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PDAT1 > 12 - External Analgesics > Flashcards

12 - External Analgesics Flashcards

1
Q

BENGAY

Ingredients & Indication & Dose

A

MENTHOL
some might have camphor / methyl salicylate

  • *AAA 3-4 times a day**
  • do NOT use with heating pads / devises*

Minor Aches
Pains of muscles & joints associated w/
arthritis / backaches / strains / sprains / bruises

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2
Q

BENGAY

ADR / CI / PC

A

Do not apply to open / broken skin
avoid contact w/ eyes / mucous membranes
no bandages / heating pads

7 DAYS AT MOST

rare allergic reactions

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3
Q

Capzasin-P & -HP

Ingredients / Indication / Dose

A
  • *CAPSAICIN**
    0. 35% / 0.1%
  • some combos might have menthol*

AAA 3-4 times a day

Temporary relief of pain from:
RA / OA
Neuralgias (Shingles / DM neuropathy)

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4
Q

Capzasin-P & -HP

ADR / CI / CP

A

AVOID contact with eyes / broken skin
do NOT use occlusion

Contact MD if no improvement in
28 days or gets worse

effects may take
up to 2 weeks to be noticed

  • *Transient burning/stinging will occur**
  • dissapears after several days of use*
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5
Q

Okay to self treat vs EX-ST

Myalgias

External Analgesics

A

Myalgia / General Muscle pain from overuse

  • *Delayed onset** = ~8 hours
  • *Peaks @ 24-48 hours** after overexertion
  • *Bursitis / Tendonitis / Repetitive** strain injury

EXCLUDED FOR MYALGIAS CAUSED BY:
Systemic Infections
Chronic disorders
Medications (statins)

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6
Q

Okay to self treat vs EX-ST

SOFT-Tissue Injury

External Analgesics

A

Okay to Treat for Soft Tissue injury to:

  • *LIGAMENTS / MUSCLE / TENDONS**
  • *GRADE 1** = Excessive stretching

AVOID IF INJURY WITH:
Abnormal joint movement
visible joint deformity

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7
Q

Okay to self treat vs EX-ST

Osteoarthritis / Chronic Neuronogic Pain

External Analgesics

A

Okay to treat ONLY AFTER HCP DIAGNOSIS
Osteoarthritis
Diabetic Neuropathy / Post-Herpetic Neuralgia

only treat AFTER DIAGNOSIS

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8
Q

Conditions Approved to SELF TREAT
with external analgesics

A
  • *Acute Lower Back Pain**
  • except if >6 weeks*
  • *Myalgia / Overuse Injuries**
  • not from chronic / medication / systemic infections*
  • *Grade 1 Soft Tissue Injuries**
  • no visible/abnormal joints*
  • *Osteoarthritis / Chronic Neurologic Pain**
  • only AFTER being DIAGNOSED by HCP*
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9
Q

Symptoms that EXCLUDE SELF CARE

for external analgesics

A

Food-Intake related
ulcer / gastritis

  • *Pain -> r**adiates to LEFT arm or UP jaw “CRUSHING”
  • ANGINA / MI*
  • *Erythema / Wamth** around joint
  • infections / inflammatory arthritis*

Systemic Symptoms
SOB / Fever / NVD

  • *Swelling** / tenderness / WARMTH
  • DVT*
  • *Pelvic** or AB-pain (other than dysmenorrhea)
  • Appendicitis / Pelvic Inflammatory disease / Pyelonephritis*
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10
Q

General EX-ST

External Analgesics

A

<2 y/o & pregnancy
OTC toxicity / systemic absorption

Severe pain
>6 pain score on 1-10 scale

Pain presistance

  • *>10 days** , except for acute lower back pain <6 weeks okay
  • *>7 days AFTER treatment/self care**
  • *worsening** of severity or nature of pain

Back pain** w/ **loss of bladder/bowel fxn

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11
Q

PQRST

Assessment Questions for External Analgesics

A

Precipitating Factor
is pain related to specific activity?

Quality
describe the pain + other symptoms

Region
localization / JOINT?

Severity

Time

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12
Q

When to REFER for
P

in PQRST

A

Precipitating Factor
Is the pain related to a specific activity?

Refer if:
pain occured
after a prolonged period of IMMOBILIZATION
plane&car ride / bedridden / hospitilization

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13
Q

When to REFER for
Q

in PQRST

A

Quality
Can you describe the pain?
Are there any other symptoms?

Refer if:
Pain is neurologic in nature or if systemic symptoms
( burn/ tingle/ electrical/ numb) / (limb weakness / swelling/redness)

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14
Q

When to REFER for
R

in PQRST

A

REGION
Where is the pain / Localized?
is the pain in or around a JOINT?

Refer if:
Pain follows a nerve path = Shooting pain
if pain in non-localizable = generalized pain
if there is joint redness / tenderness / swelling
if there is prolonged/pronounced STIFFNESS after period of inactivity
if there is joint deformity / abnormal movement

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15
Q

When to REFER for
S

in PQRST

A

Severity
how severe is the pain?

Refer if:
If pain is constant and doesnt abate with rest​ of AA
if pain is moderate - severe = >6 on 1-10 scale

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16
Q

When to REFER for
T

in PQRST

A

TIME
How long has the pain been present
How Often does the pain occur

REFER if:
pain is present for >10 days
if lower back pain >6 weeks
>7 days after treatment / self care
if pain intensity increases / resolves->reoccurs

17
Q

RICE

Non-Drug Therapy for External Analgesics

A

REST
Stop offending activity / avoid using are / use immobiling techniqiues

  • *ICE**
  • *Post Injury:** Apply for first 12-24 hours = 10 min 4-6x a day
  • *Non-Acute:** use HEAT/moist heat for 20 min every 2-4 hours
  • do not use on INFLAMMED areas or w/ counter irritants*

COMPRESSION
use bandages / wraps

ELEVATION
elevate injured area @/above level of heart

18
Q

Counter-Irritant External Agents

general info

A

Prduce acute analgesic benefit in appropriate musculoskeletal conditions
minimal efficacy for chronic pain

4 GROUPS

_Although all are applied topically:_
there is some systemic absorption
serious toxicity after EXCESSIVE use esp in children
<2 y/o, no FDA approved agents

19
Q

RUBEFACIENTS

Group A

External Analgesics

A

Produce redness & warmth with mild inflammation due to
VASODILATION“rubefAAAcients” = redness/warmth/inflammation

Methyl Salicylate
(wintergreen oil)
may have systemic effects,
DNU in children + _asprin/salicylate ALLERGY_

Other agents:
Ammonia water / allyl isothiocyanate / turpentine oil = Vicks/Sloans

20
Q

Group B

External Analgesics

A

Produce COOLING SENSATION“B-Cool”

Menthol
commonly used on its OWN = Bengay / biofreeze

Camphor
typically used w/ menthol = tiger balm
smell / avoid use in infants / young children

21
Q

Group C

External Analgesics

A

Induce VASODILATION
“vasCodilation”

Histamine Dichloride
Australian dream pain relief

Methyl Nicotinate
found in new combo products

22
Q

Group D

External Analgesics

A

Substance P Depletors
“D-epletors”
do NOT cause redness / vasodilation
Acute use –> release substance P = NT for pain perception
Chronic use –> depletes substance P = decreased pain perception

  • *CAPSAICIN / Capsicum /** Capsicum olersin
  • *Zostrix / Capzasin** HP Lotion / Cream
23
Q

Substance P Depletors

Indications

A

Depletors = Group D external analgesics

  • *Acute** use: found in combo products, limited data
  • *Chronic Disorders**
  • *DM** Neuropathy / Post-Herpetic Neralgia (shingles=herpesZ)

Arthritic Conditions = reduce PAIN, not inflammation
only for HAND OA

24
Q

Substance P Depletors

Instructions

A

Depletors = Group D for CHRONIC USE:

Apply 3-4 times QD on a SCHEDULED BASIS, not PRN

onset is SLOW
Arthritis pain = 1-2 weeks
Neurologic Pain = 2-4 weeks
pain relief MAY persist for several weeks AFTER d/c
may INITIALLY cause increased pain/burning = 72 hours

DO NOT USE ON BROKEN SKIN

25
Q

Product SELECTION guidelines for:

External Analgesics

A

do NOT select products w/ ingredients from the same class/group
except for MENTHOL + CAMPHOR = Group B-cool

READ LABELS carefully
​many brand line extensions w/ diff ingredients
look for both active & inactive ingredients
can be problematic if h/o of allergies / ADR

DO NOT USE Counterirritants w/
Topical anesthetics / antipruritics / skin protectants

26
Q

Trolamine Salicylate

External Analgesics

A

Found in Aspercreme / Blue-emu

OTC CAT 3 for efficacy, might have systemic absorption

Has same DI’s as SALICYLATES
avoid in patient with ANTICOAGS / OTHER salicylates

27
Q

Topical NSAIDS

External Analgesics

A

Diclofenac = RX only, only FDA-approved agent

Allows for localized NSAID treatment
similar benefit to ORAL NSAID

  • *AAA BID**
  • rash / topical pruritis*
  • expensive = cos issue*
28
Q

Formulation Considerations of

External Analgesics

A

Liniment / Ointment
application w/ friction or massage = therapeutic benefit

Gel
increased warmth / systemic absorption

Lotion
RAPID / uniform application + okay for hairy areas

Patch
up to 4 patches /24 hours

Spray
easy application to large areas

29
Q

Patient Education

External Analgesics

A

do NOT apply to broken skin
or use with heating pads / hot water bottles / heat wraps

do NOT bandage / tightly occlusion

overuse can lead to blistering

D/C if symptoms of HYPERsensitivity

KEEP OUT OF REACH OF CHILDREN

PDAT1 (27 decks)

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