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Orthopaedic Physiotherapy > Pharmacology & Analgesia > Flashcards

Pharmacology & Analgesia Flashcards

1
Q

What are the route of administration for drugs?

A
  • Intravenous (fastest)
  • Intramuscular
  • Intrathecal
  • Oral
  • Rectal
  • Local effect (topical)
  • Subcutaneous
  • Sublingual/suppository
  • Transdermal
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2
Q

What is pharmacokinetics?

A

Movement/concentration of drugs in the body

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3
Q

What is pharmacodynamics?

A

Effects of drugs & mechanism of their actions

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4
Q

What are the 3 methods of elimination of drugs?

A
  • Biliary (gall bladder)
  • Intestinal
  • Renal
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5
Q

What is the fraction unabsorbed (Fu)?

A

Fraction of medication that does not get absorbed - goes straight into gut & excreted out

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6
Q

What is the process of pharmokinetics?

A
  • Administration
  • Absorption
  • Distribution (bloodstream/tissues)
  • Metabolism (liver)
  • Elimination
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7
Q

What are the two points of action of analgesics?

A
  • Inflammatory pain (peripheral nociceptors)

- Tissue damage or CNS pain (neuropathic pain)

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8
Q

What tissues can be affected by analgesics?

A
  • Peripheral tissues
  • Peripheral nerve fibres
  • Dorsal horn of spinal cord
  • Key brain sites
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9
Q

What does the inhibition of cyclooxygenase (COX2 inhibitors) cause?

A
  1. Limited CNS effect
    - Inhibit central sensitisation
  2. Major peripheral effect
    - Inhibit leukocytes
    - Decrease cytokines
    - Inhibit platelet aggregation, free radicals
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10
Q

What is the simple analgesic for pain?

A

Paracetamol: Inhibits prostaglandins at hypothalamus & spine

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11
Q

What is the simple analgesic for inflammation & pain?

A

Aspirin: NSAIDs, COX2 inhibitors

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12
Q

What is the simple analgesic for muscle spasm?

A

Diazepan, benzodiazepine (valium)

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13
Q

What are the risks of NSAIDs?

A
  • Nausea, heartburn, indigestion
  • Gastric bleeding
  • Increase risk of CV events by 1/3
  • Doubles risk of heart failure
  • High doses linked to increase risk of GI complications
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14
Q

What are the risk factors for problems with NSAIDs?

A
  • Certain medications (blood thinners, corticosteroids)
  • Medical conditions (gastric ulcer/bleeding, high BP, diabetes)
  • > 65 years
  • Taking another NSAID a the same time
  • Alcohol
  • Taking more than recommended dose
  • Taking more than a few days at a time
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15
Q

What is the function of opioids?

A

Act act opioid receptors in PNS & CNS, cause relaxation/calming

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16
Q

What are the side effects of opioids?

A
  • Nausea
  • Vomiting
  • Itching
  • Constipation
  • Respiratory depression
17
Q

What are examples of opioids?

A
  • Codiene
  • Fentanyl
  • Morphine
  • Oxycodone
18
Q

What is the function of local anaesthetic?

A
  • Few hours of pain relief
  • Infiltration (peppering) of region around joint/tooth
  • E.g. nerve block to reset dislocated fingers
19
Q

What is the function of regional anaesthesia?

A
  • Spinal: Single shot into fluid surrounding spinal cord
  • Epidural: Catheter
  • Peripheral nerve block: Femoral, sciatic, subsartorius, can be single shot or catheter
20
Q

What is the function of general anaesthesia?

A
  • Temporarily unconscious
  • Paralysed & sedated
  • Intubated for breathing
  • IV or inhalation
21
Q

What is the function of an epidural?

A
  • Delivers anaesthetic by catheter slowly & can cover a long period of time
  • Causes paralysis of muscles, but patient still awake
  • Delivered to epidural space outside dural, spreads throughout tissues
  • Respiratory complications, dural puncture
22
Q

What is the function of a spinal block?

A
  • Single shot
  • Small fine needle through dura into cerebrospinal fluid
  • Short-term cover
23
Q

What are the physio implications of epidural and spinal block?

A

Patient cannot mobilise until epidural is removed & muscle strength has returned

24
Q

What are the indications for the use of a femoral nerve block?

A

Surgery of anterior thigh & knee, e.g. TKA

25
Q

What are the functions of femoral nerve blocks?

A
  • Reduce requirements for opioids

- Decrease adverse side effects from opioids

26
Q

What are the complications of femoral nerve blocks?

A
  • Nerve injury (rare)

- Risk of falls

27
Q

What muscles are affected by femoral nerve block?

A
  • Iliacus
  • Sartorius
  • Pectineus
  • Quads
28
Q

What is the function of a saphenous nerve block?

A

Numbs distal thigh, knee, lower leg, spares quads

29
Q

What are some of the drugs used for PCA?

A
  • Morphine
  • Fentanyl
  • Tramadol
30
Q

What are some of the multimodal analgesics?

A
  • Epidural
  • GA + periarticular + PCA
  • GA + femoral nerve block
  • GA + periarticular + ice

Orthopaedic Physiotherapy (11 decks)

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