain, reduced movement, and sometimes swelling

Question 46

define contusion

Answer 46

damage to blood vessels in muscles followed by bleeding, bruising

Question 47

what is tendonitis

Answer 47

due to chronic overuse of tendons

Question 48

what is tenosynovitis

Answer 48

tendon is irritated and inflammed | sometimes a crackling sound when moving

Question 49

difference between tendons and ligamnets

Answer 49

tendons join muscles to bone | ligaments join bones to other bones

Question 50

characterization of sprains

Answer 50

1st degree - excessive stretching 2nd degree - partial tear 3rd degree 0 complete tear of tissue

Question 51

red flags for sprains/strains

Answer 51

``` severe pain or weakness in any limb deformed joint abnormal joint movement systemic symptoms fracture suspected increased intensity of pain inability to bear any weight on the limb pain lasting longer than 2 weeks swelling continues more than 14 days after PRICE therapy ```

Question 52

treatment goals for sprains/strains

Answer 52

``` minimize swelling prevent long term diability optimize ability to perform daily activities minimize adverse drug reactions prevent re-injury ```

Question 53

non pharms for a strain

Answer 53

PRICE = protection, rest, ice, compression, elevation heat rehabilitation

Question 54

pharmacological treatment for a strain

Answer 54

oral analgesic | exteranal analgesic

Question 55

treatment for acute injury

Answer 55

``` RICE rest ice for 20 min every 2 hours for 48 hours to reduce inflammation compression for swelling elevation to reduce swelling ```

Question 56

what does no h.a.r.m stnad for

Answer 56

``` for 24-48 hours no heat - increases bleeding alcohol - increases swelling running - exercise worsens massage - increase swellign and bleeding ```

Question 57

roles of cryotherapy in the acute stage

Answer 57

decreases metabolism and inflammation slows nerve conduction velocity vasoconstriction decreases edema

Question 58

problem with excessive icing

Answer 58

reduces vascular clearance of inflammatory mediators and causes further tisue damage

Question 59

who should use cryotherapy wiht caution

Answer 59

urticaria | renoids disease

Question 60

applicatin of cryotherapy

Answer 60

gel packs, peas etc with a wet cloth placed between the skin and ice to prevent frostbite apply 20 min or until skin feels numb every 2 hours untill swelling decreases, up to 48 hours

Question 61

purpose of heat in subacute phase of injuries

Answer 61

vasodilation will make bleeding worse increased tissue perfusion of oxygen and nutrients helps with removal of carbon dioxide, waste, and pain mediators relaxes muscles

Question 62

who should heat be avoided in

Answer 62

``` urticaria peripheral vascular disease, neuropathy (lost feeling dont want to burn) rhuematoid arthritis (enzymes that cause damage increase) ```

Question 63

what do heat wraps contain and how do they work

Answer 63

carbon and iron | once exposed to oxygen causes oxidation so heat released

Question 64

monitoring for sprain

Answer 64

swelling and discomfort subside in 48 hours should be able to move ankle therapy for 7-10 days